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Registration Number: {{org_field_registration_no}}

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Managing Diabetes Policy

1. Purpose

This policy aims to ensure that all people we support with diabetes receive safe, effective, and person-centred care that promotes their well-being, independence, and dignity. It outlines the roles and responsibilities of care staff in monitoring, supporting, and responding to the needs of individuals with diabetes, in compliance with the Health and Social Care Standards (Scotland), the Care Inspectorate guidelines, and the SSSC Codes of Practice.

2. Scope

This policy applies to all employees of {{org_field_name}} who provide support to individuals diagnosed with diabetes, including those with Type 1, Type 2, and other forms of diabetes. It also applies to external healthcare professionals involved in the care of individuals supported by our service.

3. Related Policies

• Medication Management Policy
• Nutrition and Hydration Policy
• Risk Assessment and Management Policy
• Safeguarding Adults and Children Policy
• Care Planning and Personalisation Policy
• Emergency Procedures Policy
• Infection Control Policy

4. Principles of Diabetes Care

Our approach to managing diabetes in home care is based on:

• Person-centred care – Supporting individuals in managing their diabetes in a way that aligns with their needs, choices, and preferences.
• Prevention and early intervention – Identifying risks and responding proactively.
• Multi-disciplinary collaboration – Working closely with healthcare professionals such as GPs, district nurses, diabetes specialists, and dietitians.
• Safety and compliance – Adhering to national guidelines and safeguarding measures.
• Education and training – Ensuring staff are competent in diabetes management.

5. Diabetes Management in Home Care

5.1 Personalised Care Planning

Every person with diabetes who receives support from {{org_field_name}} must have a written personal plan which clearly sets out how their assessed health, welfare and safety needs will be met. The personal plan must be prepared in consultation with the person and, where appropriate, their representative.

In accordance with Regulation 5 of the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, the personal plan must be prepared within 28 days of the date on which the person first receives the service.

Where relevant to the person’s assessed needs and the support provided by {{org_field_name}}, the personal plan must include:

• the type of diabetes and relevant medical history, diagnoses and associated health conditions;
• the person’s usual diabetes management arrangements and the aspects of their diabetes care that they manage independently;
• the specific support that staff are required and authorised to provide;
• details of prescribed insulin and/or other diabetes medicines, including the arrangements for administration or support with medicines;
• the person’s individual blood glucose monitoring arrangements, where monitoring forms part of the care provided by the service;
• the person’s individually agreed blood glucose target range where this has been provided by an appropriate healthcare professional;
• the type of blood glucose or continuous glucose monitoring equipment used and clear instructions for its use where staff are expected to support its operation;
• the signs and symptoms of hypoglycaemia that are usual for that person and their agreed hypoglycaemia treatment plan;
• the signs and symptoms of hyperglycaemia and the agreed actions and escalation arrangements;
• ketone monitoring arrangements and sick-day rules where these have been provided by the person’s diabetes or healthcare team and are relevant to the support being delivered;
• any prescribed emergency treatment, including glucagon where applicable, together with clear instructions about who may administer it;
• dietary needs, preferences and any advice provided by a dietitian or other appropriate healthcare professional;
• relevant foot-care needs and arrangements for referral of concerns;
• communication needs and any assistance required to support informed decision-making;
• known risks associated with the person’s diabetes and the measures agreed with the person to manage those risks while promoting independence and informed choice;
• the circumstances in which staff must contact the person’s GP, diabetes team, district nurse, NHS 24 on 111 or emergency services on 999;
• relevant healthcare professional and emergency contact details; and
• how diabetes-related observations, medicines, interventions, concerns and actions are to be recorded.

Staff must follow the person’s individual personal plan and must not introduce, discontinue or alter insulin doses, diabetes medicines, blood glucose targets, carbohydrate ratios, correction doses, ketone-management instructions or other clinical treatment unless this has been authorised by an appropriately qualified healthcare professional and the change has been communicated and recorded through the appropriate process.

The personal plan must be made available to the person and to any representative who has been appropriately consulted.

The personal plan must be reviewed:

• whenever the person or their representative requests a review;
• whenever there is a significant change in the person’s health, welfare or safety needs;
• following a significant diabetes-related event where the person’s support arrangements may need to change; and
• at least once in every six-month period while the person continues to receive the service.

Following a review, the personal plan must be revised where appropriate in consultation with the person and, where appropriate, their representative. The person and any representative appropriately involved in the review must be informed of relevant revisions.

5.2 Monitoring, Diabetes Equipment and Support

Staff must provide only the diabetes-related monitoring and support that is identified within the person’s personal plan and that falls within their role, training, assessed competence and authorisation.

Where blood glucose monitoring forms part of the service, staff must:

• follow the person’s individual monitoring instructions and prescribed or clinically agreed monitoring schedule;
• use the monitoring equipment in accordance with the manufacturer’s instructions and the person’s agreed healthcare plan;
• observe appropriate infection prevention and control procedures;
• record the result accurately at the time of monitoring;
• take the action specified in the person’s personal plan where a reading is outside their agreed range or where the person is symptomatic;
• report concerns or significant changes to the appropriate healthcare professional in accordance with the person’s escalation plan; and
• seek urgent medical assistance when the person’s condition indicates that this is required.

Staff must not make independent clinical decisions about changing insulin doses, diabetes medicines or treatment solely on the basis of a blood glucose reading unless a healthcare professional has provided a clear, individualised written protocol which authorises that action and the member of staff has been trained, assessed as competent and authorised to undertake it.

Where a person uses a continuous glucose monitor, flash glucose monitor, insulin pump or other diabetes technology, the personal plan must clearly state:

• what the person manages independently;
• what support staff are expected to provide;
• the action required if the equipment fails, becomes detached, gives an error message or produces a reading inconsistent with the person’s symptoms; and
• who staff must contact for clinical or technical advice.

Staff must not operate, programme or alter settings on an insulin pump or other diabetes device unless this forms part of the agreed care arrangement and they have received appropriate device-specific training, have been assessed as competent and are authorised to undertake the task.

Any deterioration in the person’s condition, repeated episodes of hypoglycaemia or hyperglycaemia, unexpected changes in glucose readings or concerns regarding the person’s ability to manage their diabetes must be recorded and escalated in accordance with the personal plan.

5.3 Managing Hypoglycaemia (Low Blood Glucose)

Hypoglycaemia is generally defined as a blood glucose level below 4 mmol/L. Staff must treat suspected or confirmed hypoglycaemia promptly and in accordance with the person’s individual personal plan.

Signs and symptoms may include:

• sweating;
• shaking or trembling;
• hunger;
• dizziness;
• palpitations;
• weakness;
• irritability or changes in behaviour;
• confusion or difficulty concentrating;
• blurred vision;
• drowsiness;
• seizures; and
• loss of consciousness.

A person’s symptoms may differ from these examples and their individual warning signs must be recorded in their personal plan where known.

If the person is conscious, able to swallow safely and able to co-operate

Staff must:

• stop the person’s current activity and ensure that they are safe;
• confirm the blood glucose level where this is possible and forms part of the person’s care plan, but treatment must not be unnecessarily delayed where symptoms strongly indicate hypoglycaemia;
• provide the person’s agreed fast-acting hypoglycaemia treatment in accordance with their personal plan, normally providing approximately 15–20 grams of rapidly acting carbohydrate for an adult unless their healthcare professional has specified a different treatment;
• recheck the blood glucose level after approximately 10–15 minutes, or within the timeframe specified in the person’s individual plan;
• if the blood glucose level remains below 4 mmol/L, repeat the agreed fast-acting carbohydrate treatment and continue to follow the person’s hypoglycaemia protocol;
• once the blood glucose level has recovered to 4 mmol/L or above and the person’s symptoms have improved, provide the longer-acting carbohydrate specified in their personal plan, where required, or their next carbohydrate-containing meal if due; and
• record the episode, blood glucose readings, treatment provided, the person’s response and any escalation undertaken.

Repeated, unexplained or severe episodes of hypoglycaemia must be reported to the appropriate healthcare professional in accordance with the person’s personal plan.

If the person is unconscious, having a seizure, extremely drowsy or is unable to swallow safely

Staff must:

• never give food, drink, glucose tablets, glucose gel or any other substance by mouth;
• call 999 for emergency medical assistance in accordance with the person’s emergency plan;
• place the person in the recovery position where appropriate and where this can be done safely;
• monitor breathing and responsiveness while awaiting emergency assistance and provide first aid within the staff member’s training and competence;
• administer glucagon only where it has been prescribed or supplied for that person, its administration forms part of the person’s agreed emergency plan, and the member of staff has been specifically trained, assessed as competent and authorised to administer it; and
• follow instructions given by the emergency services.

The incident must be fully recorded and reported in accordance with the organisation’s incident-reporting and medication procedures.

5.4 Managing Hyperglycaemia and Risk of Diabetic Ketoacidosis

Hyperglycaemia means that a person’s blood glucose level is higher than their individual target range. Staff must respond to hyperglycaemia in accordance with the person’s individual personal plan and any written instructions provided by their diabetes or healthcare team.

Signs and symptoms may include:

• increased thirst;
• passing urine more frequently;
• tiredness or weakness;
• blurred vision;
• headache;
• nausea; and
• generally feeling unwell.

Staff must:

• check the person’s blood glucose level where monitoring forms part of their personal plan;
• encourage the person to drink sugar-free fluids where this is safe, appropriate and consistent with any fluid restrictions or clinical advice;
• follow the person’s agreed sick-day rules and ketone-monitoring instructions where these have been provided by the person’s healthcare team;
• record blood glucose and ketone results where applicable;
• follow the person’s individual escalation instructions;
• contact the person’s diabetes team, GP, district nurse or NHS 24 on 111 where required by the personal plan or where the person remains unwell or glucose levels remain unexpectedly high; and
• seek emergency medical assistance where symptoms suggest diabetic ketoacidosis or another medical emergency.

Staff must not advise or encourage physical exercise as a means of reducing an unexpectedly high blood glucose level unless this is specifically consistent with the person’s individual healthcare advice. Exercise can cause blood glucose to rise further in some circumstances and may be unsafe where ketones are present or diabetic ketoacidosis is developing.

Possible signs of diabetic ketoacidosis include:

• nausea or vomiting;
• abdominal pain;
• deep or unusually rapid breathing;
• marked thirst and frequent urination;
• severe tiredness, drowsiness or confusion;
• a distinctive ketone smell on the breath, sometimes described as similar to pear drops or nail-polish remover; and
• raised blood or urine ketones where ketone testing is part of the person’s care plan.

Staff must follow the person’s individual emergency and ketone-management instructions. Where the person has symptoms suggestive of diabetic ketoacidosis and urgent medical assessment is required, staff must obtain urgent medical assistance in accordance with the person’s plan. If the person becomes unconscious, severely unwell, has severe breathing difficulty, or the person’s emergency instructions direct this action, staff must call 999.

Staff must never independently omit, increase or reduce prescribed insulin because a person is unwell or has high blood glucose unless this action is explicitly authorised within an individual written clinical plan provided by an appropriate healthcare professional.

All significant episodes of hyperglycaemia, ketone abnormalities, actions taken, advice received and outcomes must be recorded.

5.5. Nutrition and Meal Planning

Our responsibilities include:

• Supporting individuals with meal planning that aligns with their diabetes care needs.
• Encouraging a balanced diet rich in fibre, whole grains, lean proteins, and healthy fats.
• Avoiding processed sugars and high-carbohydrate foods unless needed for hypoglycaemia treatment.
• Coordinating with dietitians or healthcare professionals for specific dietary advice.

5.6. Foot Care and Prevention of Complications

• Checking for sores, cuts, and signs of infection.
• Encouraging individuals to wear appropriate footwear.
• Referring concerns to podiatrists or nurses if needed.

5.7. Emergency and Crisis Management

In the event of a diabetes-related emergency, staff must:

• Follow the Emergency Procedures Policy.
• Contact emergency services (999 or 112) if the person is unconscious, having difficulty breathing, or showing signs of severe hypoglycaemia or ketoacidosis.
• Record and report all incidents as per incident reporting procedures.

5.8 Consent, Capacity and Diabetes Support

Diabetes care and treatment must be provided with the person’s valid consent unless there is a lawful basis for acting where the person is unable to make the relevant decision.

Staff must presume that an adult has capacity to make their own decisions unless there is evidence that they may be unable to make the particular decision in question. A diagnosis of diabetes, dementia, learning disability, mental illness or any other condition does not by itself establish that a person lacks capacity.

Staff must support the person to understand information and make their own decisions wherever possible. This may include providing information in an accessible format, allowing additional time, using the person’s preferred communication method and involving appropriate communication support.

Where there is concern that the person lacks capacity to make a relevant decision about diabetes care or treatment, staff must follow the organisation’s Adults with Incapacity procedures and seek appropriate advice. Any intervention on behalf of an adult who lacks capacity must comply with the Adults with Incapacity (Scotland) Act 2000, including the principles that the intervention must benefit the adult, take account of their present and past wishes so far as these can be ascertained, take account of relevant views of others where required, and restrict the person’s freedom only to the minimum extent necessary.

The existence and scope of any welfare power of attorney, welfare guardianship order or other relevant legal authority must be checked and recorded where another person is expected to make decisions on the person’s behalf.

A relative, next of kin or informal carer does not automatically have legal authority to consent to medical treatment or diabetes-related interventions on behalf of an adult who lacks capacity.

Any refusal of diabetes-related care or treatment must be respected where the person has capacity to make that decision. Staff must explain relevant information within their role, record the refusal, follow the person’s risk and escalation plan and seek appropriate healthcare advice where refusal may place the person at significant risk.

Staff must not use force, coercion, concealment or restrictive practices to provide diabetes treatment unless there is a clear and lawful authority for the intervention and the action is consistent with the person’s individual plan and the organisation’s relevant policies.

6. Staff Training and Competency

All care staff must:

• Complete diabetes awareness training as part of their induction.
• Receive training on blood glucose monitoring, insulin administration, and managing hypo/hyperglycaemia (where applicable).
• Be competent in recognising complications and escalation procedures.
• Undergo annual refresher courses to keep up to date with best practices.

7. Quality Assurance and Compliance

• Regular audits of diabetes care plans and incident reports.
• Feedback from people we support to ensure person-centred care is delivered.
• Compliance with Care Inspectorate and SSSC Codes of Practice​.
• Annual reviews of policies and procedures to reflect best practices.

8. Policy Review

This policy will be reviewed annually or earlier if there are legislative changes, updates in best practice, or organisational requirements.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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