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Wednesday, January 27, 2021

The diabetes nurse in Covid times

The frontline workers can make a crucial difference in training diabetes patients to manage the disease.

New Delhi | Updated: December 9, 2020 3:07:02 pm
Governments and healthcare industry must recognise the importance of investing in educating and training frontline workers who can make a huge difference in the lives of people with diabetes.

Written by Ambrish Mithal

There are no established easy solutions to mitigate COVID-19. While the world is battling the pandemic together, the graveness of the situation is felt more in countries such as India that simultaneously have a high burden of non-communicable diseases (NCDs) to tackle. Reports have revealed that people with pre-existing medical conditions such as diabetes, heart disease and kidney problems are more vulnerable to becoming severely ill with COVID-19 virus. And India, known as the diabetes capital of the world, has one in six people with diabetes. With an estimated 77 million diabetics, the ninth edition of the IDF Diabetes Atlas projected that India would continue to be at the second spot among the top 10 countries with diabetes till 2045.

As the alarming statistics of people with diabetes continue to rise across the country and the world, the role of nurses and healthcare professionals (who account for over half of the global health workforce) has become increasingly important in managing the impact of the disease. Adherence to insulin and correct injection technique plays a vital role when it comes to managing diabetes. The role of the diabetes nurse in India is performed by the diabetes educator, whose background is usually nutrition. Nurses role in insulin administration and managing hypoglycaemia is largely in the hospitalised patient, where it is very important too. Hence, the ward nurses require training on all aspects of insulin storage and administration technique. OPD is usually taken care of by diabetes educators/nutritionists.

Governments and healthcare industry must recognise the importance of investing in educating and training frontline workers who can make a huge difference in the lives of people with diabetes. Besides counselling patients with diabetes, nurses and diabetes educators can also guide them about the complications associated with incorrect injection technique, reuse of needles and wrong insulin storage. Therefore, there is a need to acknowledge how nurses as well as diabetes educators make a difference in managing diabetes.

Due to lack of awareness and training on the correct injection practices, a significant proportion of people reuse insulin pens and syringe needles that are intended for single use only. Reuse of the needle causes bending and blunting of the needle tip, increasing bleeding, pain, dosage inaccuracy and the chances of lipohypertrophy which is a thickened, rubbery swelling under the skin that develops under the usual injection site. Lipohypertrophy can lead to poor glycaemic control, hypoglycaemia, and glycaemic variability. Studies show that the frequency of needle re-use, significantly increase the risks of developing lipo., Moreover, used needles are prone to contamination by bacteria. At times, macroscopic blood regurgitation into a cartridge is also observed. In this case, if the needle is reused, it could lead to transmission of blood-borne infections.

Along with proper injecting guidance, it is imperative to know that insulin should be stored under favourable conditions. When exposed to extreme heat or cold, Insulin loses its ability to control the blood sugar. Unopened insulin should be stored in the refrigerator (2-8 degrees C) and once opened, a vial can be stored at a room temperature of around 15-25 degrees C or in the refrigerator (2-8 degrees C) for up to 28 days.

Now that we know how to store insulin and choose the right site for injecting insulin, here are a few other things to keep in mind if you have diabetes. Ensure that you do not use expired insulin as that may no longer be sterile and will likely not provide the expected outcome. As insulin needs to be given at room temperature, it is recommended to take it out from the refrigerator 30 minutes before the injection. Before injecting yourself, wash your hands properly with soap. After ensuring there are no bubbles in the syringe, draw the right dose of insulin. Push the needle into the skin while holding a skin-fold, inject slowly and steadily until it is all in and leave it in place for at least 10 seconds after injecting. Release the skin-fold after removing the needle from the skin.

Adherence to accurate medication is a major factor in determining treatment outcomes for people living with diabetes. At a time when the world is already grappling with COVID-19, patients with diabetes on insulin need to be all the more careful about managing their condition optimally. There is a need to educate patients and their families about the disadvantages related to inappropriate insulin injecting practice and to push patients to consult diabetes educators in case of any complications.

The writer is Chairman and Head, Endocrinology and Diabetes, Max Healthcare (Pan Max)

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