Diabetes; a Contemporary Approach. Managing Diabetes in a Patient with Enduring Mental Health Problems.

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DIABETES; A CONTEMPORARY APPROACH

2486 WORDS
CONTENTS
CONTENTSPAGE1
INTRODUCTIONPAGE2
DISCUSSIONPAGE2
CONCLUSIONPAGE8
REFERENCESPAGE9
ARTICLES ACCESSED ONLINEPAGE12
APPENDIX 1SCENARIOPAGE13
APPENDIX 2 ‘EATWELL PLATE’PAGE14

Introduction
Lavinia had suffered a relapse in her mental health and had been using illicit drugs and alcohol to combat the disturbing positive symptoms of her illness and had stopped taking any of her prescribed medications. The nursing assessment indicated that the first issue to deal with was her chaotic behaviour and once that was under control a series of therapeutic interventions could be put in place to aid her recovery. Initially her chaotic presentation and challenging behaviours (Beer et al, 2005; Xeniditis et al, 2001) made it difficult to engage with her with in a therapeutic way and she resisted staff’s attempts to help her. The decision was made to manage her using intramuscular injections (IM) of an anxiolytic that necessitated using physical restraint in order to administer the IM. The first few days were not pleasant for Lavinia due to staff needing to restrain and inject her in order to manage her challenging behaviours but her chaotic behaviour did resolve over time and she became more accepting of staff interventions. Lavinia’s named nurse engaged with her and spent time ‘counselling’ her and a series of therapeutic interventions were agreed. Mental health nurses are specialists in caring for people with mental health problems and it has been identified that they have deficits in their knowledge of diabetes (Nash, 2009). This was the case in caring for Lavinia at the time. Little emphasis was placed on the importance of managing her diabetes because staff were not aware of the implications of poor diabetes management.

Discussion
In the United Kingdom mental illness is by far the largest single source of burden of disease. There is no other illness or disease in the combined extent of persistence, prevalence and breadth that impacts on the person more (Friedli and Parsonage, 2007). There is an inextricable link between poor mental health and an increased risk of physical illness, increased health risk behaviour, deprivation, poor educational achievement, substance misuse (National Institute for Health and Clinical Excellence, (NICE) 2009). Managing mental illness carries the single largest cost to the National Health Service (NHS) coming in at £10.4 billion (Department of Health, 2012). Schizophrenia is a psychotic disorder that can have a debilitating effect on many aspects of a person’s life including perceptions, thinking, language, emotions, social, behaviour. The positive symptoms of schizophrenia can include hallucinations of any senses, delusions, disorganized thought processes, causing the person to lose contact with reality.

Diabetes is a serious condition that can have a debilitating effect on the person. It can cause kidney failure, blindness, heart disease, stroke, psychosocial problems, if left untreated (NICE, 2008). The United Kingdom is facing a significant increase in the number of people diagnosed with diabetes. In the past 16 years the number of people diagnosed with diabetes has increased from 1.4 million to 2.9 million cases and it is estimated that this figure will continue to increase as the number of older people and overweight/obese people increase (Diabetes in the UK, April 2012). Diabetes mellitus is a condition whereby the body is unable to properly use the glucose it produces because of either lack of or resistance to the hormone insulin. There are two main types of diabetes; type 1 & type 2. Insulin is needed to enable the glucose to pass from the blood and enter the cells of the body where it is stored. Type 1 diabetes occurs when the body (pancreas) is unable to produce its own insulin (an autoimmune disease)...
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