Patient Settings: Specific Risks

Patients with diabetes are not always physically located in care settings. More often, they are self-managing their condition and its inherent risks. Clinicians should educate patients on how to optimally manage diabetes in general, but also help them develop an understanding of how diabetes risks evolve in each health care setting they may find themselves in. This section provides some high-level resources that health care providers can offer their patients with diabetes.

Home

Patients spend most of their time at home. For patients to live safely with diabetes, they must have a firm understanding of how to self-manage their condition. Patients with diabetes should be referred to a diabetes educator to instill the knowledge and skills required to safely and successfully care for their diabetes. The development of survival skills provides patients with practical information on how to optimally address common issues.

Commonly taught survival skills that will keep patients with diabetes safe include:

  • How to take medications, including insulin administration techniques
  • How to monitor blood sugars
  • How to take care of themselves when they are feeling sick
  • How to take medications and monitor blood sugars when exercising
  • How to recognize and treat hypoglycemia
  • How to recognize and treat extreme hyperglycemia
  • Importance of regular follow-up with the health care team

Medication Acquisition

Medication management is central to safe diabetes care. A patient’s choice on where to obtain medications may have an impact on their safety. There is emerging evidence that suggests that mail-order pharmacies may be as safe, or potentially safer, than non–mail-order pharmacies.1 However, as pharmacies expand their range of services and move into the realm of acute and chronic care management through retail clinics and expanded pharmacy counseling services, patients may actually encounter new benefits and risks. Patients who have their care optimally coordinated between their physicians, pharmacists, educators, and other health care team members while they are home will have the best and safest outcomes. When patients travel outside of their home for business or leisure, they should be instructed to bring their diabetic supplies. Having a checklist of their items (including medication, syringes, needles, glucometer, test strips, lancets, and log book) and having a dedicated bag for these items will reduce the likelihood of forgetting any or all of them.

Workplace

The workplace can be a challenge for patients with diabetes. For patients with diabetes who work in the commercial transportation industry, these challenges revolve around pharmacologic treatment selections. For all patients with diabetes in the work force, monitoring and medication issues are important to consider based on job function.

  • Jobs in transportation
    To enhance patient and public safety, the Federal Motor Carrier Safety Administration was created in 2000. This agency’s explicit goal is to improve the safety of our roadways, and it provides guidance and regulation on the ability for individuals to drive in a commercial capacity. The ADA also has information about commercial driver’s licenses.
  • All workplaces
    There are multiple issues regarding diabetes and the workplace. The rights of people with diabetes are protected by law—employers cannot unfairly discriminate against them. It is incumbent on both employers and employees to reduce the risk to the employee, other employees, and the public. Risks increase when shifts are changed—night shift to day shift—and when planned meal breaks are not adhered to. An overview of these issues can be found at the ADA website.

School

Students with diabetes, especially those requiring insulin and blood glucose monitoring, are at risk of harm if they are not well managed. To minimize risk, all personnel who interact with a student need to understand their roles and responsibilities. From the bus driver to the teacher to the physical education instructor and coach, each has a responsibility to keep the student with diabetes safe. For a set of action plans and instructions, see NDEP’s Helping the Student with Diabetes Succeed: A Guide for School Personnel.

Additional helpful information can be found at:

Camp

For younger patients with diabetes, going to camp presents unique challenges due to the absence of the usual support systems that children have at home. To assure safety while at camp, the ADA provides specific guidance for camps to follow in order to minimize the risk. In addition, the ADA sponsors camps for children with diabetes in many states. These camps adhere to the tenets outlined above. To find a camp for your patients, visit the Diabetes Education and Camping Association and ADA websites.

References