**Editor’s Note: This is part of an informational series called Notes from the Nurse to increase awareness and understanding of health or clinical issues that could impact our clients and their families.

More than 463 million people are living with diabetes, and of those, 136 million of them are over the age of 65, according to The International Diabetes Federation’s World Diabetes Day 2020 Toolkit. Many more are undiagnosed.

Diabetes accounts for 10% of the total global spending on healthcare. This amounts to $760 billion worldwide. More than 4,000 Americans are diagnosed with diabetes every day, according to the American Diabetes Association.

The theme for World Diabetes Day 2020, which is November 14, is Diabetes: Nurses Make the Difference. As a registered nurse, I am proud to be one of the 19.3 million professional nurses around the world. We make up 59% of all health care professionals.

Our diabetic clients, who are at risk for complications due to this disease, require extra attention.

Diabetes can affect all systems in the body. Glucose, a type of sugar in the blood, thickens it—think of a sticky syrup that clings to everything. This thickening of the blood can cause damage and blockages in small blood vessels throughout the body.

When working with a diabetic client, I educate them on issues that could impact them, encouraging them to monitor their diet, watch their weight and have regular check-ins with their doctors. In addition to seeing their general practitioner and an endocrinologist (a doctor who specializes in diabetes), regular podiatry visits are essential for maintaining optimal health for diabetics.

I also educate all our CHHAs to be on the lookout for any of these flags and they are all trained to examine diabetic client’s feet thoroughly when bathing.

Complications may include health conditions such as:

• Foot issues that could include poor circulation or nerve damage
• Diabetic retinopathy (damage to the blood vessels in the eyes as the blood vessels swell and leak)
• Increased risk for glaucoma or cataracts
• Kidney damage (kidneys are the body’s filtration system, excess glucose can clog these filters. This can lead to kidney disease and possible kidney failure.)
• Neuropathy (blood vessels that are clogged cannot supply oxygen and nutrients to the nerves that can result in damage to the extremities, especially the foot and toes. It can lead to amputation if not kept in check.)
• Heart issues (if there is high glucose in the blood, and it becomes thicker, it does not move through the circulatory system as easy. It can also cause lesions on vessel walls which can lead to high blood pressure and the heart working harder than it needs to.)
• Wounds that take a long time/don’t heal (this is especially concerning in clients who have neuropathy because they don’t feel pain and sometimes don’t even know they have a wound. This can lead to serious infections.)
• Hearing issues
• Higher risk of dementia and Alzheimer’s
• Skin conditions
• Higher risk of infection. In fact, the American Diabetes Association reports that 40% of COVID-19 deaths in America were diabetic patients.
• Depression

As always, consult your doctor—either a general practitioner or endocrinologist—if you have any questions about your blood sugar or diabetes.

Yours in good health,

Stephen Hoelle, RN-BC

Director of Nursing, Assisting Hands Home Care

Next: Foot health is an indicator of overall diabetic health