Learning Disabilities Mortality Review (LeDeR)
Programme: Fact Sheet 22
Diabetes
Key considerations for reviewers
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Was accessible information about diabetes available to the person?
Did the person have an annual review of their diabetes?
Were their blood glucose level, cholesterol, kidney function and blood pressure checked at least once a year?
Did they have their eyes screened for signs of retinopathy every year?
Did they have their legs and feet examined every year?
Were they weighed regularly?
Did they have a clear care plan to manage their diabetes?
Did they have continuity of the same health care professional reviewing their diabetes?
Did they have hypoglycaemic attacks in the last year of life?
Did they have any unplanned admissions in the last year of life due the control of their diabetes?
Introduction
People with learning disabilities face an increased risk of diabetes compared to the general adult population. Some
of the syndromes related to a person having learning disabilities, such as Down’s syndrome and Prader–Willi
syndrome can predispose a person to having diabetes. In addition, being overweight or obese can be a risk factor.
Management of diabetes takes place mainly at home. It consists of taking medication and adopting lifestyle changes,
as well as monitoring the condition through blood tests. The complexities of diabetes and its management can lead
to misunderstandings and confusion within the general population, but this can be exacerbated for people with
learning disabilities who may have a limited ability to understand and retain abstract and complex information
related to the illness. In addition, management of diabetes by people with learning disabilities can be influenced by
the availability of support that they receive, the provision of accessible information about their condition, and the
social and cultural context in which they live.
Key Principles
Diabetes is a chronic disease that arises when the pancreas does not produce enough insulin, or when the body
cannot effectively use the insulin it produces. Insulin is important for controlling the amount of sugar circulating in
the blood. This results in a high level of sugar in the blood that the body is not able to use and that causes
complications. There are two different types of diabetes:
 Type 1 diabetes - where the person no longer produces any insulin. This is controlled by injections of insulin
at regular times throughout the day
 Type 2 diabetes - where the person does not produce enough insulin, or the body is unable to use the insulin
effectively. This is usually controlled with a combination of diet, exercise and medication.
This information was correct as of 26/05/2016 and will be reviewed on 26/05/2017
LeDeR Programme Fact Sheet 22.
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Indications that someone may have diabetes
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Type 1 diabetes usually has a fairly sudden onset with excessive thirst, notable weight loss, vomiting,
confusion and passing urine more frequently. The person can become very unwell very rapidly.
Type 2 diabetes has a much more gradual onset, and may not be noticed until the person has a blood test
for another reason. People developing Type 2 diabetes may have increased thirst, may pass urine more
frequently, have blurred vision or unusual sensations in their legs or feet. It can be difficult to identify the
symptoms of Type 2 diabetes so screening is important in people with vague related symptoms.
Managing diabetes
Managing diabetes involves balancing medication, food and activity to manage insulin levels. When the balance isn’t
right, one of the following can occur:
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Hypoglycaemia - when the level of blood sugar is too low. It can be caused by someone with diabetes
missing a meal or a snack, having too much insulin or medication, or taking more than their usual amount of
exercise. The signs of hypoglycaemia are dizziness, visual disturbances, confusion and clumsiness. The person
requires quick-acting sugar (such as a fizzy drink or a glucose tablet) urgently, followed up with some longer
lasting carbohydrate (such as a sandwich). If it is not controlled it can lead to collapse and coma.
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Hyperglycaemia - when the level of blood sugar is too high. It can be caused by someone with diabetes being
unwell with an infection, eating too much, or not taking their medication correctly. It can also be an indicator
that the person has poor control of their diabetes. The signs of hyperglycaemia are increased thirst, passing
urine more frequently, vomiting or confusion. They may not be picked up until the person tests their blood
sugar levels. If a person has hyperglycaemia they should monitor their blood sugar levels and check their diet
and medication. If they have continually raised blood glucose levels or they feel unwell they should seek
medical attention.
Supporting someone with diabetes
Diabetes UK has developed a leaflet about the 15 essential checks and services that someone with diabetes should
receive. This is the minimum level of healthcare that every person with diabetes should expect. These should be
checked at an annual review. They include:
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blood glucose levels measured at least once a year
blood pressure measured and recorded at least once a year
blood fats (cholesterol) measured every year
eyes screened for signs of retinopathy every year
legs and feet checked (incl. skin, circulation and nerve supply) examined annually
kidney functions monitored annually e.g. urine test for protein (a sign of possible kidney problems) and a
blood test to measure kidney function)
weight checked and waist measured to see if the person needs to lose weight
support if the person is a smoker including advice and support on how to quit
a clear care plan to manage diabetes and set targets
information the person can understand and ensure carers also understand what diabetes is and the
importance of good management
attend an education course to help the person understand and manage diabetes; carer should also attend if
needed
information and specialist care if the person is planning to have a baby as diabetes control has to be a lot
tighter and monitored very closely
This information was correct as of 26/05/2016 and will be reviewed on 26/05/2017
LeDeR Programme Fact Sheet 22.
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13. access to specialist diabetes healthcare professionals to help the person manage their diabetes in the local
community or hospital clinic
14. emotional and psychological support: to talk about issues and concerns with specialist healthcare
professionals
Summary of key points
Diabetes is more common in people with learning disabilities than in the general population. There are two types of
diabetes: Type 1 and Type 2. It can be difficult to identify the symptoms of Type 2 diabetes so screening is important
in people with vague related symptoms. Management of people with learning disabilities with diabetes should
include regular checks of the person’s blood glucose levels, their health and lifestyle.
Additional sources of information
National Institute of Clinical Excellence (NICE) Guidelines for Diabetes (2011)
www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal--nutritional-and-metabolicconditions/diabetes
National Service Framework for Diabetes (Department of Health 2007)
www.gov.uk/government/publications/national-service-framework-diabetes
Diabetes UK www.diabetes.org.uk/
Diabetes UK 15 essential checks
www.diabetes.org.uk/Documents/15-healthcare-essentials/15-healthcare-essentials-checklist-0714.pdf
NHS England Choices website
www.nhs.uk/conditions/diabetes/pages/diabetes.aspx
Easy Health information about diabetes
www.easyhealth.org.uk/sites/default/files/Diabetes%20-%20EH.pdf
Books Beyond Words. Two books are available, one about Type 1 diabetes and one about Type 2 diabetes
booksbeyondwords.co.uk/bookshop/paperbacks
This information was correct as of 26/05/2016 and will be reviewed on 26/05/2017
LeDeR Programme Fact Sheet 22.
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