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| Division of Occupational Therapy - OT Connect Diabetes Type I and II
Diabetes mellitus is a chronic condition in which the pancreas is not able to produce insulin, or when cells stop responding to the insulin that the body has already produced. This results in the body’s inability to absorb glucose (i.e. hyperglycemia) into the cells within the body. Common Symptoms/Course of disease
Secondary Complications (Acute & Chronic):
Age of Onset:
Sexual Bias: Slightly higher risk for boys than for girls (in high-risk populations) Cultural Biases: There is a higher prevalence of DM in people of Native American, African American and Hispanic descent. Individuals who have migrated to Western cultures from East India, Japan and Australian Aboriginal cultures are also more likely to develop the disease. Current Medical Treatment: Diagnosis of DM is made through the use of blood and urine tests. Urine testing helps to detect ketones and protein within the body and assess how well the kidneys are functioning. Blood tests include the fasting glucose test, postprandial glucose test and the oral glucose tolerance test. In these three tests, plasma glucose levels are used to confirm the presence of the disease. Insulin is used with Type I diabetes and requires the person to carry out daily injections of insulin to aid their body in the use of glucose. Insulin pumps are being used now for those who necessitate multiple daily injections. The pump administers small amounts of insulin on demand and is worn outside the body and is connected by a needle that is inserted into the abdomen. Oral medications are often used with Type II diabetes and are prescribed to help lower the individual’s blood glucose and are used in conjunction with proper diet and an exercise regimen. Both forms of DM require ongoing and careful monitoring of one’s daily dietary intake as well as careful and frequent blood glucose monitoring. Regular check-ups with a physician are also important to help reduce the chance of secondary complications of the disease. Occupational Therapy Involvement Occupational therapy’s role in the treatment of DM is not as clearly defined as with other diagnoses, but it can and does play an important part of helping an individual who has DM in living a healthy life, engaging in meaningful daily occupations and in learning to effectively manage the disease so as to prevent further complications whenever possible. It is common for a client who is receiving occupational therapy for a stroke or some other physical disability to have DM as their secondary diagnosis, but occupational therapy views the patient holistically and takes every aspect of their life into account, including their diabetes, as it certainly impacts their everyday life. The occupational therapist addresses the client’s self-care needs (i.e. getting dressed, personal hygiene) and this provides them with the ideal opportunity to address various diabetes management tasks (i.e. remembering to give daily injections, diet & exercise) that the individual might be having difficulty with due to their primary problem (i.e. stroke) or from other factors as well. The occupational therapist is constantly on the lookout for any warning signs of depression, as it is common in this population due to the chronic nature of the disease, and might use a questionnaire such as the Beck Depression Inventory if they suspect that this might be a problem. It is also very common for patients with DM to receive occupational therapy for a secondary complication of the disease. The main complications are visual impairments, sensation loss and amputations. For the visually impaired client, the occupational therapist uses standardized assessments such as a Snellon’s chart to measure visual acuity and the Test of Visual and Perceptual Skills (TVPS) to determine the client’s present visual abilities. The OT completes a home evaluation, which allows them to see how their vision loss is actually impacting the person and to determine their safety in completing home management (i.e. meal preparation, balancing the checkbook) and self-care tasks. From there, the OT would provide the client with alternative ways to carry out difficult or unsafe tasks and might also provide them with adaptive equipment (i.e. glucose meter with a enlarged display, magnifiers & pre-measured dosages of insulin) that would compensate for the vision they lack and that will help them to complete their daily routine and remain independent and safe in their home. Regarding sensation loss, the OT completes standardized tests including the Semmes Weinstein Monofilaments Test, sharp/dull and two-point discrimination to help determine the extent of the sensation loss. From there, the occupational therapist would teach ways such as testing bath water with areas of intact sensation to compensate for this loss so that they remain safe in completing various daily tasks. Often times, loss of sensation eventually warrants the need for an amputation, more commonly of the lower extremity (leg). Occupational therapy plays a crucial role in helping the client physically and psychologically adjust to this change. The OT teaches the client how to put on and take off their prosthesis and how to care for the skin surrounding the amputation to ensure proper healing of the wound. They also teach the client how to safely transfer to and from various surfaces (bed, commode). The OT also has the patient participate in strengthening activities for their upper extremities (arms), as they will have to use them more often now for various daily tasks. References
How OT Makes a Difference: Evidence-Based Practice The article that I reviewed was entitled “Occupational Therapy and the Person With Diabetes and Vision Impairment” and was written by three occupational therapists, Yolanda Cate, Shelley Sikes Baker & Mary Pat Gilbert. The article first discussed the lack of direction that OT’s often have regarding the treatment of individuals with visual impairments that stem from the presence of diabetes, which makes it difficult for the therapist to adequately evaluate and treat the issue in therapy. The article also stressed the point that occupational therapy can have a major impact on individuals with diabetes. The article discussed several issues: the role of the OT in various treatment settings, guidelines for treatment, and professional development resources. Regarding OT’s role, the article felt discussed three scenarios in which an occupational therapist might encounter diabetic patients who also suffer from visual impairments. These included traditional rehabilitation settings (i.e. home health, acute care hospitals), treatment of the diabetes as a secondary issue (i.e. patient with a stroke & diabetes) and finally the OT might be involved in either a diabetes treatment program or a low vision program. The article emphasized that although the role is greater in some settings that in others, occupational therapy can still have a major impact and therapists need to be aware all existing problems that our clients have and address them accordingly during treatment of the individual. Guidelines for treatment included aspects such as incorporating simple and specific adaptive equipments (i.e. magnifier, insulin with preset amounts) that would help the client to more safely and effectively monitor their blood glucose, addressing ADL limitations (i.e. meal preparation, grocery shopping) that might impact their ability to maintain a healthy diet, encouraging a regular exercise & leisure regimen, carefully evaluating the presence of sensory loss, and actually adapting the task of checking their blood glucose so that they are more likely to do so consistently and accurately. The OT should also be on the lookout for any signs of depression or poor coping skills and should address it appropriately (i.e. recommend support group). Finally, the article provided suggestions that will help occupational therapists develop a more solid, in-depth understanding of the disease such as consulting with other healthcare professionals (i.e. dieticians, exercise physiologists) or attending hospital-sponsored diabetes education programs so that we can treat future clients even more effectively. The person that I interviewed is a 78 year old male who received occupational therapy services for the treatment of a visual condition, diabetic retinopathy, which stems from his primary diagnosis of diabetes (type 2). He received services after having a stroke and was in a rehabilitation hospital for approximately 4 weeks. He had occupational therapy 5 days a week for an hour and a half each day while in this facility. These services were carried out by an occupational therapist. It was during the initial evaluation that his visual deficits became apparent and further vision testing was conducted by the therapist to determine if it was a result of his stroke or a secondary complication of his diabetes. He felt that the therapist was very sensitive to his needs and asked him what he would like to be able to do by the time he left the hospital. He reported that the OT inquired about the physical layout of his home and made suggestions about ways he could compensate for his visual impairments so that he could do the things he needed to do every day and be safe while doing so. The treatment he received was mainly for his stroke; however, he felt that the therapist made sure to address the problems he was having with his vision and made sure that he would be safe to return home. He said that the therapist would explain the things that they would do in therapy, but that he wasn’t always sure that he knew exactly what she meant at first, but eventually he picked up on what she was saying. He stated that as he got better, she kept “making me work harder” and always “encouraged me to try my best and not to get frustrated when I couldn’t do things in therapy”. He felt that this played a big role in his recovery and made him actually enjoy going to therapy. Overall, he felt that occupational therapy helped him be the person he was before he had the stroke, while it also helped lessen the impact of his visual problems that he had been having for several years now. Basically, he stated that it helped him to be able to do more for himself and stay independent. He stated that if it wasn’t for occupational therapy, he might have ended up in a nursing home. He also felt that occupational therapy helped him to be safe in doing his daily routine and taught him ways to do things that required less work and effort on his part. He stated that occupational therapy is “certainly a good thing in my book” and said he would recommend it to others who are having problems such as he did. Cate, Y., Baker, S. and Gilbert, M. (1995). "Occupational therapy and the person with diabetes and vision impairment." American Journal of Occupational Therapy. (49) 9: 905-9.
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