Residents of a secure mental health unit may experience special problems in attempting to cope with their diabetes, explained Elaine Emmerson, Diabetes Specialist Nurse at King’s Mill Hospital, Sutton in Ashfield.

Elaine described her experience of working in a private, women-only unit in which five of the 38 residents have type 2 diabetes. She spoke about four individuals between the ages of 28 and 52 years.

Common factors between the women include the following:

* Obesity

The women are often sedated, thus making the possibility of them taking exercise less likely. Weight control is therefore even more of a problem in this group.

* Generally poor control

Altered mood states and a lack of motivation make control difficult. In addition, self-abuse, both physical and in relation to their insulin, is common.

* Poor concordance with treatment

The secure unit represents a very restrictive environment in which peer pressure from residents can make it especially difficult for individuals to behave in any way that makes them perceived as being ‘different’ from the rest.

* Underlying mental illness and the use of antipsychotic and atypical antipsychotic drugs

Antipsychotics and atypical antipsychotics have in the past been linked with causing diabetes. At present, however, this remains unproven.

Elaine stressed that as a DSN she could play a key role in improving the ability of this vulnerable group of people with diabetes to manage their disease.

Working as part of a multidisciplinary team

By working as part of a dedicated team alongside the psychologist, diabetologist and GP–and by attending regular multidisciplinary meetings–the person with diabetes can be encouraged to recognise and take control of important aspects of their disease management:

* A facilitator could be put in place to encourage exercise and weight loss.

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* Blood glucose monitoring should be encouraged even if it is only twice a week.

* Better records need to be kept. Some individuals already keep food diaries.

* Unit staff require training and education in diabetes care.

Only by confronting the problems created by a combination of their own attitudes and by the surroundings in which they live will these women be helped to self-manage their disease.