HNY Policy and Pathway Repository - Humber

Type 1 diabetes affects over 370,000 adults in the UK. It results from destruction of the cells that normally make insulin. Loss of insulin secretion results in high blood glucose and other metabolic and haematological abnormalities, which have both short term and long term adverse effects on health. Over years, type 1 diabetes causes tissue damage which, if not detected and managed early, can result in disability: blindness, kidney failure and foot ulceration leading to amputation, as well as premature heart disease, stroke and death. The risk of all of these complications is greatly reduced by treatment that keeps circulating glucose levels to as near normal as possible, reducing tissue damage. Disability from complications that are not avoided can often be prevented by early detection and active management.

Potential Urgent Scenarios

Please see: Diagnosing diabetes - potential urgent scenarios

Any clinical suspicion that the patient may require insulin which should include:

• Young person
• Unwell
• Short duration symptoms
• Marked weight loss
• Steroid or antipsychotic medication
• Pancreatic disease
• Either in isolation or combination.

Any capillary blood glucose reading of >20mmol in previously undiagnosed DM – contact the diabetes team the same day for advice.

Unless the person is acutely unwell direct hospital admission is usually avoidable. This guidance is not designed to replace clinical judgement and does not cover rarer presentations of diabetes. If there is concern about a patient further advice should be sought.

Type 1 diabetes is treated by insulin replacement, supported by active management of other cardiovascular risk factors, such as hypertension and high circulating lipids. Modern insulin replacement therapy aims to recreate normal fluctuations in circulating insulin concentrations. This supports a flexible lifestyle with minimal restrictions and, properly done, can improve blood glucose levels, reducing the risk of both structural complications and episodes of hypoglycaemia. Flexible insulin therapy usually involves self-injecting multiple daily doses of insulin, with doses adjusted based on taken or planned exercise, intended food intake and other factors, including current blood glucose, which the insulin user needs to test on a regular basis. This self-management needs the insulin user to have the skills and confidence to manage the regimen.

One of the most important roles of healthcare professionals providing diabetes care to adults with type 1 diabetes is to ensure that systems are in place to provide informed, expert support, education and training for insulin users, as well as a range of other more conventional biomedical services and interventions.

HUTHT Urgent Advice

For healthcare professionals only, emergencies or to discuss a potential admission 24/7

Please call HEYHT switchboard (01482) 328541 and ask for the diabetes consultant on call for endocrinology.

HUTHT Non-Urgent Advice

NON-URGENT Diabetes advice - Hull and East Yorkshire Hospitals 

Advice and guidance can be accessed via NHS e-Referral Service. Questions will be responded to within two days. 

Non urgent diabetes helpline - Telephone: (01482) 675391

This telephone service is NOT an emergency service. It provides patients with help and assistance in dealing with their diabetes problems and also acts as a help line for practice nursing staff and GP's who may require more expert knowledge when dealing with patients in primary care settings.

The Diabetes helpline is managed by the Diabetes Specialist Nursing team based in the Brocklehurst Diabetes Centre in Hull.  Due to clinic requirements the phone line is not always manned, but responses are enacted as detailed below.

• Incoming calls that are received Monday to Friday morning are responded to in the afternoon of the same day.
• Incoming calls that are received Monday to Thursday afternoon are dealt with by the DSN the following morning.
• There is no service on this line on Saturdays and Sundays but a message can be left to be responded to on the following Monday morning.

Healthy Living with Diabetes

• Make sure patient understands the importance of their annual checks
• Make sure the patient is enrolled on an accredited education course
• Involve the patient in decision making about their medications
• Offer lifestyle advice including:
  • Increasing levels of activity
  • Smoking cessation
  • Dietary advice - consider referral to a diabetes specialist dietitian