Diabetes services
COVID-19
Diabetes services during the coronavirus
outbreak
The Sirona care & Health website has details
of
services for people with
diabetes, including how to contact the
diabetes community services for advice and guidance. The site also
contains resources with advice and guidance for
dealing with diabetes during the coronavirus
outbreak.
Diabetes UK are also urging parents not to let
coronavirus fears stop them from seeking medical help if they're
worried their child is showing the signs and symptoms of type 1
diabetes.
Read their news story to
find out more.
Insulin Pump Service
The insulin pump therapy service has been running for
10 years, is jointly run by a consultant endocrinologist and a
diabetes specialist nurse and is one of the largest pump services
in England. We have considerable experience and knowledge about
insulin pump therapy and we use and are familiar with many of the
pumps currently available and being used in the UK. Currently we do
10-15 insulin pump initiations per year. These are undertaken in
small groups or on a one to one basis. The team will also advise on
management of pump therapy during any inpatient episodes. This can
help to ensure 'patient safety' during their stay in
hospital.
Weekly
insulin pump clinics
We offer pre-pump assessments for people preparing to
start on insulin pump therapy, as well as pump review and trouble
shooting clinics for people already using pumps.
Structured education
-
'Pre' pump start sessions
-
Sessions for people 'new' to pumps - three to four months after
starting on a pump
-
'Refresher' sessions for people using pump therapy
This service is provided by our diabetes specialist
nurses
Tel: 0117 342 2892
Email: AdultDiabetesSpecialistNurse@uhbristol.nhs.uk
Continuous glucose monitoring (CGM)
CGM provides information about the direction, magnitude,
duration, frequency, and causes of fluctuations in blood glucose
levels and so gives a much greater insight into blood glucose
levels throughout 24 hours. Continuous glucose readings that supply
trend information can help identify and prevent unwanted periods of
hypo or hyperglycaemia. CGM is offered as a tool to help to
'troubleshoot' problems with diabetes control. This service is led
by Lis Jones.
Referrals can be made to the service lead or the diabetes
specialist nurses.
Service lead: Dr Natasha Thorogood.
Antenatal Diabetes Service
More information can be found under antenatal
endocrinology.
Endocrine service leads: Dr Karin Bradley and Dr Natasha
Thorogood.
Cystic Fibrosis Diabetes Clinic
The Bristol
Adult Cystic Fibrosis Centre (BACFC) provides
high quality multi-disciplinary care to adults with cystic fibrosis
in Bristol and the surrounding areas. 50% of people with cystic
fibrosis will develop diabetes by the age of 40. Early intervention
in treating the diabetes can have a profound impact on patient
well-being and protects against weight loss and deterioration in
lung function.
The dedicated Cystic Fibrosis Diabetes clinic is
co-ordinated by the Cystic Fibrosis team and run by Dr Natasha
Thorogood, consultant endocrinologist, jointly with the CF Team.
Clinics are held in the Cystic Fibrosis outpatients on the last
Thursday of every month.
Service lead: Dr Natasha Thorogood.
Diabetes Specialist Nurse Care
pathways/clinics
We accept direct referrals to our clinics at the BRI and
South Bristol Community Hospital. Referrals can be made through GPs
or practice nurses. We provide expert advice and all round support
to help people manage their diabetes effectively in differing life
situations. This may be through one to one work or in patient
groups. For example:
-
Managing hyperglycaemia and prevention of ketoacidosis
-
Problematic hypoglycaemia
-
Lifestyle issues such as shift work, travel advice, high
intensity sport
-
Planning pregnancy. We offer prepregnancy counselling and work
as part of the joint endocrinology and obstetric team guiding women
with diabetes during pregnancy to achieve the best outcomes
The diabetes specialist nurses are experienced
educators who deliver a variety of structured education courses for
people with Type 1 diabetes throughout Bristol.
Rapid access diabetes specialist nurse appointments
are available Monday to Friday. Referral criteria for this service
are:
-
New diagnosis Type 1 diabetes
-
Early pregnancy Type 1, Type 2 diabetes
-
Frequent and severe hypoglycaemia
-
Hyperglycaemia related to illness or infection
To refer, please telephone the diabetes specialist
nurses direct on 0117 342 2892.
General/Secondary Care Diabetes
The BRI service hosts weekly diabetes clinics (with Dr
Natasha Thorogood, Dr Bushra Ahmad and Dr Rami Fikri) offering
complex case management for patients with diabetes. All clinics are
consultant supervised and all new and follow up patients are seen
by a consultant or a senior specialist registrar. Any patients seen
by a senior specialist registrar are discussed with a consultant to
finalise the care plan.
The BRI does not offer a formal obesity service. Our
closest referral centres for obesity are at Musgrove Park Hospital,
Taunton (with Dr Rob Andrews, consultant endocrinologist) and
Southmead Hospital (with Dr Andrew Johnson, consultant
endocrinologist).
Inpatient Diabetes Service
The BRI provides a diabetes inpatient team to support
quality of care for patients whose hospital admission is
complicated by diabetes. Appropriate care pathways and guidelines
are in place. The team includes inpatient specialist nurses
dedicated to the Division of Medicine, the Division of Surgery,
Head and Neck and the Division of Specialised Services. The
endocrinology specialist registrars and consultants also support
inpatient care.
Service lead: Dr Rami Fikri.
Combined Diabetes Foot Clinic
Foot problems in diabetes result from complications such
as peripheral vascular disease or neuropathy. The common clinical
features of diabetic foot problems include infection,
osteomyelitis, neuropathy, peripheral arterial disease and charcot
arthropathy. Diabetic foot problems require urgent attention, and a
delay in diagnosis and management increases morbidity and mortality
and contributes to a higher amputation rate.
Currently UH Bristol offers a monthly MDT foot clinic,
staffed by a consultant endocrinologist, diabetes specialist
podiatrists, orthopaedic surgeon, consultant microbiologist,
vascular technician, and orthotist with access to a vascular
surgeon and medical photography.
The Diabetes Foot Team is an integral part of the MDT Foot
Team at UH Bristol. It provides twice weekly (outpatient only)
podiatry review and treatment for acute diabetes foot
problems.
Referrals can be made to the Diabetes Foot Team (Podiatry)
or to the service lead.
Service lead: Dr Natasha Thorogood.
Podiatry
The Diabetes Foot Team comprises specialist podiatrists
who work under a service level agreement for UH Bristol. The team
has close links to the diabetes service and most particularly work
together in the monthly combined Diabetes Foot
Clinic.
UH Bristol offers a dedicated (outpatient only) service
which consists of podiatrist led clinics running every Tuesday and
Friday from 8.30am to 5pm at the Diabetes Foot Clinic, Level 4,
Clinic 4, Queen's Building, Bristol Royal Infirmary. The team
specialise in the treatment of the hot foot and acute/chronic
diabetic foot wounds. Referrals are made via GP's and consultants.
Self-referrals are not accepted. We have an answerphone-only
telephone line (0117 342 2175) which is checked on clinic days
only. Referrals and queries can be faxed to our clinic
co-ordinator, Jacqui Way on 0117 342 0279.
Our service does not provide ongoing care for those
patients deemed at increased or high risk. These patients are
discharged to the care of their Community Podiatry teams. If you
would like more information about diabetes foot management, please
visit Diabetes UK.
Service lead: Dr Natasha Thorogood
Transitional Care
For young adults making the transition from paediatric to
adult care we offer dedicated clinics where consultants from both
sides attend to ensure that the handover of care is as optimal as
possible.
These are run by Dr Bradley for endocrinology and Drs
Thorogood and Ahmad for diabetes.
We work very closely with our paediatric endocrinology
colleagues who are based just next door to us in the Bristol Royal
Hospital for Children.
Affiliated Services and Specialists
Metabolic Service
Clinical services for adult patients with Inherited
Metabolic Disease (IMD's) are now organised around four national
centres. Bristol is linked with the Birmingham centre and in 2012 a
formal outreach service was established with outpatient clinics
held at the Bristol Royal Infirmary. The service is led by Dr
Charlotte Dawson (consultant in metabolic medicine at Queen
Elizabeth Medical Centre, Birmingham). Clinics are run jointly by
Dr Dawson and Dr Bayly together with specialist nurse and dietetic
support. Patients are seen with a wide range of inherited metabolic
conditions including Phenylketonuria; Galactosaemia; Glycogen
storage disorders; other disorders of carbohydrate and protein
metabolism; Urea cycle defects; Mitochondrial disorders and
Lysosomal storage diseases.
Referrals should be sent to Dr Charlotte Dawson,
consultant in metabolic medicine, Queen Elizabeth Hospital, Queen
Elizabeth Medical Centre, Birmingham, B15 2TH. For urgent advice, a
24 hour service is available from the on call IMD
consultant at Queen Elizabeth Medical Centre by calling 0121
627 2000.
Service lead: Dr Charlotte Dawson, Queen Elizabeth Medical
Centre, Birmingham.
Local service lead: Dr Graham Bayly.
Lipid Service
A secondary care lipid service is based at UH Bristol for
patients from Bristol, North Somerset and South Gloucestershire.
Genotyping for Familial Hypercholesterolaemia (FH) is available
where necessary to facilitate diagnosis or family screening.
Patients are also seen with other genetic lipid disorders, severe
hypertriglyceridaemia, statin intolerance, or poor response to
lipid lowering therapy. In addition to consultant review, patients
will routinely be offered review with a specialist dietitian at
their clinic appointment. A regional service is provided for
LDL-apheresis for patients with severe FH.
Referrals should be made to Dr Graham Bayly, consultant
biochemist, Lipid Clinic, Department of Clinical Biochemistry,
Bristol Royal Infirmary. Email advice about diagnosis, treatment or
appropriateness of referral is also available via
lipidclinic@uhbristol.nhs.uk.
A paediatric clinic for children with suspected or
confirmed FH (or other inherited lipid disorders) is available.
This service aims to see and review children with FH by the age of
10 in line with NICE guidelines. This is run jointly by Professor
Julian Shield and Dr Graham Bayly at Bristol Royal Hospital
for Children. Referrals should be made to Professor Julian Shield,
consultant paediatric endocrinologist, Lipid Clinic, Bristol Royal
Hospital for Children.
Adult service lead: Dr Graham Bayly.
Paediatric service lead: Professor Julian
Shield.
Community Podiatry Pathway Info
http://www.sirona-cic.org.uk/nhsservices/adult-services/podiatry/
Information for patients
Type 1 Diabetes exercise guidelines
(flowchart)
Diasend user instructions