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Diabetes services

Insulin Pump Service

The UH Bristol 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 Lis Jones, diabetes specialist nurse and lead pump nurse
Tel: 0117 342 2892 or
Email: elisabeth.jones@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 Lis Jones, diabetes specialist nurse.

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. 

Diabetic Neuropathic Pain Clinic

This specialist service was set up in 2009 and runs monthly at the BRI. It focuses on optimising treatment for patients across the South West with complex severe refractory painful diabetic neuropathy. An audit from 2012 demonstrated that average pain scores for clinic attenders fell by 31% and that quality of life measures improved by 31%. There was a 37% reduction in the number of patients multiply attending their GP surgeries for these symptoms and 91% of patients were very satisfied with their care and the service received.

Service lead: Professor David Wynick. 

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. 

Helen John acts as a regional genetic diabetes nurse as part of a national network led by Professor Andrew Hattersley, at the Peninsula Medical School in Exeter. Her role is to identify families likely to have monogenic diabetes and advise which genetic diagnostic tests and treatments are most appropriate. Monogenic diabetes affects 1-2% of people with diabetes, although often goes unrecognised. Further information can be found on the Diabetes Genes website. The three main features are:

  • Diabetes developed before the age of 25 years
  • Diabetes which runs in families from one generation to the next
  • Diabetes may be treated by diet or tablets and does not always need insulin treatment 

General/Secondary Care Diabetes

The BRI service hosts weekly diabetes clinics (with Dr Natasha Thorogood and Dr Bushra Ahmad) 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 Bushra Ahmad. 

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, vscular 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 Bristol Community Health employed diabetes 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 Georgina Russell

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.

Bristol Community Health, Podiatry Department

Knowle Clinic, Bristol, BS4 2UH. Tel 0117 9190275

Find out more about the service.

Led by Mr Job Wooster.