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 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 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.
Information for patients
Type 1 Diabetes exercise guidelines
(flowchart)
Diasend user instructions
