Tag: diabetes

Podiatry Template

Scott McLaughlin

This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.

Presenting Complaint

Which service is this referral aimed at:

  • General Podiatry
  • MSK Podiatry
  • Diabetes
  • Nail Surgery

Is this a request for a domicilliary visit:

  • Yes
  • No

Main Presenting Complaint: [Text – 98 character maximum]

Reason for Referral: [Text]

Date of Onset: [Date]

Priority:

  • Routine
  • Urgent

Priority Reason: [Text – 98 character maximum]

Podiatry Guideline

Podiatry Referral

Scott McLaughlin

MSK Podiatry (Biomechanic Clinic)

MSK podiatry provides diagnosis and treatment for a range of muscle and joint related foot and lower limb problems which may be due to development, posture, occupation and exercise, or due to long-term conditions such as Rheumatoid arthritis, Osteoarthritis.

Diabetes

The Podiatry Diabetes service provides assessment, diagnosis and treatment of low, medium and high risk patients with pathologies directly related to their Diabetes. This include active ulceration but excludes red flags such as Charcot foot, infection etc which should be directed to acute services which is found under the District Hospital in SCI Gateway.

General Podiatry

General Podiatry provides assessment, diagnosis and treatment for a range of foot pathologies and patients presenting with severe circulation problems with associated foot lesions.

Nail Surgery

General podiatry provides nail surgery procedures; partial or total nail avulsion.

Diabetes (Acute) Guidelines

Scott McLaughlin

SCI Gateway Referral Protocol for NHS Lanarkshire Acute Diabetes Service

MCN Guidelines are contained in the ‘Lanarkshire Diabetes Clinical Guidelines’ folder on the Diabetes Service Firstport page. (This link is only available within NHS Lanarkshire’s network).

999

THOSE WITH UNCONSCIOUS HYPOGLYCAEMIA, SUSPECTED KETOACIDOSIS OR NON-KETOTIC HYPEROSMOLAR COMA NEED REFERRAL TO A&E VIA SCOTTISH AMBULANCE SERVICE (SAS)

Acute Admission via ERC

  • Any patient with Type 1 diabetes who presents with vomiting and/or is biochemically unstable (including new diagnosis)
  • Patients with infected, necrotic or gangrenous foot ulcer/suspected Charcot foot IF unable to access specialist podiatrist
  • Patients presenting with acute deterioration in renal function

Acute Diabetes Specialist Nurse (DSN) same day (by telephone)

  • Newly diagnosed Type 1 Diabetes, where patients are not vomiting and who are biochemically stable
  • Patients with recurrent hypoglycaemia or loss of hypo awareness, who have been referred to the Consultant for review, contact the acute DSN service for interim advice

General Notes

In general, if patients require assessment, intervention and support by a diabetes specialist allied health professional (nursing, dietetics) and have Type 1 Diabetes they should be directed to the Acute service. If they have Type 2 Diabetes they should be directed to the Community service.

Expected outcome

  • Please refer to Diabetes SESP for guidance. Patients referred for ‘Continuing care of a complex patient’ may no longer be eligible for the Enhanced Service.

Consultant Diabetologist

Routine

  • People with Type 1 Diabetes who previously failed to attend, but who are now receptive to Consultant review
  • Recurrent hypoglycaemia or loss of hypo awareness
  • Persistent hypertension and hyperlipidaemia despite intensive management as per current guidelines
  • Microvascular complications associated with poor glycaemic control despite maximising treatment as per current guidelines
    • Painful neuropathy not responding to treatment as per current guideline
    • Erectile dysfunction associated with poor glycaemic control despite maximising treatment as per current guidelines
    • Suspicion of autonomic neuropathy (e.g. gustatory sweating, gastric paresis) associated with poor glycaemic control
  • Patients under 35 with a new diagnosis of Type 2 Diabetes
  • Patients for whom insulin pump therapy (CSII) is to be considered
  • Patients with Type 2 Diabetes to be considered for GLP-1 analogue therapy (e.g. exenatide, liraglutide) or insulin therapy

Diabetes Specialist Nurse (DSN) Service

Urgent

  • Destabilised Type 1 or Type 2 Diabetes ( Intercurrent illness or new medication (e.g. corticosteroids)
  • Women with Type 1 or Type 2 Diabetes contemplating or with confirmed pregnancy

Routine

Type 1

  • Poor glycaemic control in Type 1 Diabetes despite intensive management
  • People with Type 1 Diabetes who previously failed to attend, but who are now receptive to DSN review and support
  • Those requiring one to one support to overcome barriers to self-care
  • Patients for DAFNE programme (structured education for Type 1 Diabetes)

Type 2

People with Type 2 Diabetes on dual or triple oral therapy with poor glycaemic control

  • HbA1c > 58 – 64 mmol/mol (7.5 – 8%) or outwith individual agreed target, despite increasing/maximising medication
  • Recurrent hypoglycaemia, despite reduction in oral medication (or loss of hypoglycaemia awareness)

People with Type 2 Diabetes on insulin therapy with poor glycaemic control

  • HbA1c > 58 – 64 mmol/mol (7.5 – 8%) or outwith individual agreed target
  • Fasting BG levels persistently > 7 mmol
  • Pre-meal BG levels persistently > 9 – 10 mmol
  • Recurrent problems with hypoglycaemia or loss of hypoglycaemia awareness
  • Those requiring one to one support to overcome barriers to self-care

Diabetes Specialist Dietician

Type 1

  • All patients with Type 1 Diabetes aged 16 and over
  • Patients with Type 1 or Type 2 Diabetes who have developed complications which have nutritional implications (e.g. gastroparesis, nephropathy)
  • Patients with Type 1 or Type 2 diabetes who require enteral feeding

Type 2

  • Newly diagnosed Type 2 Diabetes
  • Newly identified increased risk of Diabetes (Impaired Fasting Glycaemia or Impaired Glucose Tolerance, Gestational Diabetes)
  • Patients with Type 2 Diabetes who are being commenced on insulin or GLP-1 therapy
  • Deteriorating glycaemic control in Type 2 Diabetes despite maximum tolerated oral and/or insulin therapy
  • People with Type 2 Diabetes requesting a one to one appointment for education instead of X-pert structured patient education

Diabetes Specialist Podiatrist

  • High risk feet (by telephone) – followed by SCIGW referral marked as urgent

General Podiatry

(use existing referral routes and not diabetes eReferral protocol)

  • Newly diagnosed Type 1 or Type 2 Diabetes for initial foot screening and foot care education
  • Moderate risk feet

Multidisciplinary Foot Clinic

  • Tertiary referral via specialist diabetes podiatrist

Retinal Screening

  • Automatically via SCI DC Network when diagnostic code for diabetes added to the GP Clinical IT system **only add the code when the patient has been informed of the diagnosis**
  • Via direct referral letter (if patient declines SCI DC Network inclusion)

Self Management Structured Education Programmes throughout NHS Lanarkshire

Xpert (Type 2 Diabetes)

  • Self referral by telephone

DAFNE (Type 1 Diabetes)

  • Via tertiary referral following assessment by Diabetes Specialist Team