{"id":643,"date":"2017-08-07T10:04:14","date_gmt":"2017-08-07T10:04:14","guid":{"rendered":"https:\/\/www.nhslref.scot.nhs.uk\/?p=643"},"modified":"2017-08-07T10:04:14","modified_gmt":"2017-08-07T10:04:14","slug":"diabetes-acute-guidelines","status":"publish","type":"post","link":"https:\/\/www.nhslref.scot.nhs.uk\/?p=643","title":{"rendered":"Diabetes (Acute) Guidelines"},"content":{"rendered":"

SCI Gateway Referral Protocol for NHS Lanarkshire Acute Diabetes Service<\/h2>\n

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

999<\/h3>\n

THOSE WITH UNCONSCIOUS HYPOGLYCAEMIA, SUSPECTED KETOACIDOSIS OR NON-KETOTIC HYPEROSMOLAR COMA NEED REFERRAL TO A&E VIA SCOTTISH AMBULANCE SERVICE (SAS)<\/span><\/p>\n

Acute Admission via ERC<\/h3>\n
    \n
  • Any patient with Type 1 diabetes who presents with vomiting and\/or is biochemically unstable (including new diagnosis)<\/li>\n
  • Patients with infected, necrotic or gangrenous foot ulcer\/suspected Charcot foot IF unable to access specialist podiatrist<\/li>\n
  • Patients presenting with acute deterioration in renal function<\/li>\n<\/ul>\n

    Acute Diabetes Specialist Nurse (DSN) same day (by telephone)<\/h3>\n
      \n
    • Newly diagnosed Type 1 Diabetes, where patients are not vomiting and who are biochemically stable<\/li>\n
    • 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<\/li>\n<\/ul>\n

      General Notes<\/h3>\n

      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.<\/p>\n

      Expected outcome<\/h4>\n
        \n
      • Please refer to Diabetes SESP for guidance. Patients referred for \u00e2\u20ac\u02dcContinuing care of a complex patient\u00e2\u20ac\u2122 may no longer be eligible for the Enhanced Service.<\/li>\n<\/ul>\n

        Consultant Diabetologist<\/h3>\n

        Routine<\/h3>\n
          \n
        • People with Type 1 Diabetes who previously failed to attend, but who are now receptive to Consultant review<\/li>\n
        • Recurrent hypoglycaemia or loss of hypo awareness<\/li>\n
        • Persistent hypertension and hyperlipidaemia despite intensive management as per current guidelines<\/li>\n
        • Microvascular complications associated with poor glycaemic control despite maximising treatment as per current guidelines\n
            \n
          • Painful neuropathy not responding to treatment as per current guideline<\/li>\n
          • Erectile dysfunction associated with poor glycaemic control despite maximising treatment as per current guidelines<\/li>\n
          • Suspicion of autonomic neuropathy (e.g. gustatory sweating, gastric paresis) associated with poor glycaemic control<\/li>\n<\/ul>\n<\/li>\n
          • Patients under 35 with a new diagnosis of Type 2 Diabetes<\/li>\n
          • Patients for whom insulin pump therapy (CSII) is to be considered<\/li>\n
          • Patients with Type 2 Diabetes to be considered for GLP-1 analogue therapy (e.g. exenatide, liraglutide) or insulin therapy<\/li>\n<\/ul>\n

            Diabetes Specialist Nurse (DSN) Service<\/h3>\n

            Urgent<\/h3>\n
              \n
            • Destabilised Type 1 or Type 2 Diabetes ( Intercurrent illness or new medication (e.g. corticosteroids)<\/li>\n
            • Women with Type 1 or Type 2 Diabetes contemplating or with confirmed pregnancy<\/li>\n<\/ul>\n

              Routine<\/h3>\n

              Type 1<\/h3>\n
                \n
              • Poor glycaemic control in Type 1 Diabetes despite intensive management<\/li>\n
              • People with Type 1 Diabetes who previously failed to attend, but who are now receptive to DSN review and support<\/li>\n
              • Those requiring one to one support to overcome barriers to self-care<\/li>\n
              • Patients for DAFNE programme (structured education for Type 1 Diabetes)<\/li>\n<\/ul>\n

                Type 2<\/h3>\n

                People with Type 2 Diabetes on dual or triple oral therapy with poor glycaemic control<\/p>\n

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

                  People with Type 2 Diabetes on insulin therapy with poor glycaemic control<\/p>\n

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

                    Diabetes Specialist Dietician<\/h3>\n

                    Type 1<\/h3>\n
                      \n
                    • All patients with Type 1 Diabetes aged 16 and over<\/li>\n
                    • Patients with Type 1 or Type 2 Diabetes who have developed complications which have nutritional implications (e.g. gastroparesis, nephropathy)<\/li>\n
                    • Patients with Type 1 or Type 2 diabetes who require enteral feeding<\/li>\n<\/ul>\n

                      Type 2<\/h3>\n
                        \n
                      • Newly diagnosed Type 2 Diabetes<\/li>\n
                      • Newly identified increased risk of Diabetes (Impaired Fasting Glycaemia or Impaired Glucose Tolerance, Gestational Diabetes)<\/li>\n
                      • Patients with Type 2 Diabetes who are being commenced on insulin or GLP-1 therapy<\/li>\n
                      • Deteriorating glycaemic control in Type 2 Diabetes despite maximum tolerated oral and\/or insulin therapy<\/li>\n
                      • People with Type 2 Diabetes requesting a one to one appointment for education instead of X-pert structured patient education<\/li>\n<\/ul>\n

                        Diabetes Specialist Podiatrist<\/h3>\n
                          \n
                        • High risk feet (by telephone) – followed by SCIGW referral marked as urgent<\/li>\n<\/ul>\n

                          General Podiatry<\/h3>\n

                          (use existing referral routes and not diabetes eReferral protocol)<\/p>\n

                            \n
                          • Newly diagnosed Type 1 or Type 2 Diabetes for initial foot screening and foot care education<\/li>\n
                          • Moderate risk feet<\/li>\n<\/ul>\n

                            Multidisciplinary Foot Clinic<\/h3>\n
                              \n
                            • Tertiary referral via specialist diabetes podiatrist<\/li>\n<\/ul>\n

                              Retinal Screening<\/h3>\n
                                \n
                              • 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**<\/li>\n
                              • Via direct referral letter (if patient declines SCI DC Network inclusion)<\/li>\n<\/ul>\n

                                Self Management Structured Education Programmes throughout NHS Lanarkshire<\/h3>\n

                                Xpert (Type 2 Diabetes)<\/h4>\n
                                  \n
                                • Self referral by telephone<\/li>\n<\/ul>\n

                                  DAFNE (Type 1 Diabetes)<\/h4>\n
                                    \n
                                  • Via tertiary referral following assessment by Diabetes Specialist Team<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

                                    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 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12,11],"tags":[122,118,119,120,121],"class_list":["post-643","post","type-post","status-publish","format-standard","hentry","category-all-referrals","category-gp-referrals","tag-dafne","tag-diabetes","tag-diabetic","tag-foot","tag-retinal"],"_links":{"self":[{"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/posts\/643","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=643"}],"version-history":[{"count":1,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/posts\/643\/revisions"}],"predecessor-version":[{"id":644,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/posts\/643\/revisions\/644"}],"wp:attachment":[{"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=643"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=643"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=643"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}