Connecting to Children s Diabetes

Transcription

1 Children s Diabetes Nurses How do I contact my diabetes team? Michelle, Nicky, Julia, Birgit Monday - Friday, excluding Bank Holidays Office hours plus answerphone facility (Note same day response not guaranteed) Connecting to Children s Diabetes Fax: childrensdiabetes@tst.nhs.uk Consultant Paediatricians Dr Modgil Dr Vaidya Dr Robin via secretary Office hours Dietitians Clare or Isobel Mon - Fri or How do we manage consistently high HbA1C? Urgent Advice Evenings, weekends and Bank Holidays Tell staff your child has diabetes and ask for the on-call paediatric registrar Oak Ward Author: Michelle Gardiner, Lead Nurse, Children s Diabetes Team Taunton and Somerset NHS Foundation Trust May 2015

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3 My Notes: (Left blank for you to write your own notes and thoughts about your diabetes control, plus room for any questions you might want to ask your Team). This leaflet aims to give children and young people with Type 1 diabetes and their parents / guardians information about the purpose and process of managing consistently high HbA1C. Your Diabetes team want you to understand why it is important to make changes. We also want you to be fully aware of what we offer and the action we take to help and engage you and your child in improving and maintaining good blood glucose control. Why is a high HbA1C a problem? HbA1c above 75 mmol/mol indicates that there are problems with control, and the risk of future health complications is known to be much higher for these children. Very often, people will not feel particularly unwell or have symptoms if they have a high HbA1C but the higher the number, the higher the risk of complications. If you / your child have a high result, don t panic! Even a small improvement of 10-15mmols/mol can reduce the complication risks by around 30%. It s important if you can, to start making some small changes to bring down your level a bit at a time. What targets should we be aiming for? HbA1c (proper medical name glycated haemoglobin) is a measure of your blood glucose control over about 2-3 months (approximately 60 days). HbA1c between 42 and 48 mmol/mol is considered optimal control. To achieve this, day-to-day home monitored blood glucose levels mostly need to be 4 7 mmols/l before meals and 5 9mmols/L after meals.

4 What happens if your HbA1C is high? HbA1c is measured at each clinic attendance from 3 months after diagnosis, using point of care finger-prick testing or a laboratory test. HbA1c more than 75 mmol/mol on two consecutive clinic attendances / tests (ie for 6 months or longer) Yes My Blood Glucose Targets are.. My HbA1C Target is; Clinic appointment frequency will be increased to at least every 2 months. You will be given verbal and written information about + You will be offered contact with your Diabetes Specialist Nurse at least every 4 weeks (by phone, or face-toface) My Keyworker is... Investigating and target setting together, moving towards achieving and maintaining good blood glucose control (please see further details about this on the next pages ) If HbA1c remains more than 75mmol/mol after a further 6 months we will consider the following with you Ward admission for stabilisation. A troubleshooting period of continuous blood glucose monitoring. Arranging a multi-professionals meeting and / or referral for additional support from children s social care.

5 My HbA1C results: (Please record your results in the table below or ask your Diabetes Nurse or Doctor to complete this for you when you see them) Date HbA1C Result Date HbA1C Result No Any other test results you might want to record below? Date Test / Result WELL DONE! Continue with your routine 3 monthly clinic appointments. HbA1C now less than 75mmols/mol Keep aiming for the optimal HbA1c though! (42-48 mmol/mol)

6 It can be helpful to regularly consider all aspects of an individual case. Often, talking together as professionals can highlight different options or things to try based on research and / or experience with other families. What you tell us makes a big difference and can really help inform professional case discussions, so we value your honest and detailed contributions. We want to ensure you understand and agree to the plan / targets set. There may be other life events that are affecting diabetes management and blood glucose control. This is much more common than you might think. Sometimes it is obvious to you, but sometimes these things are more complex or deep-rooted / hidden. We will explore this by asking children to complete an emotional wellbeing questionnaire and talk with you about referral for additional help and support from our Team Psychologist, Child Mental Health Services or Social Care accordingly. The Diabetes Team will discuss your child s case and review their individual management plans at the monthly multiprofessional meetings Worries, stress or upset at home or school? A full dietary review will be offered. For those who are carbohydrate counting, we will check understanding and accuracy. If not yet carbohydrate counting, learning this may help give some flexibility and improve control. We do appreciate how challenging it can be for children and young people to feel restricted by diet and frustrated at feeling they are unable to eat like their peers or as they would like. Diet / Carbohydrate counting? What information and support do you need? What can the Diabetes Team offer to help improve blood glucose control? Hypoglycaemia? Clinic review appointments will be at least every 2 months and your Diabetes Nurse will be in contact at least every 4 weeks (by phone, or home / school visits). Your diabetes Nurse will check out your understanding of the key diabetes management principles and offer information and support for any areas identified as going less well or presenting you with some practical difficulties. We all work together with you on making treatment plans and setting targets. You will be given written plans, included in your clinic letters, and written information to support and guide you in improving blood glucose control. Please tell us if you think you need more of anything! Reminders of Team contact details and your keyworkers name are included in this leaflet. Insulin doses and injection regimen? Insulin Administration? Assessing the frequency, timing and severity of hypos is important. Giving too much hypo treatment is a common cause of high glucose levels. If people have bad experiences of hypos (particularly night hypos), have no symptoms (hypo unawareness) or are fearful of hypos it can affect how they manage the diabetes.. We will work with you to try to reduce fears and increase confidence. The goal is to improve control without increasing significant hypos. We will calculate your total daily dose of insulin and assess that against recommended averages to check if / where dose increases might help. We also use this information to re-assess whether the correction (insulin sensitivity factor) is about right. Teenagers generally need significantly higher insulin doses than younger children. We will also talk about whether a different injection regimen might improve glucose control (eg. more or fewer injections depending on why things are not going so well). We will check injection sites and encourage rotation as lumpy sites cause erratic insulin absorption. We will investigate timing of injections and make sure the shortest needles available are used.all of these things can affect blood glucose levels. We appreciate knowing if it is a struggle to give some of the prescribed injections or you forget we won t judge you, but it helps in planning realistic goals together, to have the best chance of successfully improving glucose control.