Local diabetes guidance / Referral pathways
Remedy Diabetes guidance
https://remedy.bnssg.icb.nhs.uk/adults/diabetes/diabetes-mellitus-guidelines/
New diagnosis
To access a rapid assessment for patients with new onset Type 1 Diabetes Mellitus who do not require admission then please see the Rapid Access Clinic page.
Consider Diabetic ketoacidosis in patients with new onset diabetes and admit immediately to hospital if suspected.
Hyperglycaemia in T1DM
NICE CKS has guidance on the management of T1DM in intercurrent illness including information on sick day rules
NICE also has guidance on when to suspect hyperglycaemic emergencies such as Diabetic Ketoacidosis (DKA).
This Trend UK Patient leaflet gives patients with T1DM helpful advice on what to do when they are ill including adjusting their insulin.
Hyperglycaemia in T2DM
NICE CKS has guidance on the management of T2DM in intercurrent illness including information on sick day rules
TREND UK patient information leaflet has advice for patients with T2DM on what to do when they are ill or hyperglycaemic including adjusting or adding doses of short acting insulin.
NICE also has clear guidance on when to suspect hyperglycaemic emergencies such as Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic state (HHS). This includes information on ketone testing.
Those on SLGT2 inhibitors are at increased risk of DKA , even with normal glucose levels and DKA should be considered in all people with T2DM, even with normal glucose levels.
Hypoglycaemia management
Hypoglycaemia is generally defined as a capillary blood glucose of less than 3.5mmol/L
NICE CKS has guidance on the management of hypoglycaemia
Trend UK have a helpful patient information leaflet on hypoglycaemia.
Diabetic foot problems
Patients with diabetes and a new foot problem should have a same day appointment in primary care.
Those who are systemically unwell, with spreading cellulitis, evidence of necrotising infection, any suspected foot abscess or severe pain should be referred to the on call Vascular team at Southmead - see remedy flowchart here
All patients with diabetes who have a non life or limb threatening active foot problem should be referred within 1 working day to community podiatry. This includes Charcot's arthropathy.
Details on how to do so can be found on the Remedy Diabetes page here
NICE CKS has further information on diabetic foot infections, including guidance on severity
Suspected new diabetes in children
Please be mindful that if any child presents with polyuria/polydipsia/weight loss/recurrent thrush/boils they may have either type of diabetes. Advice for clinicians is to try to dip urine and do a CBG. If diabetes is confirmed or even suspected, same day referral is URGENT - send to BCH ED.
Remedy Guidance for referral of children with suspected diabetes
remedy.bnssg.icb.nhs.uk/children-young-people/diabetes/diabetes-mellitus/
Useful diabetic resources for clinicians
Diabetic Devices/ Medication/ Insulin Profile List
Information on diabetic medications & devices available in the UK can be found here. This includes information on insulin profiles.
Diabetes in Older Adults/ Frailty/ EOL
Diabetes in Frailty guidance - a resource with suggested changes to treatment in frailty
Trend UK/ Diabetes UK Guidance for HCP managing diabetes at the end of life can be found here
Patient Information Resource list
Trend UK has several patient information leaflets on how to manage diabetes that can be found here