Consultant led clinics
Secondary diabetes is diabetes that results as a consequence of another medical condition rather than the more commonly seen type 2 or type 1 diabetes. How secondary diabetes is managed can vary quite significantly depending on which condition has caused it (e.g. pancreatitis where there may be some residual pancreatic function versus pancreatectomy where there is no pancreatic function). Unlike other types of diabetes, reduced production of digestive enzymes from the pancreas needed to break down food may be present, alongside insulin insufficiency.
Usually patients are diagnosed under the care of consultants who work in speciality areas other than diabetes (e.g. oncology, gastroenterology or acute admissions), and then patients are usually followed up in an outpatient diabetes clinic for management post diagnosis.
Secondary Diabetes clinics run once a month with a doctor and specialist dietitian or diabetes nurse specialist.
Patients can expect discussions around diet and lifestyle, blood glucose control and gut function in clinic. We will review weight, blood pressure, blood tests and advise you on medications required. We always ensure that you are getting your annual diabetes foot and eye checks in clinic.
If you are having trouble with diet, lifestyle or blood glucose levels, the specialist dietitian may offer you the opportunity to be seen in a separate one to one session to provide further support. Should you need support from diabetes specialist nurses, our clinical psychologist or community services we can provide onward referral.
Patients can expect 6 monthly reviews or more if needed, and will have access to contact the diabetes team should they need to for management advice.
Many patients with diabetes are diagnosed by their general practitioners (GP). If they are thought to have type 2 diabetes they may be monitored and managed initially by the GP surgery. Patients who are newly diagnosed with type 2 diabetes are offered community diabetes education.
Sometimes patients who have been diagnosed with type 2 diabetes may need to be referred up to see the diabetes specialist team at the hospital. This typically occurs when patients have got poor control, have developed complications related to their diabetes, have a particular job that may be affected by their diabetes treatment or need to have treatment/advice or technology that the GP does not have access to.
If you have been referred up to see us you will typically be seen in one of our general diabetes clinics and will have access to the whole diabetes team. We may recommend additional treatments or monitoring of your diabetes. We may need to liaise with you via telephone, email or in person to monitor how successful treatment has been.
After you have been seen at the diabetes team you may be asked to continue your follow up here or at your GP surgery depending on what is most appropriate.
Type 1 diabetes is a complex condition which can affect almost all daily activities. Consequently people with diabetes require knowledge and skills to enable them to understand how lifestyle affects their diabetes and vice versa. With knowledge people with diabetes will feel more able to manipulate their treatment to enable them to lead the lifestyle of their choice.
When newly diagnosed with diabetes it can be an anxious time and we aim to provide close monitoring during this period. You will expect to be seen and possibly telephoned regularly by the diabetes nurses, dietitians (link), and diabetes doctors (link). You may even be referred to see our diabetic clinical psychologist (link) for help.
In the first month of treatment we will give you important information leaflets about type 1 diabetes to assist you in your ongoing management of type 1 diabetes.
We also will advise you attend our living with diabetes course to assist you learning to live with a new diagnosis of diabetes.
After you have established diabetes you will be seen on a regular basis by our diabetes team in outpatients to check how you are getting on with your insulin treatment and to monitor you for any evolving diabetes complications. We can also liaise with you about your care via email or telephone if needed.
For people who have had type 1 diabetes for a number of months we will refer you for our BERTIE course.
For some people with diabetes achieving optimal diabetes control can be difficult and we have technologies that can sometimes help for example continuous glucose sensors and insulin pump therapy.
We are a leading centre in insulin pump therapy. We have 14 years experience and we serve one of the largest groups of patients in the UK on pump therapy. We have a number of consultants, nurses and dietitians who are highly trained in insulin pump therapy.
Insulin pumps are usually offered to patients with type 1 diabetes who are having difficulties managing their diabetes effectively by multiple daily injections. Its aim is to mimic the action of the pancreas more closely than multiple injections can and thus give more flexibility to the user. Pumps use fast acting insulin which is constantly delivered over a 24 hour period. Extra doses of insulin can be given as needed.
Pump therapy can be extremely useful for some patients with diabetes. Common reasons for needing a pump are: problems with regular hypoglycaemia (low blood sugar), difficulties in achieving optimal blood sugars on injection therapy, problematic injection sites and being very insulin sensitive.
Before being referred for a pump, patients with diabetes are referred to the BERTIE course to ensure good knowledge of their diabetes and also to train patients how to carbohydrate count and also how to adjust insulin for exercise, illness etc.
Before patients can start on a pump therapy funding is needed from your local CCG. A written referral is needed from your GP or hospital consultant.
Once you and the hospital team are confident that you may benefit from insulin pump therapy and the above education has been completed we will then list you for our pump start course.
Once you are on a pump you will need close monitoring to ensure that you get benefit from your pump. We will intermittently require you to have periods of intense blood sugar monitoring whilst on a pump to adjust your insulin. We sometimes also use continuous blood glucose sensors to help us manage your diabetes.
Ongoing contact with the pump team will take place via clinic visits, email and telephone.
If you think an insulin pump may be of benefit to you please contact us.
Details about the pump start programme are available here.
For more information about your pump and diabetes in general please look at our useful websites area.
We provide a diabetes rapid access clinic for people with diabetes to access at times of crisis. The crisis could be for any reason, for example a new diagnosis of type 1 diabetes, high blood glucose levels due to steroid treatment or chemotherapy or problems with diabetes as a result of mental ill health or substance misuse. The clinic runs each Wednesday and is run by Dr Hermione Price and a diabetes nurse specialist. We aim to see every person referred within two weeks of receiving the referral. Each year the clinic sees approximately 60 patients.
The Diabetic Foot Service is a partnership between Dorset HealthCare University NHS Foundation Trust, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust. We run daily Diabetic Foot Clinics in the hospitals and daily community based Diabetic Foot Protection clinics at various clinics throughout the Bournemouth and Poole areas.
The service is lead by non-medical Consultant Podiatrist Debbie Sharman who works closely with local Diabetes Consultant Physicians and their Specialist Diabetes Teams who together continue to be dedicated to improving diabetic foot health for the local community.
Diabetes can affect the small nerves that supply the feet (neuropathy). This for some people can cause numbness, but for others can cause a debilitating painful foot condition which can also affect mobility. We run a specialist neuropathy clinic to help those patients suffering from this condition.
The Hypoglycaemia Clinic reviews patients experiencing recurrent severe hypoglycaemia episodes requiring assistance for management. The clinic mainly sees patients with type 1 diabetes, and reviews the need for education, pump therapy, continuous glucose monitoring and possible pancreatic transplantation as interventions for reducing the frequency of severe hypoglycaemia events.
The Sensor Clinic reviews patients who are regularly using continuous glucose monitoring for management of their diabetes. Patients with type 1 diabetes can also be referred to wear a continuous glucose monitor for one week for diagnostic purposes, to see if they are experiencing hypoglycaemia and/or hyperglycaemia that may be amenable to clinical interventions that improve glycaemic control.
We now offer a specialist clinic once a month on a Friday for people with diabetes and some degree of renal (kidney) impairment. This can vary from the kidneys leaking a bit of protein to those who are on dialysis or who have had a kidney and/or pancreas transplant. We work closely with our nephrology colleagues and people often attend both clinics but we try and keep the number of visits down to save on trips to hospital.
We also have a nurse led renal clinic for people with diabetes led by Steve Trowbridge and he can follow up those who have been into hospital with kidney problems or whose diabetes control needs a bit of support. Steve also visits our dialysis unit regularly to try and help with the number of clinic visits so anyone who has dialysis at Bournemouth Hospital can have all their diabetes checks done whilst on dialysis.
Patients who have diabetes are screened annually to check for diabetes complications. Retinal screening can be done at the hospital or in local opticians.
If problems are found in the eye we have a retinal clinic to help manage these problems. This is staffed jointly by the diabetic team and ophthamologists (eye specialists). During these clinics we will advise on the most up to date treatments for your eye disease as well as helping you obtain optimal diabetes and blood pressure control.
If you have diabetes and are thinking of becoming pregnant or are pregnant then read on for more information on our pre-conception and antenatal services.
I want to try for a baby and I have diabetes
If you are thinking about having a baby and are known to have diabetes we offer a pre-conception service here at the hospital. We have a team who specialise in helping with women who want to get pregnant and make sure that their diabetes control is as good as possible to minimise the risks to mum and baby.
We counsel women about the differences in antenatal care for women with diabetes and explain how women with diabetes can get the best outcomes. We also can guide women in which are the best medicines to be on and not to be on if you are planning pregnancy. We explain what screening needs to be done before falling pregnant.
Our antenatal service here at the Royal Bournemouth Hospital is closely linked with Poole General Hospital. At Bournemouth Hospital we run a weekly joint diabetic antenatal clinic every Friday morning where women can have ultrasound scans, see the diabetes team and the antenatal team all in one visit.
We also have a midwife who specialises in the care of women with diabetes who supports the clinic and also will be in contact in the community. Within the clinic the diabetes team consists of diabetes dieticians, diabetes nurses and diabetes doctors, all of whom have a specialist interest in pregnancy and diabetes. We also keep in contact via email and telephone in between clinic visits if needed and ad hoc visits can also be arranged.
For women who have been diagnosed with gestational diabetes you will also be seen in the above clinic and will have close liaison with our diabetes dieticians.
Women with diabetes deliver their babies at Poole Hospital where there is a complete maternity and paediatric centre. You may wish to contact Poole Hospital for tours of the unit. Some women who have delivered their baby and are okay and low risk may be able to transfer to Bournemouth Hospital maternity unit if a longer stay is needed.
There are a number of excellent links we would recommend you read regarding the management of both pre-existing diabetes and gestational diabetes.
