Children’s diabetes services in the Western Isles

Theis is a consultant led service. A paediatrician with an interest in diabetes (Dr Farmer) visits Lewis at 3-monthly intervals to conduct multidisciplinary clinics which are attended by the the specialist nurse, the diabetes dietician, and (on most occasions) a podiatrist.

In the intervals between clinics, day-to-day advice is provided by the specialist nurse, with telephone support from the consultant where required. In certain circumstances, it is possible to initiate insulin treatment in the community.

Emergency support

Detailed literature providing instructions on dealing with hypoglycaemia, illness, and ketonuria, is issued to all families at diagnosis. The specialist nurse and consultant also provide their home telephone numbers.

There is a general paediatrician on call in Lewis, who can supervise in-patient care when necessary. Children who require high dependency care are transferred to mainland units.

Screening

Screening for chronic complications of diabetes, and for associated autoimmune disorders, is carried out in accordance with SIGN and N.I.C.E. guidelines.

Communication

Copies of clinic correspondence are routinely sent to the family. An updated summary of information from the clinic database is sent to the GP after each visit.

Interface with adult services

Young people are usually transferred to the adult clinic at between 15 and 17 years of age, depending on circumstances. Although there is no transitional clinic, there is continuity in that they remain under the care of the same specialist nurse and dietician, and continue to attend the Diabetes Centre.

Audit and research

All young people with diabetes diagnosed before their 15^th birthday are included in the national register maintained by the Scottish Study Group for the Care of Diabetes in the Young, and non-identifiable data has been contributed to the Diabaud project.