DISN Shared Advice

DKA admission interventions
Q – We are looking for interventions for those who present a frequent basis to hospital with DKA. Often young, what strategies do you have for continued engagement/ psychological support or brief interventions?  Royal Bolton Hospital
  • We always see them whilst they are in hospital – Offer: Libre, Psychologist Appt, Inpatient DSN’s telephone support call post discharge, Community DSN service invite back for further education within one month as a group session or 1:1 offered. West Suffolk Hospital
  • Useful research slides by Dr Chris Garrett, PhD MRCP MRCPsych  DKA, mental health and future mortality. DKA, mental health and future mortality. Diabetes UK

Business Case Template
Q- Does anyone have a business case template to recruit DISN?

HHS Management Labels
Q – We are currently looking to develop a HHS management label. I wondered what you are currently using for managing HHS in your Trust? Do you have a sticky label or separate area on the drug chart? Kent & Canterbury Hospital 
  • We use an individual pathway for patients in HHS.  North Devon Hospital
  • We have been using stickers for our drug chart for DKA successfully for a couple of years, and have recently adapted them for both HHS & DKA, but are still pending approval-feel free to consider the attached. They are stuck in the VRIII section of drug chart where “alternative regimes” can be written. The size of the sticker will need to fit the space on the chart-our space isn’t quite right for standard stickers, so they needed to be cut to size. So bare this in mind when designing charts/sticker sizes! DKA& HHS_FRIII_Draft_sticker-  Maidstone Hospital
  • We have a protocol which has an insulin prescription included within alongside its own BG monitoring chart.  There is no fluid management prescription included within the protocol.  Fluids have to be prescribed on the normal drug chart but advice re such is included in the protocol.  North Devon District Hospital
  • I am afraid we do not have a separate prescription chart for HHS. We do have prescription charts for insulin prescription, VRIII and DKA ( attached so you can read). It is a rare occurrence for HHS so we use the JBDS guidelines, as patients need fluids replacements  and insulin, which can be subcut 1.Insulin px Clean 2. VRIII clean 3. DKA clean    Royal Devon & Exeter Hospital

should we be advising patients on an SGLT2 to stop 3 days prior to surgery and recommence when recovered? The Christie Hospital
Should we be advising patients on an SGLT2 to stop 3 days prior to surgery and recommence when recovered? The Christie Hospital
Libre Advice
Q – How many patients have currently been put on Libre?
Q – Do you know how many  Type 1 patients are in your area and what has been the percentage uptake of these patients?
Q – How have you selected your patients? E.g. self-funding patients first?
Q – How many staff involved/hours taken/admin time to do this project?
Q – How are the reviews going? Are the reviews 6 monthly and is a consultant present for them?
Q – Do patients bring their Libre certificate to clinic before being put onto a Libre list?


  • we are following the NICE criteria
           we have put about 150 patients on so far
          the self-funders we just sent out the contracts and libreview requests  to sign upto data sharing and most of them were known to us so will be  reviewed within 6 months
 he new to us /libre patients we did in “group stats” 6-8 at a time
we are doing an event next week with 30 !!
 the time is taken with the paperwork
we have to complete an audit form Bluteq request do a GP letter
create electronic care plan for us
log it all on our appointments system so it takes about 45 mins per patient ( 20-30 to show them the system then the rest to log everything
 we have a formal telephone review within 2 months although most pts in essence have already been in touch or we have contacted them
 then there is a physical review at 5 months before the 6 month deadline to ensure they are maintaining  the criteria ( we only started in May so we haven’t done this yet )  


  •  We have put about 530 people on the libre our Type 1 population in the area is approx 1500  but we have had people referred in from other areas. 
We have developed a structured education course our patients undertake to meet the original RMOC criteria so all folks on a libre have also undertaken structured education. 
We didn’t think it fair to do self funding first as you are setting up a bias against those who couldn’t afford to self fund so we did a bit of a first come first served basis once we put the word out to as many as .
In terms of staffing there has been an incredible amount of additional admin generated by the education and keeping track of who has been offered, arranging  contracts ensuring the ABCD audit and follow up at 6 months. Difficult to put in terms the hours but I did at one point have 18 hours a week dedicated to the education/libre process although part of that was developing the education.
The process is becoming simpler moving forward as we will no longer be giving prescription and a strict 6 month follow up is less of an issue as GP take over prescribing  the follow up will tend to happen within routine clinic appointments.
Reviews are generally well attended and any of the Drs can review and make the decision based on the Libe results and the initial contract aims.
We ask the people attending the structured education to present their online training certificates on the day


  •  Initially given to self-funders, now offered to all type 1’s
 We have the Abbott rep coming in at least once a month to provide training for usually 10 patients, some months we have two sessions depending on rep availability.
 We follow the ‘All wales’ prescribing criteria, so as long as the patient fulfils at least part of the criteria they are offered the Libre.  Even if they are inpatients at the time, the inpatient nurses will provide the education that goes along with it and fit it in the ward.  We will then try and bring them back to a nurse led clinic appointment 2 weeks later for initial review.
 Reviews at present are incorporated into the patients normal clinic visits,