Information for patients

Diabetes

What is Diabetes?

Diabetes occurs when the pancreas fails to make insulin, unable to make enough, or the insulin produced does not work properly. It is a condition that causes blood glucose (sugar) levels to be too high. Glucose enters our blood stream as a result of us eating carbohydrate foods and carbohydrate containing drinks. Insulin is a hormone made in the pancreas that allows the glucose in our blood to enter our body cells to be used as a source of energy/fuel.

See this video:

Diabetes types

The three main types of diabetes are type 1, type 2 and gestational diabetes.

Other types of diabetes

There are also more rare forms of diabetes beyond type 1, type 2 and gestational diabetes. The rare forms of diabetes make up around 2% of all people with diabetes.

This includes cystic fibrosis related diabetes, monogenic diabetes, type 3c diabetes and diabetes caused by rare syndromes.

Patient Education Programs

Type 1 Diabetes Structured Education: DAFNE

Diabetes courses are encouraged for all with type 1 diabetes no matter how long you have had it. People who have completed structured education have more stable blood glucose levels and fewer diabetes related complications as well as seeing improvements in their mental wellbeing and overall quality of life.

Addenbrooke’s diabetes clinic offers the Dose Adjustment For Normal Eating (DAFNE) group structured education for type 1 diabetes (T1DM). DAFNE has been running at Addenbrooke's since 2002.

About the course

The course based around group work, sharing and comparing experiences with the group members. However, there are opportunities for each person to speak to DAFNE educators individually.

DAFNE allows people to fit diabetes into their lifestyle, rather than changing their lifestyle to fit in with their diabetes.

DAFNE has been proven to:

  • Improve general wellbeing
  • Improve treatment satisfaction
  • Improve dietary freedom
  • Reduce the frequency of hypoglycaemia
  • Improve overall glucose control (HbA1c)

Course format

The course is delivered in different formats:

  • Over 5 days (Monday to Friday within the same week)
  • Over 5 days (One day a week for 5 consecutive weeks)
  • Over 5 days specifically for insulin pump users

To a group of up to 8 people with T1DM, with a follow up 6-8 weeks after the course finishes. The course is delivered by a diabetes specialist nurse and diabetes specialist dietitian as well as input from a diabetes consultant.

Click here to read about how DAFNE can help you.

See this video on the DAFNE course

Course Location

Courses are held within the Diabetes Clinic at CUH. We may also hold courses in the community setting, such as in Ely.

Contact us:

01223 348781 DAFNE Administrator: allison.housden@addenbrookes.nhs.uk

Key personnel

  • Lead DAFNE Dietitian: Sarah Donald
  • Lead DAFNE Nurse: Caroline Byrne
  • DAFNE administrator: Allison Housden

Resources

DAFNE Online

Online community of DAFNE graduates, health care professionals, management and friends and family of those with type 1 diabetes. Here you’ll find online blood glucose diaries, app information, DAFNE online forums, carb portion list information and even access the latest version if the DAFNE course handbook.

Type 2 Structured Education: DESMOND

In Cambridgeshire, DESMOND is offered for people newly diagnosed with type 2 diabetes, or those with type 2 diabetes who wish to have further information on how to manage their diabetes.

DESMOND is also offered in: Bedfordshire, Great Yarmouth and Waveney, Hertfordshire, Luton, East Suffolk and North Essex.

If you live outside of the above areas, please enquire with your local GP surgery what type 2 diabetes structured education is available for you locally.

An overview of what is covered in DESMOND:

  • Thoughts and feelings of the participants around diabetes
  • Understanding diabetes and glucose: what happens in the body
  • Understanding the risk factors and complications associated with diabetes
  • Understanding more about monitoring and medication
  • How to take control – food choices – physical activity
  • Planning for the future

DESMOND group courses are run countywide and you can either be referred via your GP surgery or you are able to self refer using the form found here.

If you are admitted

a) Patient information leaflet

b) Managing Diabetes in hospital

If you are too unwell or unable to self-manage:

- Nursing staff are trained to support diabetes management including blood glucose testing and the administration of medication and will do this by default unless patients express a wish or recover sufficiently to self-manage.

When you are well enough and able to self-manage:

- If you wish to continue to self-administer diabetes related medication, the ward nurses will document that it is appropriate and safe to do so by completing a self-administration of medication assessment (SAM).

Ideally, you are encouraged to

  • Keep a record of and report to the nurses – all food intake, self-monitored blood glucose results, diabetes medications and insulin doses administered.
  • Keep medications safely locked away in the bedside medication locker when not required.
  • Use own insulin needles (if on insulin) as the hospital safety needles are not appropriate for patient use. A small number of pen needles can be provided if required but please arrange for a supply from home to be brought in as soon as possible.
  • Have blood glucose tested on the hospital meter at least four times a day (occasionally we may request additional tests).

c) Handy tips for patients

If on insulin:

  • Mealtime insulin should be given before meals and the meal should contain carbohydrate (e.g. bread, cereals, rice, pasta, potatoes)
  • If the meal has arrived and insulin has not been given, please inform the nurse.
  • Never miss the basal/background/long acting insulin unless specifically advised by the doctors.
  • If the blood glucose level before bed is less than 8 mmol/L, consider having a small bedtime snack containing carbohydrate such as two digestive biscuits or one slice of toast.
  • A carbohydrate counting guide for hospital meals is available upon request.

If on tablets:

  • Metformin should be taken with/after meals
  • All other diabetes tablets should be taken before food

If not eating, discuss with the nursing staff before taking any medication.

d) How to contact us during admission

If you have any concerns about your diabetes management in relation to your hospital admission, you can request a DOT review during the admission by asking the nurses or the medical team to contact us.

e) On discharge

It is advisable to make contact with your usual diabetes healthcare professional, such as the GP or community diabetes specialist nurse, soon after discharge especially if any changes have been made to the diabetes management in hospital.

  • The blood glucose control may be more variable
  • On-going adjustments may be needed to further optimise control in the home setting
  • Adjustments may be needed in response to on-going changes in the doses of other medications
  • Changes made in hospital to cope with illness will need review/modification as you return to health

Your usual diabetes healthcare provider can support you with all these. More specific advice, if needed, will be given by a DOT member before discharge.

If we feel that you will benefit from further support following discharge we will offer you telephone follow up (up to 2 calls) and ensure your community diabetes specialist nurse/GP is aware of changes made during admission or to alert to any on-going review needs.