As part of Diabetes Awareness Week (12-18 June 2023) we spoke to advanced specialist diabetes and neuroendocrine dietitian, James Wimbury. James works in our Wolfson Diabetes and Endocrine Clinic (WDEC), he also has type 1 diabetes himself. Here James shares his CUH story.
What is your name and your role in our hospitals?
Hello, my name is James Wimbury, I’m an advanced specialist diabetes and neuroendocrine dietitian, as well as a DAFNE (Dose Adjustment For Normal Eating) and insulin pump educator in Clinic 32 in the Wolfson Diabetes and Endocrine Clinic (WDEC).
What do you enjoy most about your role?
As diabetes is a long term condition I tend to see patients regularly over a long period of time.
Having the opportunity to build a rapport with patients, getting to know them and see their progress over time is incredibly rewarding.
I’m also very fortunate to have an incredibly varied workload, which is split between inpatient and outpatient work across a number of sub-specialities and population groups (type 1 diabetes on both injections and insulin pumps, type 2 diabetes, type 3c diabetes, neuroendocrine tumours, diabetes and eating disorders). I also have the opportunity to be involved with teaching, service development and supporting the training of student dietitians and other members of the department.
Tell us a bit about your CUH journey.
I joined CUH as a Band 5 dietitian in February 2019, having previously completed one of my university placements here in 2018. I was a Band 5 dietitian until October 2020 when I became a Band 6 cardiology and diabetes specialist dietitian. I’ve now been in my current role as a Band 7 advanced diabetes and neuroendocrine dietitian since May 2022.
Why you like working at CUH?
CUH is a huge trust with so many incredible specialist areas.
As a result I see things here that I would be unlikely to experience elsewhere.
As CUH is also a large research centre the opportunity to be involved in research is a huge draw for me.
What does a usual day look like for you?
This varies depending on the day. Some days I may be helping cover part of our inpatient diabetes outreach team (DOT) – we usually have a combination of diabetes specialist nurses and diabetes specialist dietitians covering on any given day and will divide up the patient’s due for review equally. Usually for this we will attend face-to-face on the wards and review patient’s glycaemic management.
The way clinics are run at CUH differs to other hospitals, whereby specialist dietitians, such as myself, are trained in diabetes management. This means that I am able to advise patient’s on their glycaemic management and make appropriate recommendations to adjust insulin or oral medications accordingly. In many other hospitals diabetes management is only performed by specialist nurses and consultants. The way clinics are structured here means I can be involved in helping patients and further my career in a specialty which is important to me.
Other days I might be covering clinics in the morning and/or afternoon, such as our type 1 diabetes clinic, neuroendocrine dietitian clinic and young adult diabetes clinic, or alternatively starting patients on insulin pump therapy and continuous glucose monitors or teaching a DAFNE course, which stands for Dose Adjustment For Normal Eating. I also work with patients who are living with diabetes and eating disorders, a major area of interest for me, and I provide more intensive support to this group, as needed, as outpatients.
Tell us about a case study/experience at CUH that really stands out to you.
As part of my work to support individuals living with diabetes and eating disorders I recently developed a pathway to prompt healthcare professionals to screen patients for disordered eating behaviours within our clinic, patients can then be signpost to the correct service. Within a week of implementation, a patient was referred via this pathway, who, upon further discussion, I referred to the local adult eating disorder service. They now have a formal diagnosis of an eating disorder, for which they are receiving treatment, as well as input from myself to optimise their diabetes. This experience has highlighted to me that there are individuals who can fall through the gaps in this area, a particular concern given the risk of complications in this patient group, but with this pathway I was able to ensure that this patient is now receiving the appropriate care they need.
How do you feel your role benefits our patients?
As a diabetes educator I’m not here to tell patients exactly what to do in every situation, but rather to empower them and provide them with the skills to manage their diabetes themselves with the appropriate amount of support.
Given the number and range of patients that I see in my role I always aim to be as flexible as possible.
For example, some individuals may feel very confident with their diabetes management and not need as much input from our team and therefore a more hands-off approach may be suitable. Others may have more complex needs or situations that require a different approach, such as more regular contact outside scheduled clinics to optimise aspects of their diabetes management.
Has having Type 1 diabetes yourself influenced your career? And how does is impact you at work?
I saw dietitians when I was younger as part of my routine care in the diabetes clinic, so was exposed to the possibility of working in the field from a young age, and I had mapped out what I wanted my career as a diabetes dietitian to look like before I’d even started my GCSE’s.
Having diabetes myself has allowed me to see things from the other side of the table and added yet another reason to why I am passionate about improving care for those with diabetes.
I’ve used several different therapies and forms of technology to support my own management in the 19 years I’ve had diabetes, currently using an insulin pump with a sensor-augmented hybrid closed-loop system. The advances in technology and treatment options in diabetes have not only allowed me to see improvements in my own diabetes from a medical perspective, but have also reduced the impact this has around working in a busy clinic, experiencing fewer hypoglycaemic episodes in clinic being a big one!