Who will I see?
When you arrive in clinic you will be asked if you are happy to have your weight, height and blood pressure taken by one of the clinic nurses or health care assistants. Blood tests would normally be taken after you have seen the doctor, but sometimes we may have asked the clinic nurse to do this before you are seen. If you are on diabetes medication you will be sent information, prior to your appointment, regarding when to take it if you need to fast for your blood tests.
Doctor
After you have been seen by the clinic nurses, you will be seen by the doctor. They will ask you about your medical history and will carry out an examination to help in the diagnosis and planned care / treatment.
It is helpful if you can bring a list of all your current medications with you. If you have diabetes, or monitor your blood glucose levels at home, it is also useful for you to bring a glucose diary with at least a week or more of your blood glucose levels recorded.
Often the doctor will ask other members of the team such as the diabetes specialist nurse or dietitian to join them during your clinic visit. This means that all the healthcare professionals who will be involved in your care can hear your history at the same time, and avoids the need for you to repeat the same information if you need to see another member of the team afterwards. You will be asked if you are happy to have everyone in the room before the appointment starts. Please feel free to say no if you do not feel comfortable with so many people in the room, we are more than happy to accommodate this.
Diabetes Specialist Nurse (DSN)
If you have diabetes, or it is thought you may have diabetes, you may be asked to see the DSN individually after your appointment with the consultant. During this session the DSN will ask you about your current diabetes management and will review any blood glucose levels that you have brought with you. If your diabetes is treated with insulin they may suggest some adjustments to your insulin doses. If the consultant has suggested starting a new treatment, then further explanation or training for this may be given by the DSN.
Injection technique
In order to ensure that blood glucose levels outside of the target range are not caused by injection technique the DSN may suggest observing how you give your insulin. This would need to take place after you’ve had your bloods taken (which you will have fasted for if it is required) and just before you eat. There is a small coffee shop outside the clinic where you can purchase a very limited selection of snacks or you may prefer to bring some food with you as there are tables and chairs to use around the coffee shop for people with their own food.
We may also ask if you are happy for us to examine your injection sites to check that you do not have any ‘lumpy’ areas, caused by overuse of that particular area with your insulin. These areas may affect the absorption of insulin, resulting in some high readings and occasional hypos of unknown origin.
Blood glucose testing
It is really important for us to gather information about your diabetes control. The HbA1c blood test (the diabetes test usually done once a year at your annual review) gives us an idea of how much glucose has been attached to your red blood cells over the 3 months prior to the test. However, your blood glucose test results give us a better idea of how things have been on a day to day basis during the weeks leading up to your clinic appointment. The daily testing also helps us to determine which doses need adjusting. If you have been testing your blood glucose levels, please bring them with you to clinic. Ideally, document them in a blood glucose diary, or write the last 1-2 weeks of readings on paper so that we don’t spend your valuable clinic time trying to find the readings from the memory on your meter. We may also be able to download your meter in clinic.
If you do not have a blood glucose meter, we may provide one when you attend clinic and can review your readings ongoing by phone / email.
If you are using a blood glucose sensor we may provide a clinic code for you to link up to so we can review the data.
Blood glucose targets
The target blood glucose level is between 4-7mmol/l. However, we would suggest a target blood glucose range on an individual basis following discussion with you.
Dietitian
We aim to always have a Dietitian available in clinic so everyone has the opportunity to see one if they want to at both first and follow up appointments.
As dietary changes are so important in many of the conditions we see in the SIRS clinic (and are often the primary treatment for the conditions) we would encourage you to see the Dietitian.
The Dietitian can talk through the benefits of dietary changes if required or to help you confirm that you have made the right changes.
During your appointment the Dietitian may ask if you are happy to have your waist and hips measured. This helps us to monitor your body fat distribution.
The Dietitian may also ask you to complete a food diary when you come to clinic. If you would like to bring one with you to clinic to discuss at your appointment please do.
If you have any recipes or tips you would like us to add to our diet sheets, to support other patients, please do let us know. We are always keen for new ideas.
Research Nurse / Doctor
We have many research doctors who work within the SIRS team.
You may meet one of these if you have expressed an interest in research, or are taking part in research. If you are interested in research, please do let any of the SIR team know and we can then ask the research team to get in contact with you if anything suitable is available.
What should I bring?
Information about visiting Addenbrooke's hospital can be found on our website.
Preparing for clinic
If you have been asked to fast for your appointment, please see the information below.
It is particularly important to drink plenty of water. This can help if blood needs to be taken.
- Fasting for clinic and insulin
In order to get accurate results from the blood tests we do, it is important that you fast from 10pm the night before your appointment. However, the fasting does not apply to water so we would encourage you to drink plenty of water in order to keep hydrated. Dehydration can make taking blood difficult.
For those who take insulin we would give the following advice:-
- Mixed insulins e.g. Novomix 30 / Humalog mixes / Humulin M3 – take as usual the day before clinic. DO NOT TAKE the morning of clinic as you will not be eating. Bring your insulin with you so you can have it with food after you’ve had your bloods taken.
- Long acting / background insulin only e.g. Lantus (glargine) / levemir (detemir) / insulatard / humulin I – take as usual. These types of insulins can be given without food as they work “in the background” and should not cause hypos if meals are missed or delayed. However, if you have been having low glucose levels / hypos, please contact us (on the number below) to discuss a dose reduction ahead of your appointment.
- Meal time insulin and background insulin (basal bolus regimen) e.g. Novorapid / Humalog / apidra – DO NOT TAKE the meal time insulin as you are not eating. Bring your insulin with you so you can have it with food after you’ve had your bloods taken. You can take your background (long acting) insulin as usual.
If you are uncertain or have any concerns and would like to discuss this further please contact a member of the team.
- You may find it useful to write a list of questions you want to ask, and bring this with you as it can be easy to forget things when you get into the consultation
Please be aware that you are very welcome to bring someone with you to clinic.
Additional information
You can find further information on parking, transport and accommodation on our website.
The SIRs clinic is based in the Wolfson Centre (Clinic 32) in the Addenbrookes Treatment Centre (ATC)
If you want to park on site we recommend car park 2 as this is the closest to the clinic. This is a short walk from the clinic. There is a shuttle bus that runs from the car park to the ATC.
What will happen after my clinic appointment?
After every clinic we have a multidisciplinary team meeting to discuss patient management if required. Once any investigations such as blood tests and scans are available, a letter and plan (from the doctor) will go to the GP with a copy to the referring clinician and the patient. This is often referred to as your clinic letter.
A follow up appointment is either agreed at your appointment or after investigations have been completed. If you are going to be discharged from care this will be in your letter.
The DSN and dietitians may also follow up with you via email and telephone if you are happy for this contact.
If you have questions or concerns regarding your appointment or clinic letter please do contact the team to discuss. Email and phone number is shown below.
Email us (General enquiries)
Telephone: 01223 348123
You are also able to contact us via MyChart. This is an electronic patient portal at Addenbrooke’s Hospital for patients to securely access parts of their health record held within the hospitals’ EPIC electronic patient record system.