The Diabetes Outreach Team (DOT) Booklet

You are receiving this leaflet because it was noted that you are a person with diabetes. Although diabetes may not be the primary reason for your admission, being unwell can have an impact on your blood glucose levels.

Who are the Diabetes Outreach Team (DOT)?

DOT is a team of specialist nurses, dietitians, doctors and an educator who provide a diabetes advisory service for persons with diabetes who are admitted to hospital. We assess, and if needed, make recommendations to support you and the doctors and nurses looking after you to manage your blood glucose levels in hospital.

Who looks after my diabetes in hospital?

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

If you are an insulin pump user, you can continue to use this only if you are well enough to undertake full pump management by yourself. The nurses and doctors on the ward are not diabetes specialists and will be unfamiliar with the use of insulin pumps.

If you are self-managing your diabetes you will be requested to:

• Keep a record of and report to the nurses – all food intake, diabetic medications and insulin doses administered.
• Report to the nurses any blood glucose test results you complete yourself.
• Keep your diabetic medications safely locked away in the bedside medication locker when not required.
• Use your own insulin needles (if you use 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 your blood glucose tested on the hospital finger prick meter at least four times a day as follows:
  • If you are eating - before meals and before bed.
  • If you are not eating every four to six hours.
  • Occasionally we may request an additional 03:00 blood glucose check. If this has not taken place, please ask the nurses to do so.

If you use glucose sensor:

• Inform nursing staff if you are wearing a sensor.
• Your sensor readings can be used instead of finger prick readings
• Nursing staff will double check blood glucose levels with the hospital finger prick meter at least once a day to confirm accuracy and in certain cases more often, for example, if you are experiencing a hypo.
• In some situations, sensor readings are not used such as if you are on an insulin drip, if your condition is unstable or if you are very unwell. Nurses will use the hospital finger prick meters in these situations.
• Sensors will be removed when going for certain scans such as MRI.
• Sensors are not routinely provided to inpatients by the diabetes team so please arrange for replacements and charging devices to be brought in from home.

What if I am too unwell to look after my diabetes?

If you are unwell, nursing staff are trained to support your diabetes management including blood glucose testing and the administration of your medication until you are ready to undertake this yourself.

If you are an insulin pump user and at any point feel unable to continue managing your pump, you should inform the team looking after you immediately so you can be safely transitioned temporarily from pump to alternative insulin delivery methods such as injections or insulin drips. You can resume using your pump when you feel safe to do so again. The diabetes outreach team will usually be involved in supporting you and your ward team in these decisions.

Do you have any tips for me that are relevant in hospital?

If you are Type 1 or Type 3C Diabetes

• Your long acting/basal/background insulin should continue even when you are on intravenous insulin infusion (insulin drip).
• Please continue to take this or request nurses to administer if you are not doing so yourself

Other insulin related tips

• Mealtime insulin should be given before meals and your meal should contain carbohydrate, e.g. bread, pasta, potatoes/mash, rice, fruit.
• If your meal has arrived and you have not yet had your insulin, please inform the nurse looking after you.
• If your oral intake in hospital is less than compared to home, you may need less insulin than usual – discuss reducing your dose with your ward team.
• If your blood glucose level before bed is less than 8 mmol/L you should consider having a small bedtime snack containing carbohydrate such as two digestive biscuits or one slice of toast. The ward can provide you with this.
• A carb counting guide for hospital meals is available upon request.

If you are on tablets

• Metformin should be taken with/after meals
• All other diabetes tablets should be taken before food
• If you are not eating inform the nursing staff caring for you before taking any medication.

If you are scheduled for surgery

• Depending on the length of your surgery and your blood glucose levels, an insulin drip may be commenced to control your diabetes around surgery.
• Nurses will monitor your blood glucose levels at least every 1-2 hours
• Your basal/long acting/background insulin will be continued during this time if you are Type 1 or Type 3C diabetes.
• Once your surgery is complete and you are able to eat and drink full meals containing carbohydrates, you will be stepped down to your usual management unless otherwise advised by the diabetes team.

What if I need advice relating to my diabetes?

You can request a DOT review during your admission by asking the nurses or medical team to contact us. Our core working hours are Monday-Friday 08:00 to 18:00 and on Saturdays from 08:00 to 16:00. There is also out-of-hours provision for urgent diabetes related advice if needed.

Do I need to do anything after my discharge with respect to my diabetes?

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

Following discharge:

• Your blood glucose control may be more variable
• Ongoing adjustments may be needed to further optimise control
• Adjustments may be needed in response to ongoing changes in the doses of other medications you take
• Changes made in hospital to cope with illness will need review/modification as you return to health.
• We may provide 1-2 follow up phone calls with your consent if we think you need support after going home.

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

Questions and notes

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .