Diabetes

 

Exeter Children and Young People’s Diabetes Service

The Exeter Children and Young People’s Diabetes Service provides care for children aged up to 19 years old with all types of diabetes.

The most common type of diabetes in children is type 1 diabetes. This is a lifelong condition where the body's immune system attacks and destroys the cells that produce insulin. This causes blood glucose (sugar) levels to become too high. The treatment for type 1 diabetes is regular glucose monitoring, healthy diet and insulin therapy in the form of injections or a continuous insulin infusion (CSII) via a pump.

Other types of diabetes we see include:

  • Type 2 diabetes - where the body does not produce enough insulin, or the body's cells do not react to insulin produced.
  • Cystic fibrosis with diabetes. 
  • Monogenic diabetes - a term used to describe genetic forms of diabetes, such as maturity onset diabetes of the young, neonatal diabetes and other rare forms.

More on what we do

As well as insulin treatment, we support and educate all our patients and their families to help them manage their long-term condition.

Our team provides wraparound care, with telephone access to a paediatric specialist 24-hours a day. Advice and education to families is provided in the hospital at diagnosis, at home and via telephone, text, email and video consultations. The young person with diabetes is always at the centre of our team.

Paediatric Diabetes Specialist Nursing team

The Paediatric Diabetes Specialist Nursing team teach the practicalities of managing diabetes day-to-day. Each child and family is different and the team use a range of technology to support our young patient's individual diabetes management. We follow national and local guidelines and criteria when starting treatment options.

The whole team take part in reviewing treatment plans regularly with the family. Often, changes are needed as young people grow and develop. Families are encouraged to use technology to support their diabetes management. Information can then be downloaded into shared computer systems for review and analysis.

Paediatric Dietitian

The paediatric dietitian on the team educates families with healthy foods choices, growth and development, carbohydrate counting and effects of other nutrients on glucose levels. Group sessions are offered yearly to each child with Cook and Eat sessions being very popular.

Diabetes Psychologist

Our diabetes psychologist is a vital member of our team, helping families with thoughts and feelings about living with a long term condition, as well as offering support for managing difficult procedures and treatments. Our psychologist also supports the team with education and training such as our popular 'Tree of Life' session for children in Year 6 who are preparing to go to to secondary school.

Wider support

We provide training, education, individual healthcare plans and telephone support to the wider team supporting the child and family. This can include extended family, all nursery, school or college settings, youth workers, voluntary and social care sector. The dietitian will support with carbohydrate counting menus for young people in these establishments.

Transition to adult care

We also help young people with diabetes as they move on through to adult care. This transition process starts when they are 12 years old.  We support young people with education though to independence with their diabetes care. We use the Ready, Steady Go (Southampton) model to frame our discussions with families. Young people do well when parents and carers remain involved in their care throughout their transition to adulthood. Find out more here

Continual improvement

The team actively participate in national diabetes audits of care, quality assurance initiatives, patient experience surveys, research and attend regular education meetings with the local paediatric diabetes network and at a national level. We all participate in education of other non-specialist health care professionals who may encounter young people with type 1 diabetes in their care. The team members are actively involved in national steering committees including Association of British Children’s Diabetes Clinicians (ACDC), National Paediatric Diabetes Network and the British Dietetic Association Diabetes Specialist Group (Paediatric Sub-Group).

Treatments

Our aim is for all young people in our care to have glucose levels within optimal range to keep them in good health for their future lives. This requires a significant amount of time and effort for all our young people and their carers.

More than 99 per pent of our young people with type 1 diabetes use multiple daily injections of insulin (MDI) or continuous subcutaneous insulin infusion (CSII; insulin pump).

Most of our young children and their carers’ do a carbohydrate count as part of their treatment plan. 

A number of young people use continuous glucose monitoring systems (CGMS), continuously using a Sensor-Augmented Pump Therapy (SAPT) using insulin pumps. Several others use CGMS intermittently. Flash glucose monitoring is also offered if certain criteria are met.

Our team

Lead Consultant

  • Dr Chris Moudiotis: Clinical Director for Paediatrics / Consultant Paediatrician in Diabetes & Endocrinology / Clinical Lead for Exeter Children and Young People Diabetes Service. 

Consultant

  • Dr David McGregor: Consultant Paediatrician / College Tutor

Doctor

  • Dr Sue Hellewell: Speciality Doctor Paediatrics and Paediatric Diabetes

Paediatric Diabetes Specialist Nurses (PDSN)

  • Lead PDSN: Mrs Julie Kitchen (seconded to MyCare July 2020 – January 2021)
  • PDSN: Mrs Ruth Dalton / Mrs Heather Fisher (maternity leave until January 2021) / Mrs Emm Greenslade

Paediatric Diabetes Specialist Dietitian

  • Mrs Maria Leveridge

Paediatric Psychologist

  • Dr Katherine Cox (due to commence September 2020)

Where to find us

RD&E Wonford, Barrack Rd, Exeter EX2 5DW

The Paediatric Diabetes Specialist Nurse and Dietetic Team Office can be found in Paediatric Outpatients, room J158 on level 1 of template J.

We advise arranging with a member of the team before dropping in, as there is not always someone present.

Contact us

If you want to get in touch with the department, please contact:

Urgent enquiries

01392 411611 - ask the operator to put you through to the Paediatric Diabetes Specialist on call.

The Paediatric Specialist Nurse/Dietitian are on call from 8am – 6pm and Paediatric Registrar from 6pm – 8am.

Non-urgent enquiries 

Non-urgent telephone: 01392 403727, between 9am – 5pm on working days (answerphone).

Non-urgent emails: rde-tr.PaediatricDiabetes@nhs.net

Non-urgent direct contact with Dietitian: 07827239019

Community services

Information for schools:

The Paediatric Diabetes Specialist Nursing team provide advice and training for schools, nurseries and colleges. See here.

Training programme for school staff. See here.

ISPAD Position Statement on Type 1 Diabetes in Schools. See here.

Clinics

Due to the covid pandemic, the team are using Attend Anywhere video consultation platform and telephone contact for clinic appointments. Some face to face appointments will occur when required.

Paediatric diabetes clinic:
Clinics occur on Tuesday and Thursday afternoons most weeks, at Wonford Hospital. We see young people up to the age of 16 years old in this venue.

Young persons’ diabetes clinic:
Clinics occur on the second Thursday of the month in the afternoon.

Clinics take place at the Macleod Diabetes & Endocrine Centre. You will find the Macleod Centre at the Wonford Hospital site in a separate building at the corner of Barrack Road and Haldon View Terrace.

Supporting you

There are two parent led support groups in our area:

South West Families with Diabetes Group:

This is a national parent led support group for families with diabetes linked to the National Children and Young People (CYP) Diabetes Network. This Patient/Parent/Carer reference group was set up to allow direct influence from those using the paediatric centres to feed into the national agenda.

www.facebook.com/groups/351695801609372/

Information for healthcare professionals

All young people with suspected type 1 diabetes should be referred to the hospital emergency department for same day admission. Please see https://northeast.devonformularyguidance.nhs.uk/referral-guidance/northern-locality/paediatrics/diabetes

If BG more than 11mmol/l or glycosuria (+/- ketonuria):

  • Refer immediately (same day) to the acute paediatrics on-call team
  • Inform child and family of the suspected diagnosis of diabetes

British Society for Paediatric Endocrinology and Diabetes (BSPED)
UK guidance for all aspects of diabetes care for children and young people
https://www.bsped.org.uk/

Association of British Children’s Diabetes Clinicians (ACDC)
UK guidance for all aspects of diabetes care for children and young people
http://www.a-c-d-c.org/endorsed-guidelines/

International Society Pediatric and Adolescent Diabetes (ISPAD)
Guidance for all aspects of diabetes care for children and young people
https://www.ispad.org/

National Institute Clinical Excellence (NICE) Guidance for children and young people with type 1 and 1 diabetes
https://www.nice.org.uk/guidance/ng18

Guidance on other types of diabetes (monogenic and neonatal diabetes)
https://www.diabetesgenes.org/ [Section 4]

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