July 2010 Issue 1

Welcome to the first edition of Grampian Diabetes Matters. It is hoped that this newsletter will be distributed twice a year, to update and inform community colleagues of the ongoing developments and changes in diabetes care, treatments and equipment in the adult diabetes service.

Prevalence of Diabetes in Grampian

Latest figures indicate that the number of people known to have diabetes in the Grampian area has grown to a massive 22,924. This equates to 4.2% of the local population.

The Acute / Inpatient and Community Diabetes Specialist Nurse Teams

Due to the increasing prevalence of diabetes, it has been necessary to review the diabetes nursing service. NHS Grampian Diabetes Nurse Manager Linda Caie has been in post for almost a year and has been working on the redesign of the adult and adolescent Diabetes Nursing Service across NHS Grampian. Any changes to be implemented will be reported in due course.

The current members of the adolescent and adult diabetes specialist nurse (DSN) team and their contact telephone numbers are as follows:

Adolescents

Grampian-wide Edna Stewart 01224 555527

Adults - Community

Aberdeen City Razia Amin 01224 555471

Trish McDonald 01224 555481

Jill Strathdee 01224 555395

Kincardine and Deeside Sandra Wilson / Jill Strathdee 01569 792075

Banff and Buchan Sheena Duffus / Kay Rosie 01346 585244

Moray Sharon Wright / Lorna Ferry 01343 567844

Adults – Inpatient /Acute

Aberdeen Royal Infirmary Moira Still / Hilary Yule 01224 559364

Research Nurse

Woolmanhill, Aberdeen Norma Alexander 01224 555306

Scottish Intercollegiate Guidelines Network

SIGN Guideline 116 Management of Diabetes has been updated and was launched in March 2010. This is an extremely useful guideline, a valuable reference and essential reading for everyone involved in the delivery of diabetes care - available at www.sign.ac.uk

Injection Technique

In recent years there has been a major shift towards the use of smaller gauge, shorter length pen needles as studies proving their safety, efficacy and user preference have been published. The Forum for Injection Technique is a national group dedicated to establishing and promoting best practice in injection technique for all involved in diabetes. National guidelines and recommendations are in the process of being finalised and will be distributed when available.

This is a good opportunity to also highlight the importance re-suspending pre-mixed and isophaneinsulin's e.g. Mixtard30,Humulin M3, Humalog Mix 25, Novomix 30, Humulin I, Insulatard. These insulin'smust be re-suspended adequately prior to every injection.It may seem atrivial point, butis one whichcan have a significant impact on the variabilty of blood glucose levels and in the worst case scenario could result in the individual having hyperglycaemia or severe hypoglycaemia.

If a pen device is used to administer insulin, then a 'test' shot is recommended prior to every injection. This is to ensure that the pen needle is OK and that the pen device is in working order to ensure that the insulin dose is delivered.

Pen Devices v Vials and Syringes

Clarification has been requested on this issue. All commonly used insulin’s are available in pen cartridges. Insulin that is only available in pen cartridges must be used in a pen device. There is no evidence that using a pen device increases the risk of needlestick injury. Insulin that is available in vials can only be administered with syringes. The following points should be considered:

·  When using a vial and syringe, the syringe needle has to be inserted into rubber bung of the vial which strips off some of the lubricant prior to it being injected. This is almost the equivalent of reusing a needle which may result in a more painful injection for the recipient.

·  Becton Dickinson plan to manufacture 5mm needle length syringes. In the meantime the smallest syringes needle size available is 8mm.

Withdrawal of MIXTARD 30 Insulin

NovoNordisk announced in late June 2010 that Mixtard 30 insulin is to be withdrawn in the UK by the end of the year. The products to be discontinued include:

Mixtard 30 10ml vial : Mixtard 30 Penfill 3ml cartridge : Mixtard 30 InnoLet

Dr Ken McHardy, Consultant Diabetologist, has prepared a document providing guidance on change options for adults only. This is available on the Grampian diabetes website at www.diabetes.nhsgrampian.org

The main difficulty anticipated is to find an alternative for those individuals who currently manage their injections independently with the Mixtard 30 InnoLet device. This may be a challenge for some individuals. We hope to work closely with community teams to try and help people find suitable alternatives to maintain independence with their diabetes management. Please contact the DSN aligned to your surgery / area if you would like to discuss the needs of specific patients.

Blood Glucose Meters

The list of blood glucose meters recommended for use in NHS Grampian has recently been revised by the DSN group. Details of these along with recommended lancer/lancets for use by health care professionals and others involved in blood glucose monitoring can be accessed at www.diabetes.nhsgrampian.org

All GP surgeries should stock one or more of the blood glucose meters from the recommended list. If your practice does not stock the particular meter from the list that is required, please contact the manufacturing company directly. All companies will provide meters free of charge and post them promptly on request.

The Revival of Isophane Insulin

Lantus (Glargine) and Levemir (Detemir) are basal analogue insulin’s which have been used extensively over the last few years. SIGN state that Isophane insulin is as effective in reducing HbA1c as basal analogue insulin therapy and it is also considerably less costly. Therefore, Human Insulatard and Humulin I are being used as alternatives to Lantus and Levemir where appropriate for people with Type 2 diabetes requiring to commence basal insulin. An important difference in relation to administration is the timing of Isophane insulin injections. If nocturnal hypoglycaemia is or becomes an issue then basal analogue insulin may be considered. If patients require basal insulin and you would like to discuss, please contact the DSN aligned to your surgery / area.

Study Days / Training

Forthcoming diabetes study days / courses can be viewed on the Grampian diabetes website at www.diabetes.nhsgrampian.org If interested remember to book early to be sure of a place.

Razia Amin

Diabetes Specialist Nurse

Editor

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