What happens at the diabetes clinic?

There are certain things that you should expect from your medical team. If you have just been diagnosed with Type 1 diabetes you should have: a full medical examination, a talk with a diabetes care nurse who will explain what diabetes is and about your treatment. Following this you should have several sessions with your diabetes nurse for basic instruction on injection technique, looking after your insulin, syringes and pen, blood glucose testing and what the results of your own testing means. You should also expect to have a discussion about hypoglycaemia (hypos) and how to deal with it. (See Diabetes UK website and 'Understanding diabetes' produced by The British Medical Association.) 

After this initial help and when you diabetes is under control you should have access to a diabetes care team where you will have the opportunity to talk to doctors, nurses and dieticians. They will assess your diabetes control and discuss any problems with you. You should also be given a contact number so that you are able to contact a member of the team for advice whenever you need it. Most diabetic clinics have a specialist nurse who will visit you at home between hospital appointments especially in the early days after your diagnosis. Each time you go to the clinic your weight, height a urine test and a blood test called the HbA1c will be taken. This last is a test that measures the long-term control of your diabetes. Also your injection sites should be examined. (See Diabetes UK website and 'Understanding diabetes' produced by The British Medical Association.)

Each year you should have an Annual Review or an MOT assessment by the diabetes care team. In addition to the tests done at your regular check-ups, the annual review includes an examination of your eyes. A photo may be taken from outside the front of your eyes of the back of your eyes (your retina), your feet and legs should be examined to check your circulation and nerve supply. The annual review is also an opportunity to discuss how your control of your diabetes is going and your home monitoring results. (See Diabetes UK website and 'Understanding diabetes' produced by The British Medical Association.)

Your clinic should keep you in touch with the latest advances in the management of diabetes and if these are appropriate for you they will be able to prescribe modern equipment for delivery of insulin and for measuring glucose levels which your GP might not be able to prescribe. They will also be able to adjust and monitor your insulin regimen as you get older and become more independent.

Experiences of care:

Talks about what happens at the clinic each time she goes for regular check-ups.

Talks about what happens during regular check-ups and at the annual review or MOT.

Most of you said that you have appointments with your diabetes care team every three or six months. One young man hasn't being seen at a diabetes clinic for almost three years and has been getting his supplies from his GP surgery. Many indicated that as they learned to control their diabetes better, the nurse home visit became less frequent. You also said that you are able to contact your specialist diabetes nurse in between appointments when you need her/his advice. A few of the young people we talked to said that they have no access to a diabetes specialist nurse outside their visits to the diabetes clinic. And one young woman is unhappy about seeing her diabetes care team only once a year. She says it is difficult to get to know her nurse because she has seen her only once in the past year and a half.

She is unhappy about her once a year appointment with her diabetes care team because as a nineteen year old feels that she still needs more support.

He would like to have access to a health professional with specialist diabetes knowledge outside his clinic appointments.

All of you said that you have an annual review or MOT that includes all the tests and examination listed above. Some of you indicated that you have 'no idea' what the urine test is for. Also some of you indicated that you haven't had certain tests or examinations done for some time. One young woman indicated that she has not had an eye examination done at hospital in the last three years but she goes to the optician once a year. Some indicated that they go to their GP for feet and legs examinations. All these tests and examinations are very important because they provide earlier detection of possible complications.

A urine test done at the diabetic clinic had traces of protein in it. This lead to further investigations where it was found that she had developed kidney problems.

Describes an eye examination and indicates that the last time she had one done at her hospital was three years ago.

Explains how the nerves and blood vessels of her feet are checked.

Before diagnosis he was having problems with his vision but didn't know it was because of diabetes. Says that his consultant examine his eyes quite regularly.

Note: If you want to find out more about what standards of care to expect please refer to the National Service Framework (NSF) for Diabetes produced by the Departments of Health in England, Northern Ireland, Wales and Scotland. The NSF has set out a list of standards of care to be met by 2013. (See Department of Health website; Diabetes UK website, NHS direct or your local primary care trust.)

You should be able to collect the following supplies from your clinic: finger pricking device, monitoring diary, insulin pen injector, blood glucose meter (if available). And from your GP: lancets for finger pricking devices, blood glucose test strips, strips to test urine for glucose and ketones, disposable insulin syringes, insulin, glucagons (GlucaGen Kit), Hypostop gel, needle clipper, pen injector needles and some insulin pens.