Medway and Swale Children’s and Young People’s Diabetes Service

Monday to Friday: 8am to 6pm

Call: 01634 825135 (select option 1)
Email: met-tr.coastdiabetesteam@nhs.net

The Medway and Swale Children’s and Young People’s Diabetes Service is based at Medway Maritime Hospital. We offer support to children and young people and their families to develop skills in diabetes self-management so they can lead a safe, healthy and happy life that is not hampered by their diagnosis.

Need advice?

For non-urgent advice, or if you have a general enquiry, please contact the team, Monday to Friday from 8am to 6pm, on 01634 825135, option 1 or email met-tr.coastdiabetesteam@nhs.net

If you are calling out of hours and need urgent advice, please call the Penguin Assessment Unit on 01634 825065. In an emergency call 999.

On this page:

Clinic Appointments

Diabetes and Surgery

Resources

Clinic appointments

Have you had your annual review? This should include:

Thyroid blood test
Urine test (only those over 12yrs)
Blood pressure (only those over 12yrs)
Foot check (only those over 12yrs
Offer of psychology support

If not, please ask at your next appointment.

We realise that sometimes clinic appointments need to be changed. Please let us know as soon as possible so the appointment can be offered to another family. Missed appointments do affect everyone. Clinics are fully booked, and it may not be possible to offer another appointment for several months.

Call us on 01634 825135

Be prepared – Remember to download data from your blood glucose meter/insulin pump/CGMS/Freestyle Libre before your clinic reviews.

Write down any questions that you want to ask.

Diabetes passport – Remember to bring your passport to clinic appointments so we can record details of any changes made in clinic (such as insulin doses or carbohydrate ratios), set individual targets for the next 3 months (such as avoiding injections/inserting pump cannulas into lumpy sites or bringing a urine specimen). Results of your height, weight, HbA1c and any blood tests can also be recorded in your passport.

Be informed – Be aware of available treatments and devices to support your diabetes management so you can discuss these further during your appointment.

Be honest – Provide accurate information about your health and current treatment. If you are honest about your diabetes then you will be treated more effectively.

Communication – Respect healthcare professional for their medical knowledge, but they should also respect you for your experiences in the management of your diabetes. Mutual respect will allow you both to make decisions you are both happy with.

Download your Libre at home directly to the Medway Paediatrics Diabetes Team account

To share your readings with the diabetes team to enable them to support you in your diabetes, we would suggest you set up a LibreView account.

Set up a LibreView account on www2.libreview.com
Go to your Settings section and select Account Settings
Click on My Practices
Enter in your healthcare provider’s Practice ID which is 06636025 and click Add.

You should now see our practice name appear under your practice list.

To stop sharing data with us, click on remove.

Practice Name is: Medwaypaediatricdiabetes

Practice ID is: 06636025

Diabetes and Surgery

These are guidelines to help manage your child’s diabetes around the time of surgery. They will be discussed with you at pre-assessment. If you are not entirely clear about what you have to do, about fasting, insulin dose or any other issue, please ask before your child comes in for surgery. You can ask the pre-assessment nurse, or any of the Paediatric Diabetes specialist nurses.

What you have to do will depend on the insulin regime your child has, the type of surgery (minor or major), and the time of the surgery. Please look at the part of these guidelines that applies to your child. The pre-assessment nurse will let you know if the operation is considered minor or major.

Your child should be first on either the morning or afternoon operating list. Please ask if they are not.

This applies if your child receives insulin using a mixture (such as Humulin M3, NovoMix 30, Humalog Mix 25 or Insuman Comb 15) twice a day or a system involving a mixture in the morning, short acting insulin with dinner, and long acting insulin at bedtime.

Minor Procedure

Surgery in the morning

Normal food and insulin requirements until 6 hours prior to surgery.

Fast from 2.30am (clear fluids allowable until 2 hrs before surgery)
If your child has a hypo at home, use your normal treatment in the usual doses (eg. glucose tablets, sugary drink, GlucoGel) until the blood glucose has returned to normal
Come to Sunderland Day Care Unit / Dolphin Ward as directed in the early morning prior to surgery (7.30 am for 9 am list)
No breakfast
No insulin
Check the finger prick blood glucose on arrival
If less than 6 mmol/l, your child should be given one 10g tube of GlucoGel
Recheck blood glucose 10-15 mins later and repeat GlucoGel if it is still low
If greater than 15 mmol/l, intravenous fluids and insulin should be started.

Surgery in the afternoon

Before breakfast at home give 20% dose (1/5) of usual insulin mixture.

Normal breakfast and admit to hospital by 12.30pm

No food after breakfast, clear fluids until 2 hrs pre-op.
Check capillary blood glucose on arrival.
If less than 6 mmol/l or greater than 15 mmol/l, manage as above.

After surgery

Your child should be offered a clear fluid drink 1 to 2 hours after surgery, then a small snack, but this will depend on the type of surgery and how your child feels. If there is no vomiting, then 33% (1/3) of the usual morning insulin dose can be given before lunch, and the normal dose before the evening meal. The nursing/medical staff will decide on this. Your child will be discharged in the evening if well. The normal doses of insulin should be given in the evening and the following day.

Major Procedure

You will be given an individual plan for admission depending on the type of surgery planned. However, this will almost certainly involve your child being put on intravenous fluid and insulin before theatre.

This applies if your child injects a short acting insulin (such as Humulog Lispro or NovoRapid) before meals, and a long acting insulin (such as Levemir, Lantus, Abasaglar or insulatard) once or twice a day.

Minor Procedure

Surgery in the morning

Normal food and insulin requirements the day/evening before surgery and until 6 hours prior to surgery

Fast from 2.30am (clear fluids allowable until 2 hrs before surgery)
If your child has a hypo at home, use your normal treatment in the usual doses (eg glucose tablets, sugary drink, GlucoGel until the blood glucose has returned to normal
Admit early morning prior to surgery (7.30 am for 9 am list)
No breakfast.
No short acting insulin. Give normal long acting insulin if this is normally given in the morning.
Check finger prick blood glucose on arrival.
If less than 6 mmol/l, your child should be given one 10g tube of GlucoGel.
Recheck blood glucose 10-15 mins later and repeat GlucoGel if it is still low.
If greater than 15 mmol/l, intravenous fluids and insulin should be started.

Surgery in the afternoon

Before breakfast at home give normal dose of short acting insulin and normal dose of long acting insulin if it is given at this time.
Normal breakfast and admit to hospital by 12.30pm

No food after breakfast, clear fluids until 2 hrs pre-op.
Check capillary blood glucose on arrival.
If less than 6 mmol/l or greater than 15 mmol/l, manage as above

After surgery

Your child should be offered a clear fluid drink 1 to 2 hours after surgery, then a small snack, but this will depend on the type of surgery and how your child feels. If there is no vomiting, then the normal insulin dose can be given before lunch, and the normal dose before the evening meal. The nursing/medical staff will decide on whether your child is ready for this, but you can help decide the insulin dose. Your child will be discharged in the evening if well. The normal evening long acting insulin dose should be given and normal doses the following day.

Major Procedure

If your child is on pump therapy, then there will be a discussion with the diabetes team about how best to manage the diabetes around the time of surgery.