by Bernie English
PEOPLE with diabetes in the Mid West region are being forced to take chances with their vital insulin regimes because there is no local dietician who can train them to manage the condition.
And they have launched a campaign in advance of World Diabetes Day, November 14, to highlight the lack of services provided by the University of Limerick Hospitals Group (ULHG) for people over 18 years of age. They are also calling on ULHG to address these issues urgently.
Funding has been approved for a dietician but, according to the Mid West Diabetes Advocacy Group, ULHG has had no success in filling the outpatient diabetes clinic post. Neither is there any guarantee that when the post is filled the person appointed is qualified to teach the DAPHNE (dose adjustment for normal eating) programme to calculate the daily balance between nutrition and insulin needs.
Limerick woman Aisling White, who is a member of the advocacy group, told the Limerick Post that adults with diabetes have to travel long distances to other centres to be trained on the DAPHNE programme. This enables them manage the complex insulin calculations and prevent serious consequences including hospitalisation, amputation, and kidney dialysis.
“These are specific calculations measuring how much insulin is needed to balance the amount of carbohydrates consumed in a meal. People with diabetes need to know how to calculate that to manage their condition efficiently,” Aisling explained.
Another major issue with the Limerick Hospital service is the lack of automatic insulin pumps for people over 18, although the pumps are provided for a number of child patients in the area.
This means people with diabetes have to take blood sugar readings up to 18 times a day and then calculate what dose of medication they need to administer by injection,.
“There are currently 51 adults attending the clinic who use insulin pumps with only one member of staff trained in supporting them. An insulin pump offers greater flexibility for people with diabetes as the user can adjust insulin more precisely than with injections and in much smaller doses,” said Aisling.
“Insulin pump therapy should be offered as a treatment option when health outcome targets are not being reached using injections or when the individual is extremely sensitive to insulin and requires very small doses.
“One of the barriers identified with insulin pump access is the lack of a pump specialist nursing staff. We are calling on ULHG to seek funding to secure a minimum of one full-time diabetes specialist pump nurse to initiate insulin pumps for people over 18.”
The third concern is the five-year waiting list to be seen by a consultant endocrinologist in the Limerick diabetes outpatient clinic.
663 people are waiting on their first appointment to UL Hospital’s outpatient diabetes clinic, with over half of them on the waiting list for 24 months or longer.
In response, a spokesperson for ULHG told the Limerick Post: “We recognise the need for additional resources within our adult diabetic services. This issue is a core focus for UL Hospitals Group and we are committed to improving the service for our patients. Developing services around insulin pump therapy and structured education in particular require us to fill further specialist posts, including nursing and dietitian posts.
“While there is a specialist dietitian working with our paediatric diabetes patients, there is currently no specialist dietitian in post for adults with Type 1 Diabetes. Patients are seen by a ward dietitian as inpatients but there is no specialist dietetic care or outpatient appointments for adult diabetes patients in UHL.”
The spokesperson said that UHL is currently unable to commence adult patients on insulin pumps “due to service demands”.
He continued: “We do, however, accept patients established on pumps from elsewhere and these patients are managed under the care of a consultant endocrinologist. The largest group of these patients are those who have transferred from the paediatric diabetes service in UHL. All of our insulin pump patients are seen in University Hospital Limerick. At present, there are currently 51 patients within our Adult Diabetes Service using insulin pump therapy.”
With regard to staffing, the spokesperson said that the hospital received confirmation in December 2020 of funding to recruit three additional dietetic posts for the treatment of adult diabetes.
“These posts include two senior dieticians and one staff grade dietician. The recruitment process for the two senior dieticians is at an advanced stage. The recruitment process is also ongoing for the staff grade dietician. We will be able to provide a more precise timeline on when we expect successful candidates to take up posts in the near future,” he explained.
The spokesperson noted that two further consultant endocrinology posts have been approved for UHL and are currently being progressed through the HR process. However, he said it was “not possible at this time to give a definitive timeline as to when these posts will be filled”.
The spokesperson also revealed that four new Diabetic Clinical Nurse Specialist (CNS) posts have been approved for UHL.
“Of these, two have been recruited and will commence post over the coming months, the recruitment campaign is currently ongoing for the other CNS posts. There are also two Diabetic Staff Nurse positions within the Diabetes Unit at UHL; both of these positions have been filled,” he concluded.
