Joint Trainers & Trainees Meeting: 12th June 2007

Dear Colleague,

The annual Joint Trainers and Trainees meeting is scheduled for Tuesday 12th June 2007, 1730 hours at the Board Room in the Medical School.

Best wishes,

Shaz Wahid

Deanery Course Calendar to March 2007

Exchange in Endocrinology Expertise

Exchange in Endocrinology Expertise
Novo Nordisk & the Section/Board of Endocrinology of the UEMS

In order to facilitate within Europe the exchange of trainees specialising in Endocrinology and to harmonise and improve the training of the new endocrinologists, the Section/Board of Endocrinology of the UEMS and Novo Nordisk A/S have set up a fellowship program called ‘3E’, the Exchange in Endocrinology Expertise.

The Exchange in Endocrinology Expertise program will support candidates for an assignment in a leading centre in endocrinology, diabetes and metabolism in Europe. The task will include both clinical practice and research, leading to publication.

Although on average, the assignment duration is 6 months, the length of the period will be dependent to the requirement of each individual project.

Whenever possible, the assignment should include both clinical practice and research. Publication should be seeked, and if not relevant a report has to be written at the end.
Novo Nordisk would like to present the Section/Board of Endocrinology a list of topic of interest within diabetes that could be a source of inspiration for potential future candidates.

In 2006, the project will pilot up to 6 candidates.

The selection of the candidates will be done by a Committee from the Section/Board of Endocrinology according to well defined criteria of eligibility approved by both organising parties.

The criteria for a candidate to be selected are the following
At least 1 publication in a peer reviewed journal
Recommendation from the head of the department
Language: incompatibility of language should be avoided (the UEMS Committee will evaluate case by case if the knowledge of the receiving centre language is necessary)
Education: minimum of 1 year in the specialty of endocrinology education up to 5 years after end of specialty education
Motivation proven with a specific project proposal including an interesting topic, a proposal of centre and feasibility letter from the receiving centre

In terms of process for application, it is up to the candidate to choose a specific centre within the list of the RQE (Recognition of Quality in Endocrinology) accredited centres by the Board of Endocrinology and to initiate the first contacts to investigate feasibility of the project prior to the submission of the application. The RQE centres are listed on the website of the Section/Board of Endocrinology.

The country of origin might be any of the European Union countries, member of the Section/Board of Endocrinology of the UEMS. However, it will be taken into account that differences can occur in the level of skills from one country to the other.

The centre for the program will be selected from the list of RQE centres that have been accredited by the Board of Endocrinology based on the level of quality of care.

The budget for the fellowship will cover the salary, the travel expenses (one return trip) and potentially research expenses like bench fees.

The communication of the program will, in a first instance, be done through the national delegates of the Section/Board of Endocrinology, who will take the responsibility to spread the information in their own individual countries.

The fellowship applications should be sent to the following address before February 5, 2007 :

Prof. Rolf C. Gaillard
President Section/Board of Endocrinology of UEMS
Service d’endocrinologie,diabétologie et métabolisme
University Hospital (CHUV)
CH-1011 LAUSANNE / Switzerland

Troubleshooting Insulin Pump Problems

Dear Colleague,

I have compiled some information on the insulin infusion pump and have attached herewith.

Few useful tips:

1-If the pump is malfunctioning or high or low glucose persist, the patient should be advised to transition back to conventional insulin injections. They have all been made aware that this is required to ensure safe management when they run into difficulties and all should have short and (almost always) long-acting insulin preparations prescribed.

2-Emergency paramedic / in-patient management should be according to standard iv dextrose and insulin protocols with pump therapy relinquished in the short term. Likewise all patients have been counselled to accept routine in-patient protocols for glycaemic stabilisation. If the in-patient team are happy to support the patient in managing their own pump in hospital, that is fine; but pump users are by-and-large encouraged to contact the team for advice on recommencing pump therapy prior to discharge.

3-If you need help ,the diabetes specialist nurse Emma Heslop can be contacted through DSN helpline (0191 2563003) or ext 22595 from 9 am -5 pm. Dr Shaw is more than happy to help at anytime if you contact him through switchboard (I have put these numbers in the folder as well).

A training session on CSII has been organised with Dr Shaw on 26 Jan 2007 at 2 pm in the seminar room in the Newcastle Diabetes Centre. Please inform myself or Dr Shaw if you are interested.

The best wishes,

Arut

Arutchelvam
Clinical Research Fellow & SPR

Guidelines on the treatment of Hypoglycaemia (Low blood glucose level)

It is important you check your glucose level a minimum of 4-6 times per day. This will help you detect any significant changes in your glucose control, so that you can respond quickly. Symptoms of hypoglycaemia may be different on a pump, so if in doubt check your glucose level.

Treatment of Low Glucose Levels:

1. Take 15 grams of fast acting carbohydrate e.g. approximately 4 glucose tablets (check dose on packet for accuracy), 4 - 5 fruit pastels, 90 ml fruit juice or sugary drink. Please read the label to accurately calculate how much is needed.
2. Test blood glucose level again in 15 mins
3. If the glucose level is still4 mmol/l or less repeat steps above
4. Always carry fast acting carbohydrate with you

Try to identify the cause and take preventative measures:

• Is the correct basal rate set?
• Has the correct bolus been given?
• Does the insulin dose relate to the carbohydrate intake?
• Check the pump’s alarm screen to see if an error has been identified
• Carry out a “self – test” if applicable to check the pump is functioning correctly
• Has more exercise been taken than usual?
• Have you been exposed to excessive heat such as sauna, bath or sun?
• Always check your glucose level before you go to bed. Confirm the appropriate levels with your health care team e.g. not below 7.0 – 8.0mmol/l for the first few days of starting pump therapy
• Avoid driving until your blood glucose levels are more predictable. Discuss the appropriate level with your healthcare team; avoid driving if your glucose level is below the recommended level. Monitor your glucose level before you drive. On long journeys repeat the glucose test at least 2 hourly.
• Monitor your glucose levels before, during and after exercise
• Carry out an extra test if alcohol has been consumed
• Make sure your family, friends, colleagues or teachers know how to treat a hypo including the administration of GlucaGen
• Show family members how to cancel the alarms and how to stop and suspend the pump
• Set the auto – off safety alarm
• Pre – set the maximum basal and bolus rates
• Consider using other features of the pump such as the bolus wizard or CarbSmart, temporary basals and different types of boluses.

Please liaise with Dr Shaw or Emma Heslop following all calls (the following morning; after the weekend; or if need additional input out-of-hours)

HYPOLGLYCAEMIA FLOWCHART

HYPERGLYCAEMIA FLOWCHART

Sick Day Rules - Coping with Illness

Your body needs insulin in order to provide glucose for the cells to create energy. Even when you do not eat, your body continues to produce glucose from your body stores. Your blood glucose level usually rises when you become ill and you will usually require more insulin. As you feel better your blood glucose level will return to your usual range. This means the insulin dose can be reduced, often to the original dose. Do not stop the insulin - you could become very ill, which may require hospital treatment.

What should you do if you are ill?

• Continue taking the insulin, do not disconnect from the pump
• Test your blood glucose level every 1 – 2 hours. Discuss with the Diabetes Team
• Take corrective insulin boluses for all glucose levels above target (eg 1 unit to reduce glucose by 2mmol/L or according to your own calculated insulin sensitivity factor or using the bolus wizard if you use this)
• Document the blood glucose results clearly
• Whilst ill aim for blood glucose levels between 5.0 to 14.0mmol/l
• Check for ketones as soon as the illness starts
• If ketones are present you may need a higher corrective dose than usual to lower your blood glucose
• Drink 3-4 litres (4-6 pints) of sugar-free liquid throughout the day
• If you do not feel like eating, replace your solid food with a sugary drink e.g. sipping lucozade, milk, fruit juice, and coke….
• If your blood glucose levels are over 14.0 mmol/l consider increasing the insulin dose (basal, bolus or by injection)
• To cope with illness you will often have to increase your basal rates by 10-20%. This can be achieved with the temporary basal feature or by reprogramming basal rates.
• Read the guidelines for the treatment of hyperglycaemia
  

Consult the Diabetes On-call service (0191 233 6161) if:

• Y0u have ketones
• You are vomiting or too nauseated to eat or drink
• Your blood glucose level remains above 14.0 mmol/l
• Your condition does not improve
• If you are not sure what action to take
  

Hospital treatment is essential if you cannot stop vomiting, you have deep rapid breathing or you feel noticeably drowsy. Ring your GP or go to the nearest Accident and Emergency Department. Ring 999 if necessary.

Pump contact numbers-Newcastle insulin pump service

24 hour on-call SpR/Consultant: 0191 233 6161

Monday - Friday 9 am - 5 pm:
Dr James Shaw: 0191 233 6161
Emma Heslop: 0191 233 6161 ext 22595
DSN helplin: 0191 256 3003

Editor's note: Please refer to emailed attachments for insulin dose calculation/adjustment

STC Meeting: 17 Nov 2006

Dear Friends,
I attended the Specialist training committee (STC) meeting as the SPR representative on 17.11.06 at the Medical School, Newcastle. I wish to convey some of the important points discussed.
1-Bishop Auckland- General medical training:Following representation from Beas Bhattacharya last year with problems in general medical commitments at Bishop Auckland,the STC has intervened .The programme director Dr.Shaz Wahid and Dr.Mcculloch has worked together and made significant changes in the training programme.This includes the SPR being moved to a 1 in 12 third on call (previously on 1 in 7 SHO rota).These changes have been confirmed by the PD in discussion with the current SPR Arun.The diabetes training at Bishop remains excellent .On behalf of all SPRs I thank the STC, Shaz, Dr. Mcculloch and Beas for making such an effort with a positive result.
2-Dr.Richard Quinton gave an overview on 'quality management in the Northern Deanery'.
3-An action plan was discussed:
a. Each Training Unit is to nominate an Educational Lead to liase with the STC.
b. An updated structured job description with the following headings: General Trust Description; Description of Consultant, Junior Dr and MDT support for the Training Unit; Unit Timetable; SpR Job Plan; Specialist clinics available for SpR to attend; Description of acute medicine activity; Description of Educational Supervision available; A list of educational activity available for training, e.g. x-ray meeting, departmental meeting, etc; What Admin support is available in terms of office, IT support & Library support.
3-Learning contract: It was strongly suggested that every SPR makes a learning contract with the educational supervisor at the beginning of the rotation.All foundation programme doctors will have an example.I will send one to you all soon.I have attached an example being used by Shaz in South Tyneside.
4-Core curriculum:It is really important that we all read our curriculum(available in the speciality website)carefully and try to fulfil all our educational needs.
5-Our speciality website is up and running and it can be accessed through the PIMD website in the speciality section.Please use the site and make suggestions to Shaz or myself.The site has very important information like assessment tools(mini CEX, reflective writing etc)
Hope we will continue to enjoy our rotation .Please feel free to contact me if I can be of any help.
Best wishes
Arut

Dr. Arutchelvam V
SPR representative
Clinical Research Fellow

LEARNING & ASSESSMENT OPPORTUNITIES FOR THE SpR IN DIABETES & ENDOCRINOLOGY AT SOUTH TYNESIDE DISTRICT HOSPITAL

SpR Name……………………………………….. Educational Supervisor…………………………………….

Clinical Supervisor(s)………………………………… GIM Supervisor……………………………………….

General Training in Diabetes & Endocrinology, GIM and generic skills will be offered. Specialist training Can be offered in Community Diabetes, Renal Diabetes, Diabetic Foot, Diabetic Eyes, Adolescent Diabetes, Paediatric Diabetes, Radio-Iodine Administration, Obstetric-Medicine and Osteoporoses clinics.

Study Leave: One session per week will be provided for CME/CPD purposes. Time will be scheduled for you to attend the regional GIM training ½ days, the regional Diabetes & Endocrinology CME days, NERRAG and NORDAG meetings. You will be expected to attend ONE national or international conference. Further study leave can be tailored to your training needs identified during your RITA/Appraisal and will include………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

AUDIT You will be expected to conduct and complete ONE audit. If the opportunity arises the audit should be presented during your time with us or within one year of rotating elsewhere.

The following minimum assessments will occur:

1. Four Mini-CEX assessments of New outpatients scheduled for a Monday afternoon with Dr Parr (2 diabetes cases) and Tuesday afternoon with Dr Wahid (2 endocrine cases).

2. Six case based discussions to include

-Renal Diabetes Case (Dr Wahid)

-Diabetic Foot Case (Dr Wahid)

-Adolescent Diabetes (Dr Wahid)

-Bone Disease Case (Dr Parr)

-Miscellaneous Endocrine Case (Dr Parr)

-A diabetes or Endocrine Pregnancy case (Dr Parr)

3. A Multi-Source-Feedback exercise conducted in March. The results will be discussed at a feedback session with Dr Parr in April/May.

4. If your training stage requires observed ward-rounds, 2 Tuesday mornings will be scheduled for you to lead the post-take ward round on AMAU under the observation of Dr Parr. Your morning for these 2 sessions will not include other commitments (including on-call). Feedback will be provided immediately.

5. If following your RITA further assessments are required, these will be scheduled for July, August or September.

6. Your Learning needs/objectives identified today are:

a.

b.

c.

d.

e.

f.

h.

i.

j.

k.

IT IS YOUR RESPONSIBILITY TO UTILISE THE ABOVE OPPORTUNITES TO HELP ACHIEVE YOUR LEARNING NEEDS AND PROVIDE EVIDENCE OF LEARNING TO INFORM YOUR RITA. FOR YOUR RITA IT IS YOUR RESPONSIBILTY TO KEEP AN UP TO DATE LOG BOOK/PORTFOLIO AND OBTAIN THE NECESSARY SIGNATURES ON RELEVANT DOCUMENTATIONS. IT IS YOUR RESPONSIBILTY TO ARRANGE 3 APPRAISALS WITH YOUR EDUCATIONAL SUPERVISOR.

DATE __ __/__ __/__ __ __ __

SpR signature…………………………………………………

Educational Supervisor Signature…………………………………………………………