Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S Clinic Organisation Echelon 1 - 2.

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Clinic Organisation

Echelon 1 - 2

Programme

1

2

4

3

5

Equipping a clinic

External partners and donors

Diabetes camps

Patient safety

Ordering insulin

Equipping a clinic

Echelons of care

• Echelon 1• Primary care facilities• Hospitals where children with diabetes are rarely seen• Goals:

• Diagnosis of diabetes• Recognise the role of insulin• Understand principles and priorities of treating children

with diabetes• Understand storage and use of insulin• Assist with continuing care• Local support of the child with diabetes

Echelon 1: Equipment (1)

• Blood glucose meter with test strips• Urine strips for glucose, ketones &

protein• Benedict’s solution, test tube and

spirit lamp • Blood pressure set

(child and adult cuffs) • Weigh scale• Height measure• Height and weight charts

ELOUISE BARRETUnited KingdomElouise has type 1 diabetes

Echelon 1: Equipment (2)

• Regular insulin • Intermediate or long-acting insulin • 100 U/ml syringes with needles• Drip setting equipment and IV fluids• Chart for diagnosis of diabetes mellitus• Chart with emergency treatment of DKA• Chart with management of sick days

Echelon 1: Support

• Communication chain with access to an echelon 2-4 centre

• Access to transport• A paper-based recording

system

LIAM & JORDAN CARSTENSSouth AfricaLiam & Jordan have type 1 diabetes

Echelon 2

• Echelon 1• Echelon 2

• Have basic exposure to diagnosis and treatment of diabetes

• Have insulin and diabetes supplies on site• Know how to start treatment with insulin• Recognize and start basic measures for DKA• Distribute insulin and diabetes supplies to patients• Supervise care prescribed by an echelon 3 facility

Echelon 2: Staffing

• Project officer responsible • Order supplies• Collect and record data• Distribute insulin, needles, syringes and diabetes supplies

• One or more clinic personnel would have attended a specialised workshop on the care of diabetes in childhood

• Healthcare worker for administering the data collection and management of stocks of medications

Echelon 2: Equipment (1)

• Glucose meters and strips • Filter paper strip for HbA1c determination

or HbA1c point of care analyzer• Urine microalbumin strips• Urine glucose and ketone strips • Refrigerated storage and insulin supplies• Stadiometer• Weigh scale

Echelon 2: Equipment (2)

• Be able to send samples for laboratory testing

• A computer to enter demographic data as part of a central registry

• A computer programme to track attendees and defaulters

• Display diagnosis posters

LIAM CARSTENSSouth AfricaLiam has type 1 diabetes

Equipment for in-patient care

• Blood glucose meter• Access to laboratory measurements• IV fluids for DKA management• IV infusion pump/3-way tap /Y connector• Chart for DKA management• Copies of the treatment plan (completed)

Teaching support

• Charts for:• Routine diabetes clinic

visit

• Sick days

• Managing DKA patient

• Teaching insulin injections

• Blood and urine testing

• Simple dietetic advice

• Information for schools

• Recording booklets (diaries)

• Diabetes support group

Ordering insulin

Maintaining supply of insulin

• Insulin is a life-saving drug• Crucial to keep adequate supplies at the clinic• Needs transportation and storage at 2-8o C• It has a limited shelf life – take note of expiry dates• Excess stocks of insulin should be returned as soon as it

is confirmed that they are not needed

Ordering insulin

• Should have at least double the amount needed by the hospital between resupply intervals

• 2 groups who require insulin • Existing patients• New type 1 diabetes patients

• Insulin requirements increase with growth

• Increased requirement for illness / DKA

Information needed

• How many vials or units of insulin did your centre use last year? Was it enough?

• When was there a shortage of insulin during the year? Do you know the cause?

• How many patients are in your clinic or centre now?• How many new patients tend to come each year (on

average)?

Patient safety

Patient safety

• Children and adolescents with diabetes who are not well controlled (i.e. high Hb1C) are vulnerable to infection

• Infection can cause DKA• Nosocomial infections possible

during clinic visitS• Safety programme (WHO)

Safety programme

• Wash hands before and after examinations• Use standard precautions• Clean and disinfect equipment• Specimen transport to the laboratory • Handling and disposing of sharp and contaminated

items • Ensure that the clinic is well ventilated• Regular cleaning

Diabetes camps

Diabetes camps

• Camps are a great source of learning and support for both children and professionals

• Can be organised just for children or just for adolescents• Can also include other family members, parents, siblings

• Goal is to share knowledge about living with childhood diabetes

• Live with other children who have diabetes for a few days

• Teaching by healthcare professionals, children and parents

Goals of the camps

• Knowledge and confidence to: • Give injections• Test glucose levels• Estimate food portions • Deal with other illnesses• Understand why diabetes in children is different from

adult diabetes

• Learn how to live a normal life with diabetes with peer-to-peer teaching and role modelling

• Parents learn how to give emotional and practical support to the child

External partners and donors

External partners & donors

• Reinforce the development of your clinic with support from external partners and donors

• Knowledge• Manpower• Resources• Skills • Experience

• Process and considerations in manual

• ISPAD (www.ispad.org)

• International Diabetes Federation (IDF) (www.idf.org)

• World Diabetes Foundation (WDF) (www.worlddiabetesfoundation.org)

• Life for a Child (www.lifeforachild.org)

• Children with Diabetes (www.childrenwithdiabetes.com)

• Rotary Club (www.rotary.org)

• Lions Club (www.lionsclub.org)

• Juvenile Diabetes Research Foundation (JDRF) (www.jdrf.org)

Organizations

Questions