COVID-19: Diabetes and Endocrinology service guide

April 2020

Scope

This information provides guidance on the management of Diabetes and Endocrinology patients across Northern Devon during the COVID-19 pandemic. The information is based on national guidance from various national sources which includes regularly updated resources for patients and health care professionals.

National guidance

Excellent information is available on:

Society for Endocrinology (SFE) website for COVID-19 and endocrine conditions

COVID-19 resources for managing endocrine conditions

Adrenal Crisis Information

Diabetes UK website

Updates: Coronavirus and diabetes

Association of British Clinical diabetologists (ABCD) website

Clinical guide for the management of acute diabetes patients during the coronavirus pandemic

COVID-19 Advice for Patients

Same day referrals

  • New diagnosis of type 1 diabetes
  • Gestational diabetes and diabetes in pregnancy
  • Diabetic foot ulcers – refer through foot pathway

Urgent referrals

  • Rapidly worsening diabetes control with severe hyperglycaemia
  • Recurrent severe hypoglycaemia and hypoglycaemia unawareness
  • New diagnosis of or strongly suspected Addison's disease, hypopituitarism, phaeochromocytoma, neuro-endocrine tumour, Cushing's syndrome.
  • Hyperthyroidism
  • Severe symptomatic Hypercalcemia with Calcium greater than 2.85 mmol
  • New onset rapidly progressing hirsutism
  • Severe hypertension (suspected endocrine) e.g. phaeochromocytoma

Routine referrals

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered.

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate. These are being prioritised according to clinical urgency.

Urgent advice

Here are the various ways in which you can seek specialist advice;

Existing methods
  • Diabetes nurse specialist. For queries from patients and health professionals, regarding diabetes treatment options, dose adjustments and general information specific to diabetes. Telephone: 01271 322726 (messages left on this phone are picked up regularly throughout the day Monday - Friday) alternatively contact main switch and ask them to bleep: 044. For less urgent enquiries you can email: ndht.diabetes@nhs.net, we aim to reply within one working day
  • Endocrine nurse specialist. For queries from patients who are already known to RD&E. Telephone: 01392 402847, or email: rde-tr.exeterendocrinenurses@nhs.net
  • Diabetes/endocrine consultant. For queries from health professionals only. Suitable for endocrinology and discussion of treatment options in diabetes, less suitable for insulin dose adjustment. Telephone: 0781 8002363 – we aim to be available 14:00 -14:45, Monday - Friday. Email: rde-tr.diabetesadvice@nhs.net – we aim to reply within a working day
  • NHS e-Referrals Advice & Guidance. Only suitable for generic diabetes/endocrine queries that could be answered by any consultant. Not suitable for queries about patients already known to the service, or lipid queries, as the system does not allow forwarding to colleagues
  • The diabetes foot service for urgent foot problems
  • The diabetes pregnancy service

Advice & Guidance

Advice and Guidance services aim to maintain operation for urgent and non-urgent patients. This is through DRSS referral system which is reviewed daily.

NHS e-Referrals Advice & Guidance is Only suitable for generic diabetes/endocrine queries that could be answered by any consultant. Not suitable for queries about patients already known to the service, or lipid queries, as the system does not allow forwarding to colleagues

Additional information found:

Website

  • The existing Exeter Diabetes Handbook
  • The new COVID-19 pages on the Handbook – contains advice on insulin dose adjustment and guidance for steroid-dependent patients

COVID-19 high risk patient advice for diabetes and endocrinology

High risk patient advice can be obtained from:

Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19

Extremely vulnerable and require shielding
  1. Patients with cystic fibrosis and advance lung disease with diabetes
  2. Those who have had organ transplant (with diabetes)
  3. Those who have endocrine complications from ongoing chemotherapy or immunosuppressive cancer treatment
At increased risk of severe illness from coronavirus (COVID-19) to be particularly stringent in following social distancing measures
  1. Patients on steroid replacement – Addison's disease, Congenital Adrenal Hyperplasia, hypopituitarism
  2. Patients with Diabetes in pregnancy
  3. Patients with diabetes and other co-morbidities

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 12-05-2020

 

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