Dr. Nandu Thalange, 25th February 2016
- 28 March 2016
- Group News
Dr Nandu Thalange, Consultant Paediatrician, Norfolk and Norwich University Hospital
Dr Thalange started his presentation by outlining the treatment provided for young Type 1 diabetics in the 1990s and gave examples that described the limitations of the processes then available and the many problems that could and did unfortunately arise in some cases.
He then reviewed the period between 2002-2013 through which the aim was to provide diabetic children with as normal a life as possible. Over this time technical improvements that included new insulin analogues, more convenient testing and other advances such as insulin pumps were coupled to advancing practices such as increasing specialist nurse time, psychological and dietary support, carb counting education, a 24-hour phone helpline and regular patient contact via ‘phone, text and E-mail, all intended to give patients and their families an improved ability to self-manage, and thereby reduce the risk of complications.
Then three years ago the idea of ‘best practise tariff’ recognised the need to expand the diabetes team and use a now well established of model of care that is easily delivered by non-specialists. This model involves the early delivery of a self-management plan with, once diabetes skills are learnt, quick progress to basal-bolus treatment, starting on Novorapid and Levemir using cartridge pens that are calibrated in half units. In this system in-patient admissions are now confined to cases where diabetic ketoacidosis (DKA) develops. A 2013 Pilot further gave targets of 7-10 mmol/l for bedtime or sport and a post-prandial of 5-9 mmol/l. Happily all of the paediatric, diabetes dieticians and the rest of the diabetic team and clinical staffs accepted and are committed to this model of care.
Next year The NICE HbA1c target is 48mm per mol and helping with this 27 of the 35 newly diagnosed in 2014 are already on pumps, so greatly improving their control. This quick progress onto pumps is known to greatly reduce complications even 20 years on and these children can also be expected to enjoy longer lives. A recent further advance in testing comes as a small patch with tiny probes that sticks to the body and constantly measures blood sugars (actually measuring the correlated interstitial fluid’s sugars). Whenever needed it is easily read by simply passing a scanner/reader over it and this also very valuably indicates whether sugars are rising or falling, as well as keeping detailed records and analyses of results. This will be so much easier for children to use to manage their blood sugars compared to the laborious and uncomfortable finger pricking, strip and meter system, as will the apps they can use on their smart phones to easily calculate the carbohydrate values of meals.
Encouragingly in 2013/14 the target results achieved here in Norfolk exceeded the national average, but looking forward Dr Thalange was concerned that still too many children are presenting with DKA. Thus attention is being given to more training for ward staff in carb counting, the introduction of a weekend service for basal-bolus initiation and the rapid introduction of pumps within two weeks of diagnosis. He noted that the on-call rota for the telephone service is already in place. But for the overall success of these many and welcome advances EARLY DIAGNOSIS is still very critical.
The audience greatly appreciated Dr Thalange’s talk and were encouraged by the many advances in children’s diabetes care made by his team.