Changing Diabetes and the Apis bull logo are registered trademarks of Novo Nordisk A/S

Organisation
Clinic

Echelon 1 - 2
Programme

1 Equipping a clinic

2 Ordering insulin

3 Patient safety

4 Diabetes camps

5 External partners and donors

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
Benedicts solution, test tube and
spirit lamp
Blood pressure set
(child and adult cuffs)
Weigh scale
Height measure
Height and weight charts ELOUISE BARRET
United Kingdom
Elouise 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 CARSTENS

South Africa
Liam & 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 CARSTENS
South Africa
Liam 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: Recording booklets
(diaries)
Routine diabetes clinic
visit Diabetes support group
Sick days
Managing DKA patient
Teaching insulin injections
Blood and urine testing
Simple dietetic advice
Information for schools
Ordering insulin
Maintaining supply of insulin

Insulin is a life-saving drug

Crucial to keep adequate supplies at the clinic
o
Needs transportation and storage at 2-8 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
Organizations

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)
Questions