Echelon 1 - 2
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Clinic
Organisation
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
• Benedict’s 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)
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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
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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
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
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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:
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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 peerto-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