18. Going home from hospital after a diagnosis of diabetes

Going home from hospital after your child has been diagnosed with diabetes can be stressful for families. It is normal to feel this way. The diabetes team are available every day to support you through this transition, so do please let us know if you are worried or finding things difficult.

It can be hard to take in a lot of information when you are tired and dealing with a new diagnosis. Remember that you don't need to know everything before you leave hospital, but we do want you to feel confident with the really important things such as giving insulin, testing blood glucose levels, treating hypoglycaemia and when to call. Before you go home, one of the Diabetes Nurse Specialists will spend time with you going through a brief summary of everything you learnt in hosptial. Also, you will be contacting us daily to discuss your child's blood glucose levels.

Here are some tips to help make the transition from hospital to home a little easier:

• Take care of yourself. Try to eat and sleep well as this may help you better cope with the changes and to support your child

• Talk to friends and family about your feelings. Get them to help with practical things like cooking, laundry and housework

• Try to get your prescription filled before leaving hospital if possible

• Start planning the return to school or pre-school. Arrange a time to meet up with your child's teacher and other staff who will be involved with helping them manage the diabetes at school/pre-school

• It can be really helpful for the whole family to write a simple plan of your child's daily routines, adding in when they have insulin and blood glucose tests. You can write this up or do it on a spreadsheet and put it in a place where everyone can see (e.g. on the fridge)

• You will need to call the diabetes nurses daily for the first few weeks to discuss your child's blood glucose levels and daily activities

Contacting the diabetes team for support

• Monday to Friday 1-4pm: The Diabetes Nurse Specialists are available to take calls from families, schools or anybody else connected with the care of children with diabetes between 1-4pm, Monday to Friday on 631 0790 and press option 2 or via email "diabnurse@adhb.govt.nz". The nurses are happy to talk about any aspect of diabetes care and management you may be concerned about and also provide advice about insulin doses.

• There is a Diabetes Doctor available for urgent support on 631 0790 and press option 1, 24 hours/day, 7 days/week however calls to the doctor should only be for the following reasons:

  • Your child is unwell with vomiting, diarrhoea, and/or fever

  • Your child tests positive for blood or urinary Ketones (>0.6 blood ketone test or pink/purple colour on urinary dip strip after 15 seconds)

  • Your child has had a severe hypoglycaemic episode or you are having problems keeping the blood glucose levels >4 despite repeated juice and carbohydrate treatment for hypoglycaemia

  • It is a weekend or public holiday and you are unsure of the insulin dose for your child (ring during the day)

Once stabilised (the levels are mostly within the target range and the insulin doses have stopped changing frequently) it is recommended that families ring the Diabetes Nurses:

• If the blood glucose readings are under 4mmol at the same time of day for 2 consecutive days,

Or

• If the blood glucose levels are above 10 for 3 days in a row at the same time of day.

Note about the Diabetes Telephone Support Service

It is important to note that the Starship Diabetes Service provide a telephone service to support families, it is impossible especially during times of high demand, to answer every call immediately.

There may be times when your call is diverted to an answer phone. In these instances, it is most likely because the nurse or doctor is taking another call/driving or out of range. Please leave a message on the nurse's phone and somebody will get back to you as soon as possible.

Please DO NOT LEAVE A MESSAGE ON THE DOCTORS PHONE - AS THIS PHONE DOES NOT HAVE THE CAPACITY TO STORE MESSAGES. Try again in 10-15 minutes. In the unlikely event that you are unable to reach the Diabetes Doctors or any of the nurses (for example a phone network failure) and you are not sure what dose of insulin to give, do not delay the meal; instead give the same amount of insulin you gave at that meal the day before and discuss with the diabetes team when you are able to make contact.

In an emergency situation call 111.

Checklist of things you need before you leave hospital

• Prescription or diabetes supplies (if already collected from pharmacy)

• Child disability allowance form

• Medic alert form

• Log book with insulin doses for next 24 hours

• Contact details for diabetes team

• Insulin pens (if applicable)

• Blood glucose meter pack

• School management plan and flip-chart

• Parents manual

• Sharps container

• Appointment for follow-up

Download the Starship Diabetes Team discharge advice brochure here.

Think you've got it sorted now?

If you have read through the information above, and you feel confident that you understand this topic, print off and fill in the evaluation form below (you might need to ask someone to print this off for you) and return to the nurse on your ward. If you have any questions, note them down on this form and your diabetes nurse specialist will discuss them with you.

Going home: evaluation

After reading this teaching module I: