Diabetes Transition Clinic

Patient Information Leaflet

Introduction

Transition is described as the process of preparing, planning and moving from children’s (also known as paediatric) to adult services.

Moving away from a team of doctors and nurses that a young person has been with for many years can be a daunting prospect. The Dudley Group NHS Foundation Trust has developed this information leaflet to give you all the information and advice you will need about your transitional care with us.

What does transition mean and why do I need to move from my current diabetes team?

In healthcare, we use the word transition to describe the process of preparing, planning and moving your care from a child centred service to an adult service.

Transition is an important step in your care, as you change from a child orientated care package to an adult focused approach.

It is necessary as you move towards adulthood to have the right care in the right place, with healthcare professionals that are geared towards your needs. Everyone with a long term health condition, such as type 1 diabetes, will need to undergo a process of transition.

What is the young person’s diabetes transition clinic?                                                                     

It is a service aimed at providing care, treatment and education for young people with diabetes aged from 16 years onwards until 19 years of age, depending on needs. Your paediatric specialist diabetes doctor will refer you to the transitional clinic when you are ready.

Who provides the service?

It is provided by some of the same doctors and nurses who may have treated you when you were in the children’s clinic alongside the adult diabetes team. The young person’s diabetes transition clinic is a multidisciplinary clinic, and you can expect to meet

• The adult diabetes consultant and the children’s diabetes nurse.

OR

• The children’s diabetes consultant and the adult diabetes nurse.

The idea is you will get to know your new team alongside the team you already know, and we will all work together to give you the best diabetes care.

There is also a dietitian in clinic who you will meet during your time in the young person’s diabetes transition clinic. The dietitian will offer you carbohydrate counting advice, book sessions with you to review your diet, and can also offer advice regarding exercise management and treating Hypoglycaemia (low blood glucose levels). You can always request to see the dietitian when you wish.

Where and when is the clinic?

It is held on the third Tuesday morning of each month from 9.00am to 12.00pm. The clinic is at the diabetes centre at Russells Hall Hospital. Our clinic slots last half an hour, however depending on what you need, you may take longer.

What happens in the clinic?

Please bring your blood glucose meter to the clinic. This is really important as we will be able to review your recent blood glucose readings. Also bring along your home blood glucose monitoring diary (if you keep one). Before coming to your appointment, think about any questions you would like to ask and write them down so you do not forget.

When you arrive, you will be greeted by our reception staff and directed to have your blood pressure (BP), weight and finger prick HbA1c test taken. Over time, glucose in your blood slowly attaches to a protein called Haemoglobin. This is called Glycosylated Haemoglobin or HbA1C. The higher the blood glucose levels are, the higher the HbA1c will be.

The finger prick test is just like a home blood glucose test. You do not need to fast for this test and you are welcome to use your own finger pricking device. Once a year your bloods and a sample of your urine will need to be taken in the phlebotomy department as part of your annual screening.

You will then be invited into your clinic consultation by members of our team. You may be invited to attend clinic by yourself as part of preparing you for transition. Your parent(s) or carer(s) are always welcome to attend part of the consultation and to wait with you.

Please ask any member of staff if you do not understand anything that was discussed or the results of any tests. This is your appointment, so make the most of it.

You will have appointments every three months, but in between these appointments you may be seen by the diabetes specialist nurse or dietitian. You can also contact them by phone, text or email for non-urgent advice.

What are the targets for blood glucose control in the young person’s diabetes transition clinic?

There is a lot of research that advises people with diabetes targets for their diabetes control, blood pressure and cholesterol.

You should aim for the following targets:

Blood glucose range: 4 – 7mmol/L

HbA1c ≤ 48mmol/mol (6.5%)

It is important that you know these targets to help with your self-management of your diabetes. Please feel free to discuss with the team for your own achievable personal targets.

What can the transition team offer me?                          

We have tried to make the young adult clinic as welcoming as possible, and there is a specific waiting area where you can meet other young people with diabetes if you wish. There are also information leaflets which provide information on travel, exercise/sport, work, college, university and supporting you as a young person while you try and fit diabetes into your life.

The team also provides support and education on managing your diabetes and carbohydrate counting. We also offer you information about glucose sensors and insulin pumps if needed.

What is Ready Steady Go?                                            

The Dudley Group NHS Foundation Trust use the Ready Steady Go programme to support young people through their time of transition, and to encourage them to get involved in the transition process to make them feel confident and happier about the change.

You will be asked how you are progressing at the young person’s diabetes transition clinic in order for the team to assess when you are ready to be fully discharged into the adult diabetes service.

At this point, the children’s diabetes team will no longer be managing your care, and you will be solely cared for by the adult team in the young adult diabetes clinic.

What happens if I need help out of hours? Who do I need to call?                                                                

If you are aged 16-19, you will be seen within the young person’s diabetes transition clinic to help with your transition, but your care will remain under the children’s team. This means you will still be able to contact the children’s diabetes out of hours advice service. All the numbers you need are at the end of this information leaflet.

Contact Details

Children’s team

Diabetes team office: 01384 456111 ext. 3148, 3149 or 3150 (open Monday to Friday, 9.00am – 5.00pm)

Consultant: Dr Petkar

Secretary Paulette Dell: 01384 244367 (Monday to Friday,    9.00am – 5.00pm)

Diabetes specialist lead nurse: Jo Elford

Dietitian: Heba Abuwarda

Out of hours service: Ward C2 Children’s Ward 01384 244271

Email: dgft.paediatric.diabetes@nhs.net

Adult diabetes team

Consultant: Dr Siddique

Diabetes specialist nurse: Dawn Breeze

Dietitian: Carlie Bruce

Changing your appointment

Should you have a query or need to change an appointment, please use the phone number stated on your appointment letter.

A text reminder service is available should you wish to have a reminder of your appointment sent to you through text messages. This can be set up for you when you attend your clinic appointment.

Confidentiality and keeping your health information private                                                        

Doctors and nurses need to know certain things about you in order to look after you. This is your personal health information.

The law says that doctors and nurses must keep your information private, however, they are allowed to tell other doctors or nurses, for example, your GP. Sometimes, if you or someone else is at risk, information will be shared in order to safeguard and protect you and others.

Sometimes, your information can also be used to help improve our services to you. Usually, details such as your name and address will not be passed on when this happens.

Further information

Diabetes UK have a section for information regarding diabetes in young adults called ‘My Life’, www.diabetes.org.uk. Another good website is www.jdrf.org.uk.

If you are keen on sport then www.runsweet.com can give you extra practical advice on how to manage your diabetes when playing sport.

A website for young people with type 1 diabetes created by young people is www.Justdukit.org.uk.

Diabetes online community, e.g. Ninjabetic1.blogspot, www.dafne.uk.com.

For resources and further information about diabetes, please go to https://www.t1resources.uk/home/.

If you have any questions, or if there is anything you do not understand about this leaflet, please contact:

Russells Hall Hospital switchboard number: 01384 456111

Paediatric Diabetes Team: ext. 3148, 3149 or 3150

Adult Diabetes Team: ext. 3399

If you have any feedback on this patient information leaflet, please email dgft.patient.information@nhs.net

Originator: Hayley Weekes Date originated: November 2018 Date reviewed: October 2025 Next review date: October 2028 Version: 3 DGH ref: DGH/PIL/02018