Insulin Dose Adjustment by a Dietitian.
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Date
2014-07
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Abstract
Background: Locally, experienced dietitians have been teaching carbohydrate counting
(CHOC) and associated insulin dose adjustment as per nationally recognised structured
patient education programmes for people with type 1 diabetes since 2005. In 2007, the
BDA suggested a protocol with organisational approval was best practice to ratify this
extended role1. As organisations have a responsibility to ensure competency of staff there
is sometimes, understandably, a reluctance to give local agreement without a legal
framework to underpin this practice. Dietitians are currently not eligible to do the nonmedical
prescribers course2.
Methods: People with type 1 diabetes who do not wish to attend secondary care, sit within
the level 3 diabetes service in primary care. Following completion of a CHOC workshop,
they often opt for e-consultation. This involves submitting electronic charts detailing blood
glucose (BG), carbohydrate (CHO) loads and insulin doses for advice. All insulin dose
adjustment advice by a dietitian is cross-checked by a prescriber (Diabetes Specialist
Nurse DSN) prior to email response. Three case reviews illustrate this process.
Discussion: Waiting for a prescriber to okay insulin dose adjustment advice from the
dietitian delays email response to patient by an average of 38 hours. A regulatory
framework such as a patient group directive or protocol would enable a dietitian to provide
this advice in a timely manner. Without organisational support locally, dietitians have been
refused this mechanism. Conclusion: This brief abstract provides evidence of on-going safe working of a dietitian
in an extended insulin dose adjustment role and reinforces the need for a legal framework
to underpin this practice.
Description
Keywords
Dietitian, Non-medical prescribing, Diabetes, Insulin dose adjustment
Citation
Boocock R, Bannister M. Insulin Dose Adjustment by a Dietitian. European Journal of Nutrition & Food Safety. 2014 Jul-Sept; 4(3): 218-220.