60 seconds with Amanda Malinga
What do you do?
I have been lead for the Diabetes Specialist Nurse Team at The Royal London Hospital since July last year, but I have been a Diabetes Specialist Nurse since 2009.
Prior to that I worked in general and acute medicine in the old Royal London Hospital. I was a Diabetes Link Nurse for the ward and left to be a DSN in Primary Care. I moved to secondary care in 2015 but this was at Barts and now I’m here.
Shout out to my former managers Sarah Capsey and Elsa Cardoza for supporting me with time off to attend study days!
What challenges are we facing?
There are few challenges and one of the biggest challenge is our knowledge of diabetes. A lot has changed over the years and it is difficult for our colleagues on the wards and in clinics to stay updated and that includes nurses, doctors, pharmacists and other healthcare professionals. The challenge we have as a team is to tackle that fear surrounding diabetes so our colleagues can confidently manage less complex diabetes needs for their patients. Diabetes is an ever expanding condition and we need to tackle that head on.
Managing diabetes in secondary care can be challenging as it sometimes takes a backseat to the primary reason for admission to hospital.
With the increasing number of patients with diabetes staff nurses on wards staff are often busy and do not realise the implications of omitting insulin or timing of oral medications, due to staffing and time constraints. I am not sure how much our staff know or appreciate the importance and relationship between blood glucose monitoring, meal timing and insulin administration. All three are linked and our patients are aware of this.
Test, Treat and Eat - TEST - blood glucose before eating, TREAT - give diabetes medications before food and then EAT - people with diabetes should get priority.
Our team is working hard in making sure hospital healthcare professionals are adequately trained in the care and management of diabetes.
What could be improved?
There is an ever expanding population of more than 3 million people living with diabetes therefore diabetes is not for the specialist but for all professionals. I would like to see more of our colleagues feel comfortable in at least basic management of less complex patients with diabetes. Sometimes this is as easy as asking the patient what they take for their diabetes and how they manage at home. Our patients have access to diabetes professionals in the community and will be able to impart some of their knowledge to our nurses and doctors. I know it’s busy on the wards but this would save a lot of errors.
I would also like to see a decrease in the number of medication and insulin errors particularly omission of insulin in our patients with Type 1 diabetes. Omitting long acting insulin in a person with type 1 diabetes leads to life threatening DKA.