Insulin Dose Adjustment by a Dietitian

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 non-medical 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.