More about what happens as an outpatient
Registering at Reception
You must report to the reception desk first. This lets the receptionist register that you have come and they will also check your details on the hospital computer, including your GP details and address.
Heights and Weights
You will then be told to report to the outpatient clinic nurses. They will measure your weight and height, because your weight is so important to your diabetes control. They will also ask you to provide a urine sample for testing. Some patients do the urine test at home on the morning of the appointment and bring it with them to clinic. This is more convenient for everyone. You can pick up a urine sample pot at the clinic to bring back with you next time.
You will then have a blood sample taken by one of the clinic nurses. This is sent immediately to the laboratory and the results should be available when you are seen. That blood is tested to show how well your diabetes has been control (using a HbA1c measurement).
If you are having your annual check up or if there has been a problem with your eyes, you will have a check done on your vision. The clinic nurse will ask you to read letters from a chart, to test the strength of your vision. They will then put eye drops into your eyes to dilate your pupils. This allows the doctor your look into your eyes.
You should not drive to the clinic if you are having an eye examination. The drops affect your vision and your ability to focus. This means that you cannot drive home safely for at least three hours after the eyes have been given. The eye examination is only done routinely once a year. The eyes are not examined in the diabetes clinic is you attend an eye clinic or if you are screened by an optician, as part of our community eye screening programme. Please also tell the clinic nurse if you have glaucoma. The eye drops should not be used in patients with glaucoma.
You will then be asked to sit in the waiting area. Unfortunately you may have to wait for some time, but we are always trying to improve the situation.
Seeing the Diabetes Doctor
You will then be called in for review. For some appointments, you will be seeing the Diabetes Doctor. For other appointments, you will be seeing the Diabetes Specialist Nurse. We work closely together and many patients see the Diabetes Nurse more than the Diabetes Doctor, particularly when we are working to improve the diabetes control.
On a routine review, the Doctor will mainly concentrate on your diabetes control and blood pressures. At your once a year full annual review, the Doctor will also examine your feet, insulin injection sites and eyes.
The Doctor will advise you about your medication and will usually ask other members of the Diabetes Team to see you, including the Diabetes Dietitian and Diabetes Nurse. Please remember that you yourself can ask the Doctor if you can see the Dietitian or Nurse.
When the Diabetes Doctor has finished seeing you, you will be given an outcome slip. Before you leave the clinic, you must take this to the reception desk to make your next appointments.
Seeing the Diabetes Dietitian
The Diabetes Doctor or Diabetes Nurse may ask for you to see the Diabetes Dietitian and they will show you where to go, You can also ask to be reviewed yourself and some patients come up for specific appointments on separate days to see the Diabetes Dietitian.
The Diabetes Dietitian will talk to you about your diet. There may be specific issues to discuss, such as plans for healthy eating, weight loss and adjusting your insulin doses to your food intake. There are often new developments, so that even if your diabetes control is good, you may benefit from seeing the Diabetes Dietitian once a year.
Seeing the Diabetes Specialist Nurse
Many patients attend the Diabetes Clinic specifically to see the Diabetes Specialist Nurse, rather than the Doctor. For example, this would happen if a review of the diabetes control is needed, if adjustments are being made to insulin treatments or if the Diabetes Nurse is teaching a patient or showing them new equipment. The procedure is still the same in the clinic and you will need to have your height and weight measured, a urine sample checked and a blood sample taken.
At other timer, after seeing the Doctor, they may ask for you to see the Diabetes Nurse on that day. You can always ask to be reviewed by the Diabetes Nurses yourself.
Seeing the Hypertension NurseThe Diabetes Doctor may ask for you to be seen by the Hypertension Nurse. This might happen if your blood pressure is high in clinic. Sometimes, all that needs to happen is for the Nurse to check the blood pressure reading. Sometimes, we may need to make adjustments to your blood pressure tablets and you may have to come back for several specific appointments with the Hypertension Nurse.
If you are coming to the clinic only to see the Hypertension Nurse, the Nurse will see you first before organising any other blood or urine tests, as these may not be needed. The Hypertension Nurse also sees patients to organise 24 hour blood pressure recordings, which we use when we are unsure about whether their blood pressure is really too high or not.
Making your next appointment
Before you leave the clinic, you need to report back to the reception desk to make your next appointment. These are requested on your outcome slip, which you need to give to the receptionist. Some patients may leave with more than one appointment. For example, you may have an appointment for the Diabetes Nurse, an appointment for the Hypertension Nurse and an appointment for the Diabetes Doctor. It can be very confusion and please ask the receptionist if there is anything you do not understand. Also, remember to pick up a urine sample pot before you leave the clinic, so that you can bring a morning urine sample with you when you come back the next time.