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This month is World Diabetes Awareness Month and to raise awareness Diabetes Gibraltar has submitted this article to the Chronicle.

Every year, World Diabetes Day has a different annual theme, which highlights an important factor for the diabetic patient and diabetes care. This year, they have chosen the important role of nurses.

In Gibraltar the GHA runs nurse led Diabetes Clinics for adults, which cater mostly for Type 2 and a smaller number of adult Type 1 diabetic patients, and their emphasis is mainly on healthy lifestyle choices, as well as running education aimed at prevention of Type 2. The GHA also runs a separate Children’s Diabetes Clinic, which at present is exclusively Type 1 diabetes patients aged 0-20.

Type 1 diabetes is NOT preventable. Basically, for reasons yet to be established, the pancreas stops producing insulin, and therefore the person with Type 1 requires lifelong multiple daily insulin (either injected or pumped) to control their blood sugar.

I met up recently with Gibraltar’s Paediatric Diabetes Specialist Nurse, Cynthia Maoko and asked her about her role in dealing with Type 1 diabetic children. I asked how Type 1 diabetes was diagnosed in children; she explained that often parents noticed their child becoming tired, losing weight despite eating well, being thirsty all the time and passing lots of urine. This often prompted a visit to their GP who then referred them to the Children’s Diabetes Team; either to the Paediatrician or to the Paediatric Diabetes Specialist Nurse (PDSN).

A blood test would then be carried out to confirm Type 1 Diabetes.

Often the diagnosis is a huge shock not only for the child but the whole family. The PDSN’s role is one of support, reassurance and teaching the whole family how to manage the condition.

She gives unlimited time to guide and instruct the child and family, which can include any member who cares for the child, like grandparents and aunties etc. She also visits the school the child attends, any after school clubs and sports teams, making sure they are not only aware of the condition, but how to handle possible emergency situations, for example a hypo: very low blood sugar.

With the management of Type 1 diabetes, the patient would have to carry out a finger prick test 6 to 8 times a day to monitor their blood sugar levels. In Gibraltar now the majority of Type 1s (children and adults) are offered a “FreeStyle Libre” which is a glucose sensor which is usually worn on the back of the upper arm. This continuously monitors blood glucose and avoids the need to carry out finger prick tests.

The sensor can be scanned as many times as required, and the nurse explained that this has really helped parents who worry particularly at night that their child’s sugar levels would rise too high or drop too low. The parent can scan the sensor while the child sleeps.

The nurse was explaining how important it was to empower the diabetes patients to understand why they must monitor themselves. She teaches them to self-inject the insulin from the very first appointment (dependent on age) and gives them confidence to inject themselves even in public places, for example in a restaurant or at school. If appropriate, she will teach the child about insulin pumps which can be worn and give small frequent doses of insulin, instead of using the usual injections.

The nurse pointed out that as they child grows, their needs change. She sees Type 1 children as often as they need, and can always be accessed by email. As the child gets older friends become very important, and the nurse encourages a friend to attend the clinic appointments, and she feels this is especially important in teenage years when this friend becomes an “accountability buddy” and will keep an eye out especially at the beach or perhaps on a night out.

So, besides clinics, emails, blood tests, treatment plans and supporting the Type 1 diabetic child and family, I asked what other responsibilities the Paediatric Diabetes Specialist Nurse had. She replied that training was another big role. She trains and updates the nurses on Rainbow Ward in St Bernard’s so that if they receive a Type 1 diabetic child they are up to date with current protocols. She’s arranged training sessions on the use and maintenance of insulin pumps in the School of Health Studies and on Zoom.

Another part of her role is working in conjunction with the Diabetes Gibraltar Charity which is supported by her GHA managers, as both entities strive to give the best help and care to all diabetic people. Her main role within the charity is to be the voice for Type 1 children and organise and oversee social events sponsored and funded by Diabetes Gibraltar. Every year she organises the Type 1 diabetes children to get together for a Christmas party and last summer she arranged a respite sleep over at the Retreat Centre.

Pre-Covid, she also took diabetes teenage children to UK for summer camps organised by Diabetes UK. As you can imagine it’s so reassuring for child and parents to have a qualified nurse at these events, and it gives the children a chance to socialise with others who have the same condition as themselves.

As I re-read this article I was amazed at the dedication and hard work that this nurse does for the good of her patients, and like her, there are numerous other nurses who really care and go over and above for their patients. I am not surprised World Diabetes Day highlighted the very valuable and crucial roll nurses play in the care of diabetes.

Why nurses make the difference for diabetes: from helping to diagnose diabetes early to ensure prompt treatment, to providing self-management training and psychological support, nurses help people with diabetes manage their condition to prevent life-changing complications.

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