• Your home ward is F6.
• Social meetings (Tue, Thurs 12pm) are held at the Doctor's office on F6
• MDT Foot Round (Tue, 5pm) also starts at Doctor's office (usually foot patients on F6 then outliers)
• Foot clinic - Wolfson Diabetes & Endocrine Clinic in the Addenbrooke's Treatment Centre (opposite to Day Surgery)
• Departmental teaching/ M&M meeting - Wolfson Diabetes & Endocrine Clinic

Team structure: All patients are split between two teams. Diabetes and Endocrine/GIM (general medicine) with a consultant and registrar for each team. Each team should have an FY1. There is one CMT on the ward and he/she will be assigned to one of the teams as indicated by workload.

During a full 4month rotation you will be spending one half on the ward, and the other half doing the acute block. The acute block is similar in all medical specialties and includes your annual leave. The 2 months on the ward are also split such that you spend one month on the diabetes side and one month on the general internal medicine (GIM). There is a different team for each half, so you will gain a broad experience. (This is not rota-ed and should be discussed among the FY1s and Dr E Gurnell (Clinical Supervisor)

The diabetes side looks after patients with diabetes and other endocrine conditions. It also receives acute admissions from foot clinic (Wolfson Centre, ATC) which you will be asked to clerk.

The GIM side look after general medical patients whom are allocated to the team in morning report each day. You automatically cover any medical transfers to F6, medical admissions to A block and R2/rehab.

There are a lot of different meetings during the week where cases are presented by consultants/registrars and discussed. Most of these you will not be expected to go to but are welcome to if you have time and are interested.

Every Tuesday evening on the specialty side is the diabetic foot round. At 5pm on F6 a diabetes consultant (usually Dr Coll), a vascular consultant, an orthopaedic consultant and a podiatrist meet and go round all the inpatients with diabetic foot disease. You will be expected to join them and write in the notes for the patients they see who are under diabetes. During the round you will also need to get any imaging up for the surgeons. Vascular surgeons like arterial duplexes and angioplasties. Orthopaedic surgeons like to see X-rays and MRIs. It may be very difficult to organise MRIs of the feet, because they need to be approved by a MSK radiologist, of which there is only one in Addenbrookes. I would recommend requesting these by email, because it is virtually impossible to get hold of the right person when you need them. Under the new contract, since foot round usually extends beyond your normal working hours, you will need to exception report this.

It is highly advisable to prepare a proforma before the foot round starts, so that you are prepared to answer questions about microbiology results, antibiotics sensitivities, anticoagulation etc. It is also useful to make note of how long the patient has been antibiotics and blood tests (particularly renal function)

Every Tuesday and Thursday noon, there is a MDT/social meeting to discuss discharge planning. It is useful to make a brief note of MDT outcome.

DKA is very common. There is a DKA protocol order set on epic! Usually DKA protocol would have been started by the time you see them.They are usually on insulin sliding scale/ insulin infusion. It is important to check potassium levels before prescribing fluid (with KCL or without KCL), and make sure fluids are given at the correct rate as per DKA protocol. Similar to all patients on sliding scale, You need to make sure that they are eating and drinking normally; they have had their background insulin; and take down insulin sliding scale 1-2 hours after meal.

Hypoglycaemia- there is a guideline on connect. Management will depend on patients conscious levels. Important to give a quick acting carbohydrate followed by a long acting carbohydrate to sustain blood sugar levels.

Patients are often admitted from foot clinic and if working on the diabetes side you will need to clerk them. The plan is generally to give them IV antibiotics, bed rest. They may also need an arterial duplex or an MRI arranging but this will be decided by the admitting consultant. Most patients will need PICC lines arranging soon after admission as they tend to have many weeks of antibiotics

It's difficult to order some investigations (particularly radiology) before a patient is formally admitted- if there's no urgency clerking on the ward can be more straightforward. Make sure you gain IV access and send a set of routine bloods early - antibiotic doses may need to be adjusted because of impaired renal function and it's a lot easier to do that during the day shift than out of hours.

Endocrine admissions-

Occasionally patients come in for unusual endocrine investigations/treatments - for example lutate radionucleotide therapy. They will need to be (briefly) clerked in the endocrine unit (to the left as you walk into the WDEC diabetes clinc in ATC). It's important to write the discharge letter as part of the clerking as the procedures are usually overnight admissions with discharge before 9am following a registrar review the following day. If you're contacted by the endocrine unit and don't know what to do talk to the registrar on specialty (diabetes/endocrine) or Dr Helen Simpson (an endocrinolgy consultant). Dr Simpson has a set of EPIC smartphrases/favourite orders to correctly prescribe the necessary drugs and she'll probably want to check that you know what to do when you're first asked to clerk someone in the endocrine unit. The nursing staff in the endocrine unit may also be able to give you a paper protocol for the relevant pre-procedure drugs.

Request an arterial duplex - 'VSU arterial duplex' on epic, does not need to be discussed and is normally done within 1-2 days

Request an angioplasty - 'IR angio femoral (right or left)' on epic, does not need to be discussed by you. Normally done within 1-2 weeks

Request an MRI foot - 'MRI foot' on epic. Needs to be discussed with an MSK radiologist. Ring 6718 and ask if any are around - alternatively send an email to the MSK radiologist

On Endocrinology, evening cover (6-9pm) includes Endocrinology, Gastroenterology, ID and Acute Medicine (MSEU). You may also be asked to cover EAU4 between 8-9pm.

152409 - on call bleep for evening wardcover junior covering diab/gastro/ID&MSEU

157967 - GIM junior bleep

This rota averages at 47 hours per week, pay as per the national pay circular

There is a helpful protocol for the 72 hour fast. The nurses/ PA are usually happy to take the blood when needed, but it is often better to take it yourself, as the sooner the sample is taken the better it is for the patient (the sooner you take the sample when they are hypoglycemic, the sooner you can give glucose to the patient).

Hyperglycaemia is very commonly seen on F6. Patients usually have correct insulin prescribed PRN already. Nurses on F6 are usually very good at checking BM and give correction doses. Correction inuslins are usually prescribed as 1-4 units of Novorapid (If CBG 12-14.9, give 1 unit; if CBG 15-19.9, give 2 units; if CBG 20-24.9, give 3 units; if CBG above 25, give 4 units and inform a doctor) - though some consultants prefer tighter control. Check glucose 4 hours after correction dose is given. Do not check glucose too soon because if it is high, there is not much you can do as correction dose can only be give every 4 hours. It is important to watch out for mixed insulins, eg. Novomix. Because mixed insulins contain short acting insulin. If you give short acting insulin/ sliding scale at the same time as mixed insulins, there is a risk of hypoglycaemia.