Hospital Hub: Spotlight

Q&A with Siobhan Hatten, CF-related Diabetes Nurse Specialist, SVUH

CF Ireland were lucky to have a virtual Q&A with nurse Siobhan Hatton from St Vincent’s University Hospital (SVUH). Siobhan is the only CF-related Diabetes nurse specialist working in Ireland.

Liz Jacques, Regional Development Officer, had a virtual ‘sit down’ with Siobhan to ask her more about her role and her insights into this specialist area of nursing.

Tell us a little about your educational and professional background and how you came into your current role?

I graduated from University College Dublin (UCD) with a BSc in Nursing in 2007 and during my nursing training in St. Vincent’s University Hospital I worked on the cystic fibrosis ward. I thoroughly enjoyed my experience there. When I started my nursing career in St. Vincent’s University Hospital I requested to work on the CF ward.

From here I gained an interest in diabetes and its effects on people with CF, both physically and emotionally. In 2009 I was offered a position within the SVUH Diabetes Centre and completed my Higher Diploma in Diabetes while working here. During my time working in the Diabetes Centre, the complexity of Cystic Fibrosis related diabetes was noted. In 2015, I was appointed the first dedicated Cystic Fibrosis Related Diabetes Clinical Nurse Specialist (CFRD CNS) in Ireland.

How long have you been in your post?

Five years

CFRD is a unique form of diabetes, different to type 1 and type 2 DM. How would you explain this difference and what does this mean for people living with CFRD in terms of health outcomes?

CFRD is a unique form of diabetes specific to people with Cystic Fibrosis. Type 1 Diabetes is an autoimmune condition where the immune system attacks the cells in the pancreas that make insulin. People with Type 1 Diabetes are dependent on insulin injections. Usually people are diagnosed with Type 1 Diabetes when they are younger. People with Type 2 Diabetes may not make enough insulin and/or may have some insulin resistance, where the cells do not allow the insulin to work effectively. Often Type 2 Diabetes occurs in older people or adults who are overweight.

CFRD can share certain aspects of both Type 1 and Type 2 Diabetes. In CF, sticky mucus can cause scarring to the pancreas which creates a lack of insulin being produced or released. Insulin resistance can also occur during illness, steroid use or pregnancy in CF.

CFRD can be complicated due to the high calorie, high protein and high fat diet that is required in order to maintain weight in CF. This is very different to the advice given to people with Type 1 and Type 2 diabetes, which can lead to confusion for some people.

Some people with CF need to have high energy supplement drinks or overnight enteral feeds, which can further complicate insulin requirements. Individualised dietary advice should be provided by a dietitian with experience in CF and diabetes.

Untreated CFRD is known to have a negative impact on the body mass index and lung function. People with CFRD are also at risk of microvascular and macrovascular complications as well, however the occurrence of these appear to be less than in Type 1 or Type 2 diabetes. Due to this risk, it is recommended that all people with CFRD attend a specialised diabetes clinic regularly for review.

What has been the most challenging part of doing a unique nursing role, considering there is no one else in the country working as a CFRD nurse?

The most challenging part was to develop a service for people with CFRD which is entirely different to other forms of diabetes. I have had to adjust my skill set to the unpredictability of CFRD and think outside of the usual approach to treatment of diabetes. I am fortunate to have worked with incredible, inspirational nurses throughout my time in the SVUH diabetes centre. They have a wealth of knowledge that they were willing to share with me. I also have very supportive consultants, dietitians and medical doctors to help guide me. Without their help I feel the service would not have developed as it is today.

How has the COVID-19 pandemic impacted your patient cohort?

Unfortunately at the beginning of the Covid-19 pandemic the diabetes nurses were redeployed to assist the nurses on the wards. All of our clinics were moved to virtual clinics. The virtual clinics worked quite well for diabetes due to technology where patients could upload their data to a secure online platform. We also offered video calls, as well as phone calls. Through this it has allowed people with CFRD to stay connected with the diabetes team.

What is the most rewarding aspect of your nursing role?

The most rewarding part is definitely getting to know people with CFRD and their life experiences. It is a huge privilege to be in a position where I can help to improve their lives.

What advice would you give to someone who has recently been diagnosed with CFRD?

I always feel it is good to acknowledge that it is normal to have times where you have negative emotions towards your diabetes. The most important thing to do when you feel like this is to speak to your healthcare worker. Together you can work towards a suitable solution to help you.

What is the most common question your patients ask?

The most common question is usually related to the long-term use of insulin and if at some stage this can be stopped. In CFRD this question can be very difficult to answer as it is a very unique type of diabetes and dependent on the reasons for commencing insulin. Generally however, most CF people with diabetes would remain on insulin after starting it. It would be unusual to discontinue it.

How do new technologies help you in your role, for example virtual clinic technologies or remote monitoring?

The emerging technologies in diabetes have been a huge help in tailoring insulin regimens to the individual. A lot of the newer glucose monitors have apps that you can connect your meter to your phone. Some of these apps can alert the user to developing trends and allows you to email reports to your healthcare worker.

Siobhan recently spoke at the CFI Annual Conference on the topic of CF-Related Diabetes, alongside Dr. Eoin Noctor and Dietitian Lynda O'Shaughnessy. You can watch back the session on www.cfireland.ie