Diabetes

Signs and Symptoms

Symptoms of type 1 diabetes

• Classic symptoms:
  • polyuria
  • polydipsia
  • weight loss
  • lethargy
• Less classic symptoms:
  • enuresis / nocturia in a previously toilet-trained child
  • unusually heavy nappies
  • vaginal candidiasis (esp. in pre-pubertal girls)
  • failure to gain weight in a growing child
  • poor school performance
  • recurrent infections
• Emergency symptoms (suggestive of DKA): Dehydration, vomiting, acetone breath, abdominal pain, hyperventilation, confusion, shock
• Be aware:
  • symptoms can progress within days or weeks. Have a high index of suspicion. Think of the Diabetes UK campaign of 4Ts:
    • toilet
    • thirsty
    • tired
    • thinner
• Diagnosis of diabetes can be missed in younger / preschool children due to a more rapid progression of symptoms, failure to consider the diagnosis, and more non-specific symptoms

Symptoms suggesting type 2 diabetes

• Obesity
• Aged over 10 years
• Strong family history of T2DM
• Acanthosis nigricans
• High risk racial or ethnic group

If diabetes is suspected

• Perform capillary blood glucose (BG) testing immediately
• If BG testing is not available then perform urinary dipstick testing
• If BG or urinalysis not available then refer immediately
• Do not perform fasting BG measurement, HbA1C, or oral glucose tolerance test
• Do not refer as an outpatient

If BG more than 11mmol/l or glycosuria (+/- ketonuria):

• Refer immediately (same day) to the acute paediatrics on-call team
• Inform child and family of the suspected diagnosis of diabetes

Management in secondary care

For type 1 diabetes

• Local paediatric team to confirm diagnosis
• Admit to hospital
• Manage DKA according to South West regional DKA guideline and local guideline for well children with diabetes
• Stabilise blood glucose levels prior to discharge
• Provide structured education for the child and family (to include a paediatrician with an expertise in diabetes, a paediatric diabetes specialist nurse and dietician)
• Provide initial prescriptions for insulin and equipment for the diabetes management (further prescriptions to be dispensed in primary care)

For other forms of diabetes, including type 2 diabetes

• Manage according to local expertise with involvement of tertiary specialists as appropriate to case

• Care will be provided by a specialist multidisciplinary team (MDT) including a paediatrician with expertise in diabetes, paediatric diabetes specialist nursing, dietetics and clinical psychology
• Although the MDT will be based in secondary care, support for the child and their family will also be provided in the community both at home and at school
• High quality care in line with the criteria set out in the Paediatric Diabetes, Best Practice Tariff (introduced in 2012)
• A minimum of 4 outpatient appointments per year including one annual review appointment, and an additional appointment with a dietitian
• Regular contact with the diabetes team, which might include telephone support/advice, home or school visits, and on-going education
• A minimum of 4 HbA1C measurements per year
• 24 hour access to advice on diabetes management
• Transition to adult services at a stage appropriate to the young person in accordance with locally agreed pathways
• Annual retinal screening from 12 years of age to be arranged according to local pathway

Royal Devon and Exeter Hospitals NHS Foundation Trust

• Referrals: Contact PDSN team daily from 8am to 6pm on their pager via switchboard on 01392 411611 for urgent advice
• Out of hours advice: Between 6pm and 8am contact switchboard on 01392 411611 and ask for on-call Paediatric Registrar. Advice is available 24 hours a day.
• Lead Paediatrician: Dr Chris Moudiotis
• Lead PDSN: Julie Kitchen

North Devon Healthcare NHS Trust

• Referrals: Paediatric diabetes team: 07884266159 / 07920235237
• Email: ndht.cypdiabetes@nhs.net
• Out of hours advice: Paediatric Registrar via switchboard - 01271 322577
• Lead Paediatrician – Dr Stuart Davison
• Lead PDSN – Richard Todd / Beverly Anderson

South Devon Healthcare NHS Foundation Trust

• Referrals: Tel: 07788416019 between 8am to 6pm Monday to Friday
• Out of hours advice: Contact Louisa Cary Ward on 01803 655526 or 01803 655531 and ask for the Paediatric Registrar
• Lead Paediatrician: Dr Phil Reilly

Plymouth Hospitals NHS Trust

• All referrals to the paediatric diabetes service for newly diagnosed patients should be made through the on-call paediatric registrar through Derriford Hospital Switchboard on 0845 1558155
• Lead Paediatrician: Dr Becky Smith

Patient Information

Diabetes UK

Evidence

National Paediatric Diabetes Audit Report 2012-13

Diabetes UK

Pathway Group

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: September 2016