Scope
This guideline is for children and young people below 18 years of age. For young people aged 16-18 years: the use of this pathway may depend on your local paediatric service provision for new referrals within this age-group.
Background
- There are approximately 25,000 children with diabetes in the England and Wales, of which the vast majority have type 1 diabetes.
- Approximately 25% of cases are not diagnosed until the child is in diabetic ketoacidosis (DKA), although this rate is higher (approx. 35%) in the under 5s.
- DKA requires intensive medical intervention, is traumatising for the child, and may have a long-term adverse effect on their diabetes control.
History
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
Assessment and referral
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
Red Flags
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
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
On-going care for children with diabetes
- 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
Paediatric Diabetes Teams in Devon
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
Home >
Referral >
Eastern locality >
Children and Adolescents >
Diabetes
- First line
- Second line
- Specialist
- Hospital