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Immediate management of suspected type 1 diabetes (Guidelines)

Type 1 diabetes is most frequent in children and young adults, but can occur at any age. This document focuses on the management of diabetes in children and young people. Guidance on the immediate management of suspected diabetes in adults can be accessed here.

Diabetes in children is almost always type 1, and the onset is fairly acute. The first symptoms are polydipsia and polyuria, which may in turn result in enuresis. Weight loss and lack of energy are often present as well. The duration of symptoms at presentation is typically between 1 and 6 weeks. The initial indications may be particularly difficult to pick up in children under 2 years of age.

Quite a few times each year, we become aware of a delay in diagnosis or referral which could have been avoided had a healthcare professional acted differently. As the condition can progress rapidly, a few days delay in diagnosis can result in Ketoacidosis, with associated morbidity and risk of death.

Making a presumptive diagnosis of diabetes

If diabetes is suspected on the basis of the symptoms above, blood sugar should be tested immediately using a blood sugar meter. A single random measurement of over 11 mmol/L is strong evidence of diabetes. In children particularly, a random blood glucose sample may be more useful than a fasting one. Children have limited glycogen stores, and a child who is hyperglycaemic during the day may have a near-normal blood sugar first thing in the morning.

In the event that blood testing is impractical, stick testing of urine for glucose should be performed - the finding of glycosuria in this context justifies a presumptive diagnosis of diabetes, whereas the absence of glycosuria makes the diagnosis very unlikely. Stick testing also allows evaluation of ketonuria, which indicates impending decompensation and may inform the urgency of further referral.

What to do next

On reaching a presumptive diagnosis of type 1 diabetes, the patient should be referred the same day, by telephone to the appropriate hospital-based service (Raigmore or Lorne and the Isles). Admission will be required that day if ketonuria is found; in the absence of ketonuria, the admitting team may elect to defer admission until the following day if this is more convenient for the family.

Raising awareness

Diabetes UK provide excellent Type 1 diabetes awareness posters, which may be suitable for display in surgeries.

Author(s): Consultant Paediatrician.

Approved By: TAM subgroup of ADTC

Reviewer name(s): George Farmer.

Document Id: TAM160