Diabetes Mellitus in Children

Overview

Background

• There are approximately 30,000 children with diabetes in the England and Wales, of which the vast majority have type 1 diabetes.The incidence is increasing in those aged between 0-15 years.
• 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 longterm adverse effect on their diabetes control.
• BRHC have noted an increasing number of presentations of diabetes in children; both Type 1 Diabetes and Type 2 Diabetes (related to obesity often with strong FH or from BME groups).

Guidelines

• CKS Guidelines - Overview of Diabetes (type 1 and type 2) in Children (1)
• Referral of children with suspected Diabetes- links to Bristol Royal Hospital for Children guideline.
• Pathway for diagnosing type 1 diabetes in children - poster from Diabetes UK. Raising awareness of the 4 Ts of diabetes.

Red Flags

Symptoms

Clinicians should be aware of the symptoms of diabetes in children and test if there is any concern.

Symptoms of diabetes in children | Diabetes UK

• Toilet — Going to the toilet a lot to pass urine, bed wetting by a previously dry child or heavier nappies in babies. Getting up in the night to go to the toilet.  
• Thirsty — Being really thirsty and not being able to quench the thirst. Children may ask for a drink more often, finish drinks very quickly or generally drink more. 
• Tired — Feeling more tired than usual. Having less energy than normal, not playing as often, less energy for sports  
• Thinner — Losing weight or looking thinner than usual.

Test Immediately

Advice for clinicians is to perform a capillary (finger prick) blood glucose level immediately and if >11 to refer to Bristol Childrens  Hospital Emergency department the same day (Telephone 0117 342 8666).

• If blood glucose testing is not available then perform urinary dipstick testing and refer immediately if positive.
• If BG or urinalysis not available then refer immediately (see below)
• Do not perform fasting BG measurement, HbA1C, or glucose tolerance test
• Do not refer as an outpatient

See the BRCH advice on Referral of children with suspected Diabetes

Diabetic Ketoacidosis

Call 999 if Emergency symptoms (suggestive of DKA) : Dehydration, vomiting, acetone breath, abdominal pain, hyperventilation, confusion, shock. 

Referral for established diabetes

All children with a suspected new diagnosis of diabetes (type 1 or type 2) should be referred as described in the Red Flags section above.

Children or Young people with established diabetes should already be under the care of paediatric diabetes services. Children who are new to area or lost to follow up should be referred as below or see the Remedy Service Guide:

BRHC

Refer via eRS (Urgent) to Paediatric Endocrinology (children aged under 16).

Advice is available from the duty Paediatric Diabetes Specialist Nurses (PDSNs) on either 0117 3428572 or 0117 342 8559.

Out of Hours and weekend advice: Phone 0117 923 0000 and ask for the on-call paediatric registrar.

Weston

Refer via eRS to General Paediatrics (children aged under 16)

RUH Bath

Refer via eRS to General Paediatrics (children aged under 17)

Young Adults

Children should automatically transition to adult services when appropriate.

There are also Young Adult Clinics at NBT (aged 16-23) and RUH (aged 16-21) - available via eRS referral. See Service Guide for details.

Resources

(1) Overview | Diabetes (type 1 and type 2) in children and young people: diagnosis and management

Presentation of newly diagnosed type 1 diabetes in children and young people during COVID-19: a national UK survey | BMJ Paediatrics Open

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.