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Diabetes Guidelines

Diabetes in Children and Young People

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Introduction

In the UK there has been a significant increase in the number of children and young people diagnosed with type 1 diabetes particularly in the under-five-year-olds. Type 2 diabetes is also increasing due to rising childhood obesity.

Providing services and care for children and young people with diabetes is very different than it is for adults. It is a complex process that needs to be focused firmly on the child or young person and their family/carers, involving multi-agency input. The health care professionals providing these services must be highly skilled and experienced within this field ( See - Clinical Care of Children and Young People with Diabetes - DoH 2007): the service must be led by a specialist paediatric diabetes team.

Diabetes can affect children and young people’s mental health and emotional well being. Day-to-day management of food, insulin, physical activity and mood can affect a wide range of their activities and development.

Risk taking behaviour amongst young people is a normal activity, but it can have serious consequences for those with diabetes. Although the challenges are considerable, many children and young people with diabetes achieve great things in all spheres of life.

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Aims of Care

Provide early access to specialist paediatric diabetes care.

Ongoing proactive clinical assessment, education about self care, support and access to advice.

Provide advice and support in schools and early years settings

Provide timely psychological support to avoid psychosocial vulnerabilities such as eating problems, social isolation, and fear of stigmas, depression and psychiatric difficulties.

Review 3 monthly. Monitor glycaemic control working towards an HbA1c target of less than 53 mmol/mol without frequent disabling hypoglycaemia.

Provide up to date monitoring and screening for: coeliac disease every 3 years, thyroid disease annually.

From the age of 12 years, screen for retinopathy, microalbuminuria and check blood pressure annually as recommended by NICE guidelines.

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Special Management issues

Clinical

All children and young adults suspected of having diabetes must be referred as an emergency ( See - Management of Newly Diagnosed Diabetes) for specialist assessment

Set realistic goals: overzealous application of clinical targets may compromise quality of life.

Adjust insulin regimes to suit the changes in individual lifestyle.

Many children with Type1 Diabetes will use a continuous subcutaneous insulin infusion pump. The child and family must be competent in carbohydrate counting, demonstrate blood glucose monitoring at least 4 times a day, have an awareness of insulin dose adjustment and be able to take steps to correct glucose levels.

Avoid strict dietary regimes.

3 monthly clinics where advice and education take place

Minimum additional contacts 8 times / year
Offer annual dietetic review
Provide additional specialist input for those who have HBa1c above 75 mmol/mol
Offer follow up appointments and additional contacts for those who DNA.

If type 2 diabetes, encourage diet and lifestyle changes before considering oral medication

Education

People working with children and young people with diabetes require regular and ongoing educational and training programmes

Playgroup / childminders / school teachers need education about diabetes, insulin administration and treatment of hypoglycaemia.

Provide advice on devices that suit the individual child/young person and their carers. This may include the use of insulin pens, insulin pumps, blood glucose meters, or syringes with newly diagnosed or young children where free mixing of insulin is required.

Provision of adequate glucose test strips as most will check their blood sugars 4 times a day. This needs to be increased if they are unwell or when parents / carer have concerns especially in young children.

Provision of blood or urine ketones strips to enable the early detection of ketones so action can be take to reduce the risk of developing diabetic keto-acidosis.

Sex education and advice regarding contraception (see - Sexual Issues and Contraception) at the earliest appropriate age is vital to prevent unplanned pregnancies

Support and Access

The complexity of the care of children and young people requires increased support in the community from experienced health professionals such as specialist paediatric diabetes nurses and dietitians

Open access to the children’s ward for a diabetes related problem

24 hour contact numbers

Help with disability living allowance forms.

Social activities to enable young people to meet and discuss their diabetes freely.
 

Referred as an Emergency - See Management of Newly Diagnosed Diabetes Guideline

Sex education and advice regarding contraception  - (See Sexual Issues and Contraception) - and Pregnancy (See - Diabetes & Pregnancy)

 

Transition to Adult Service

Under the ‘Best Practice Tariff ‘ arrangements young people with diabetes remain under the care of the Paediatric service until their 19th birthday but  at 16  they will move into a transition phase run jointly with the adult service.

From the age of 19 patients will move to a Young Adult (19-25) clinic (Bedford)

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Useful External Links & Resources
View National Patient Safety Suite - Caring for children and young people with diabetes mellitus - e-learning module
PDF File DoH | Making every Young Person with Diabetes Matter
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