Background: Adequate sick day management at home may reduce the risk of progression to diabetic ketoacidosis (DKA) and admission to hospital. The UK does not have a consensus guideline for sick day management advice to children and young people with type 1 diabetes mellitus (T1DM). Childrens diabetes services vary in their practice of education and advice in the use of urine or blood ketone monitoring during illness.
Objective and hypotheses: The aim of this project was to review the variation of management of diabetes during illness.
Method: A survey was conducted by the Association of Childrens Diabetes Clinicians (ACDC) who sent out questionnaires to all paediatric diabetes units managing children and young people with T1DM including: local sick day management rules, out of hours diabetes support for families and information about the local diabetes service.
Results: 93/127 (73%) of the units responded to the survey. There were 14 tertiary centres. Median number of children per service was 161 (range 73450). The majority of units (93%) have a sick day management guideline in place.
|Advice on extra insulin||72% Based on total daily dose, 24% units/kg, and 23% other locally derived rule|
|Ketone monitoring||58% Blood ketones, 3% urine ketones only, and 40% used both|
|Out of hours advice for diabetes patients||49% Paediatric registrar, 16% diabetes nurse specialist or diabetes consultant, 27% diabetes nurse specialist/diabetes consultant on a joint rota, and 14% from diabetes team in the evenings/weekends and paediatric on-call overnight|
Conclusion: There was a wide variation in the practice of monitoring and advice given during illness. All guidelines advised increased doses of insulin during sick days but there was no consensus on how to calculate increased doses. There were also variations in the use of ketone testing and frequency on blood glucose monitoring. Some units still use urine ketone testing routinely. There is a need for evidence based national guidance to be in place.
01 Oct 2015 - 03 Oct 2015