ESPE Abstracts (2015) 84 P-3-688

ESPE2015 Poster Category 3 Diabetes (94 abstracts)

Management of Children with Type 1 Diabetes During Illness (Sick Days): Is There a Need for National Consensus Guideline?

Astha Soni a , Chizo Agwu b , Neil Wright c , Chris Moudiotis d , Melanie Kershaw e , Julie Edge f , Josephine Drew g & Sze May Ng a

aDepartment of Paediatrics, Southport and Ormskirk Hospitals NHS Trust, Ormskirk, UK; bDepartment of Paediatrics, Sandwell and West Birmingham NHS Trust, West Bromwich, UK; cDepartment of Endocrinology, Sheffield Children’s Hospital, Sheffield, UK; dDepartment of Paediatrics, Royal Devon and Exeter NHS foundation Trust, Exeter, UK; eDepartment of Endocrinology and Diabetes, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK; fDepartment of Diabetes and Endocrinology, Oxford Children’s Hospital, Oxford University Hospitals NHS Trust, Oxford, UK; gDepartment of Endocrinology, Nottingham Children’s Hospital, Nottingham, UK

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). Children’s 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 Children’s 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 73–450). The majority of units (93%) have a sick day management guideline in place.

Table 1 Results of survey.
Advice on extra insulin72% Based on total daily dose, 24% units/kg, and 23% other locally derived rule
Ketone monitoring58% Blood ketones, 3% urine ketones only, and 40% used both
Out of hours advice for diabetes patients49% 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.

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