In this section : Diabetes and Endocrinology
Paediatric Diabetic Ketoacidosis (DKA) Guideline
Paediatric Ketone Correction Guideline
Insulin Correction Factor Table (Paediatrics)
Management of Hypoglycaemia in Children with Type 1 Diabetes
Newly diagnosed diabetic – not in DKA (Walking wounded)
Prescribing Advice on Admission – Insulin
Diabetic Retinopathy
Adrenal Insufficiency
Hyperglycaemia & Steroids
Variable Rate Insulin Infusion
In-patient Hyperglycaemia Management
Hyperthyroidism
Newer Antidiabetic Drugs
Hypoglycaemia
Diabetic Ketoacidosis
Switching from VRII
Insulin Pumps
Diabetes Mellitus
The Diabetic Foot
Subcutaneous Insulin
Diabetes and Acute Coronary Syndrome
Hyperosmolar Hyperglycaemic State
Diabetes Mellitus
Last updated 3rd December 2020
Diagnostic Criteria
OGTT = oral glucose tolerance test with 75g glucose load
Symptoms = polyuria, thirst and/or unexplained weight loss
IFG = impaired fasting glucose, IGT = impaired glucose tolerance
If patient asymptomatic, 2 confirmatory tests are required
Approach to the Newly Diagnosed with Diabetes
- Important to decide whether type 1 or type 2 diabetes – type 1 needs insulin to avoid risk of ketoacidosis.
- Type 1 diabetes more likely if: age at onset < 40years; ketonuria/ketonaemia; weight loss; short history (few weeks) of symptoms; family history of type 1 diabetes or other auto-immune disease.
- If in doubt treat with insulin until advised by diabetes team
Poorly Controlled Type 2 Diabetes
- HbA1C <53 is ideal, <64 is acceptable, >75 should trigger referral to Diabetes Nurses
- Check for previous HbAlc results on the computer – is the poor control pre-existing or related to intercurrent illness? – temporary insulin treatment may be indicated.
- Check compliance with diet & drugs. Consider referral to dietitian.
- Consider increasing the doses of existing therapy or adding in additional therapy. Refer to diabetes team if likely to need insulin.
Conversion HbA1c from mmol/mol to %
- Most of us still think in terms of HbA1c%. To convert from mmol/mol to % add 24 then divide by 11. See table below for examples:
When to Check for Ketones
- Type 1 Diabetes with capillary blood sugar >13 mmol/l
- OR if following the DKA pathway
How to Interpret Ketones
- >1.5 mmol/l in blood or +++ – ++++ in urine. Risk of ketoacidosis. Patient requires urgent medical assessment to exclude DKA
- 0.6-1.5mmol/l or ++ – +++ in urine. Repeat capillary blood glucose and ketone measurement 2 hourly. May need to consider adjustment of insulin doses
- < 0.6mmol/l or + – ++ within the normal range. Repeat capillary blood glucose in 4 hours and ketones only if glucose still >13mmol/l
Referrals
- Consider referral for DKA/HHS, severe hypoglycaemia, newly diagnosed type 1, IV Insulin infusions with glucose outside limits or duration over 48 hours, unable to self manage, parenteral/enteral nutrition, foot ulcers, patient request.
- Please notify the Diabetes Nurses on 33896 or 33897 between 0800-1600 hours Mon-Fri or Dr Fiona Green (33864), Dr Salman Hassoun (32186) or Dr Muna Mohamed (33062) for Consultant advice.