Vaccination Referrals from ED Paediatric Antimicrobial Guidance Children’s Services Resolution and Escalation Protocol Blunt Chest Wall Trauma/Rib Fractures Information for Parents Carers of Children Having Investigations in Relation to Unexplained Injuries + Consent form Bruising and Injuries in Babies and Children – Parents Leaflet Multi-Agency Protocol for Injuries to Non-Mobile Children Flowchart for children attending Galloway Community Hospital (GCH) for NAI Follow Up Skeletal Survey Flowchart for children attending DGRI for NAI Follow-Up Skeletal Survey Cognitive Function Conscious Level Kidney Biopsy Complications Parenteral Iron for Non-HD CKD Patients Fracture Management Guidelines (Paediatric) Fracture Management Guidelines (Adult) Management of Hypertension in Acute Stroke Prescribing for CAU Patients Still in ED Hypothermia Deactivation of Implantable Cardioverter Defibrillator Myeloma Croup Care Of Burns In Scotland (COBIS) Paediatric Guidance Management of Epistaxis Sore Throat Differential Diagnosis Dizziness Differential Diagnosis Peritonsillar Abscess/Quinsy Acute Tonsillitis Acute Mastoiditis Otitis Media Otitis Externa Extravasation of IV Amiodarone WoS Paediatric Drooling and Aspiration Guideline Palliative Care – How to Refer Eating Disorders Stroke Care Warfarin Anticoagulation for AF, DVT and PE Molnupiravir MyPsych Foundation Doctors Toolkit Paediatric Febrile Neutropenia Guidance PAEDIATRIC HYPOGLYCAEMIA MANAGEMENT in NON DIABETIC CHILDREN   Paediatric Diabetic Ketoacidosis (DKA) Guideline Child Protection Policies and Procedures (D&G) Management of Acute Behavioural Challenges in Adolescents and Young People presenting to Secondary Care Cancer of Unknown Primary Patients Returning from Interventional Cardiac Procedure Treatment of Malaria Discharging Patients on High Dose Steroids Sotrovimab Paediatric Ketone Correction Guideline Insulin Correction Factor Table (Paediatrics) Management of uncomplicated Henoch-Schonlein Purpura (HSP) in under 16s Management of Hypoglycaemia in Children with Type 1 Diabetes Newly diagnosed diabetic – not in DKA (Walking wounded) Proton Pump Inhibitor Guideline for Neonatal and Paediatrics Stroke – Post Thrombolysis Neonatal Guidelines Gentamicin Prescribing (Paediatrics) Management of Anaphylaxis (Paediatrics) Management of Prolonged Seizures (Convulsive Status Epilepticus) in Children Bronchiolitis Acute Wheeze or Asthma in Paediatrics Conscious Proning Covid-19 Basics Remdesivir Thromboprophylaxis Identifying Patients in the Highest Risk Groups Steroids for Patients with Covid-19 Infection IL-6 Inhibitors – Tocilizumab or Sarilumab Baricitinib Paxlovid (Nirmatrelvir/Ritonavir) Influenza A Inhalers for Adults with Asthma Standard Operating Procedure for AMU Trigger Finger/Thumb Osteoarthritis of the Hand/Thumb Mallet Finger Ganglion Dupuytren’s Contracture De Quervain’s Tenosynovitis Carpal Tunnel Syndrome Prescribing Advice on Admission – Clozapine Prescribing Advice on Admission – Methadone/Buprenorphine Prescribing Advice on Admission – Corticosteroids Prescribing Advice on Admission – Items Not Prescribed by GP Prescribing Advice on Admission – Patients on Chemotherapy Regimes Prescribing Advice on Admission – Medication for Parkinson’s Disease Prescribing Advice on Admission – Insulin Prescribing Advice on Admission Medical Emergencies in Eating Disorders (MEED) Gentamicin & Vancomycin HIV Testing Guidelines Metabolic Syndrome Associated Fatty Liver Disease (MAFLD) Greener Inhaler Prescribing C4 Predischarge Beds Handover Safe and Secure Handling of Medicines Blood Glucose & Steroids IV Fentanyl & Morphine for Acute Pain in Adults Assessment & Management of Acute Pain Hospitalised and Has Coronavirus19 Infection (No suspected Viral Pneumonia Syndrome) Hospitalised Due to Coronavirus19 with Likely Viral Pneumonia Bi-Level NIV S/T Guidelines for CCU Phase Bi-Level NIV S/T Guidelines for ED Phase Adults With Incapacity Premenstrual Syndrome Pelvic USS Boarding Coeliac diagnosis pathway (Adults) Voice clinic Ear Wax Dermatology Squamous Cell Carcinoma (SCC) Malignant Melanoma Basal Cell Carcinoma (BCC) Nipple Discharge Early Cancer Diagnostic Clinic (ECDC) Genetics Referrals Breast Infections Breast Pain Primary Care Prescribing Guidelines Emergency Department Anaesthetics and Chronic Pain Team Respiratory Referrals Chronic Cough Pathway GP Clinical Handbook Test Paediatric Bronchiolitis Early Cancer Diagnosis Clinic (ECDC) Obstetrics & Gynaecology/Medicine Admission Agreement Idiopathic Intrancranial Hypertension Urology Out of Hours Urology Out of Hours Sengstaken/Minnesota Tube for Bleeding Varices Eradication of Helicobacter pylori Transfer from Galloway Community Hospital Repatriation of Patients from Tertiary Hospitals THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 1, Risk factors THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 3, Postnatal assessment & management THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 4 THROMBOPROPHYLAXIS IN PREGNANCY – Appendix 2, Management of women with previous VTE THROMBOPROPHYLAXIS IN PREGNANCY, LABOUR AND THE PUERPERIUM Orthopaedic VTE Risk Assessment Sodium Glucose Transporter 2 Inhibitors (SGLT2i) Cardiology Referrals Vascular Referrals ‘Watershed’ Conditions Myasthenia Gravis Gentamicin in Renal Replacement Therapy Vancomycin in Renal Replacement Therapy REDMAP Poster Realistic Conversations Summary Plan for Deteriorating Health Treatment Escalation Plans Ambulatory Care for Blood and/or Iron Infusion Principles for Light Touch Patients – B2 Clostridiodes difficile Infection Post Astra Zeneca Vaccine Headache Blood Culture Rhabdomyolysis Analgesia Acute Appendicitis Small Bowel Obstruction Elective Admission – Colorectal Surgery Trauma Admissions Post-operative Care Gallstone Disease Vasopressors and Inotropes/Chronotropes Shock Elective Admission – ERCP Elective Admission – Orthopaedics Laxatives Fat Embolism Compartment Syndrome Surgical Post-operative Complications Stoma Diverticular Disease High Dose Steroid Pre-Treatment Checklist Acute Surgical Admissions Level 1 CCU Medical Area Acute Oncology STEMI Thrombolysis Protocol Haemolytic Anaemia Conversion Charts Anticipatory ‘As Required’ Medications Syringe Driver Chart Scottish Palliative Care Guidelines Covid-19 Sick Day Rules for Patients with Primary Adrenal Insufficiency Diabetic Retinopathy Coming Off Benzodiazepines and “Z” Drugs Dental Abscess Facial Trauma – Mandibular Fractures Facial Trauma – Orbital Fractures Facial Trauma – Zygoma Platelet Transfusion Death Certification Parenteral Iron in Adults >18 Years OPAT SBAR (Complex Infections) Mental Health Liaison Team Referrals STEMI Admitting Patients with Tracheostomy/Laryngectomy to DGRI Emergency Laryngectomy Management Emergency Tracheostomy Management Safe Transfer of Patients with Tracheostomy/Laryngectomy within DGRI Other Tracheostomy Documents Systemic Anticancer Therapy Toxicity Haemodialysis Medication Prescribing Breaking Bad News by Telephone End of Life Diabetes Care Adrenal Insufficiency Serotonin Syndrome DGRI Referrals Confirmation of Death Neuroleptic Malignant Syndrome Pulmonary Embolism Deep Vein Thrombosis of Lower Extremities Exacerbation of COPD Contrast Associated AKI Acute Kidney Injury – Introduction Paracetamol Hypertensive Emergencies Staphylococcus aureus Bacteraemia (SAB) Rate Control in AF Common Scenarios Acute Severe Ulcerative Colitis IV Fluid Prescription in Adults Chronic Obstructive Pulmonary Disease Legionnaires Disease Septic Arthritis Guillain-Barré Syndrome Back Pain Anaesthetics – Unscheduled Procedures Requests Hyperglycaemia & Steroids Variable Rate Insulin Infusion Decompensated Liver Disease Fast Atrial Fibrillation – ACP Hyperkalaemia Contraindications to MRI Magnetic Resonance Imaging Bleeding with Other Antithrombotics In-patient Hyperglycaemia Management Anaemia (Management) – ACP Suspected NSTEMI – ACP Guidance on Chaperones Compulsory Admission and Treatment Radiology Immediate Discharge Letter Alcohol Withdrawal Fentanyl Patches in the Last Days of Life Care in the Last Days of Life Low Molecular Weight Heparin Interstitial Lung Disease Haematinic Testing Thromboprophylaxis for Non-Covid Patients Lung Cancer Osteoporosis Heart Failure Fluid Replacement in AKI Death & The Procurator Fiscal Thrombophilia Screening Neutropenic Sepsis Acute Vertigo Aortic Dissection Antithrombotics in Hip Fracture Transient Global Amnesia Hypomagnesaemia Hypophosphataemia Oxygen Therapy Falls – ACP Falls Acute Asthma Oncology Contact Details & General Advice Reversal of Warfarin Lumbar Puncture, Antiplatelet & Anticoagulant Drugs Antithrombotics & Surgery Non ST Elevation MI (NSTEMI) Suspected Acute Coronary Syndrome Antibiotics and the Kidney Acute Upper GI Bleeding (AUGIB) Pericardiocentesis Pleural Effusion Spontaneous Pneumothorax Acute Diarrhoea Iron Deficiency Anaemia Hyperthyroidism Gout Giant Cell Arteritis Pacemakers Clinical Suspicion PE – ACP Community Acquired Pneumonia (CAP) Management of Urinary Symptoms Management of Acute Kidney Injury SSRI Poisoning Immobility Autopsies Indications for Echocardiography Bradycardia Suspected Meningitis Hypernatraemia Diarrhoea – ACP Suspected Meningitis – ACP Blood Transfusion Brain Tumours Newer Antidiabetic Drugs Parkinson’s Disease Major Haemorrhage Protocols (DGRI & GCH) Major Haemorrhage Stroke Thrombolysis Heart Failure – ACP Suspected Anaphylaxis Anaphylaxis – ACP The AMB Score – ACP Transient Loss of Consciousness (TLOC) – ACP Bell’s Palsy – ACP Suspected Sepsis Lumbar Puncture Hypokalaemia Gentamicin Dosing Transient Loss of Consciousness Urinary Tract Infection Urethral Catheterisation Vancomycin Dosing Hyponatraemia Narrow Complex Tachycardia Hypocalcaemia New Onset Type 1 Diabetes – ACP Paracentesis for Tense Ascites – ACP Idiopathic Intracranial Hypertension – ACP Other Funny Turns Hypoglycaemia Hypoglycaemia – ACP Management of Transfusion Reactions Hypercalcaemia Haematemesis – ACP Anti-Platelet Therapy in Coronary Heart Disease Unfractionated Heparin Infusion Anaemia (Investigation) – ACP Delirium Suspected Seizure – ACP Headache – ACP Community Acquired Pneumonia – ACP Cellulitis Dyspepsia Management of Acute AF Rhythm Control in AF Atrial Fibrillation Renal Transplants Massive Pulmonary Embolism Head and Neck Injury Diabetic Ketoacidosis Switching from VRII Insulin Pumps Diabetes Mellitus Aspirin Digoxin Poisoning Tricyclic Antidepressants Opiates Benzodiazepines Gut Decontamination Deliberate Self Harm Acute Liver Failure Asymptomatic Raised Transaminases (ALT & AST) Nutritional Support in Adults Refeeding Syndrome Parenteral Nutrition Crohn’s Disease Acute Pancreatitis Abdominal Aortic Aneurysms Malignant Spinal Cord Compression Post Splenectomy Sepsis Ascites in Cirrhosis Alcohol Related Liver Disease Hepatitis C Symptom Control Suspected Variceal Bleeding Severe Headache Status Epilepsy in Adults Lower Gastrointestinal Bleeding Functional & Social Assessment Breathlessness with Abnormal CXR Polymyalgia Rheumatica Rheumatoid Arthritis Ureteric Colic & Renal Stones Intravascular Catheter Related Blood Stream Infection Care of Vascular Access Urinary Incontinence Peritoneal Dialysis Related Peritonitis The First Seizure Hypertension Ventricular Tachycardia Cardiogenic Shock Complicating Acute Coronary Syndrome Telemetry The Diabetic Foot Subcutaneous Insulin Diabetes and Acute Coronary Syndrome Hyperosmolar Hyperglycaemic State Multiple Sclerosis Coma
In this section Close
Home | Articles | Diabetes and Endocrinology | Newly diagnosed diabetic – not in DKA (Walking wounded)

Newly diagnosed diabetic – not in DKA (Walking wounded)

Last updated 9th March 2023


  • Most patients will present with classic symptoms of diabetes or hyperglycaemic crisis (see below), with  a random plasma  glucose concentration  of ≥11.1 mmol/litre (200 mg/dL)  on two different occasions or
  • Fasting plasma glucose  of ≥ 7.0 mmol/L (≥126 mg/dL). Fasting is defined as no caloric intake for at least 8 h
  • In certain situations, the diagnosis of diabetes maybe unclear. It should be confirmed with observation, fasting and 2hour post prandial blood glucose or an oral glucose tolerance test. These situations include:
    • Hyperglycaemia found incidentally in a patient participating in a screening study
    • Presence of mild or atypical symptoms of diabetes
    • Hyperglycaemia in situations of acute infection, trauma, or other  stress


  • Polydypsia
  • Weight loss
  • Thrush
  • Excessive tiredness
  • Polyuria
  • Nocturia
  • Polyphagia

Please note that classical symptoms may be absent.

If patient is obese, of Black or Asian descent, has no ketonuria or there is evidence of insulin resistance (e.g. acanthosis nigricans), consider type 2 diabetes1

When diagnosing diabetes in a child or young person, assume type 1 diabetes unless there is a strong indication for type 2, monogenic or mitochondrial diabetes1

Initial Investigations

  • Height and weight
  • Blood for : (Available on the Order comms test group as Paediatric New Diabetic patient under or over 10 years of age)
    • Venous glucose, Blood ketones
    • Electrolytes(sodium, potassium, urea, creatinine)
    • Venous gas (pH, Bicarbonate)
    • Haemoglobin A1c (HbA1c)
    • Thyroid Function tests (TSH and fT4)
    • Thyroid peroxidase antibody
    • Tissue Transglutaminase (TTG) ( immunology request form needed)
    • Islet cell antibodies (GAD antibodies & Anti-IA2)
    • Cholesterol and triglycerides  if more than 10 years of age


Inform diabetes team, doctor, dietician, diabetes specialist nurse and the clinical psychologist.


  • Ward Staff should commence basic diabetes education focussing on practical elements, encouraging families to download the diabetes education app ‘deapp’ on their electronic devices.
  • Continuing diabetes education will be provided by the diabetes team.

Target blood sugar levels

  • Pre meal blood sugar targets 4-7mmol/l
    • 2 hour Post meal blood sugar targets 5- 9 mmol/l


  • Start all patients on multiple daily injections/Basal Bolus Regimen.
  • The usual total daily insulin is about 0.7 units/kg/day

Basal Insulin

  • For all patients,  start  Levemir (Detemir) on 0.4units/kg/day, split into 2 divided doses – i.e. 0.2units/kg in the morning and 0.2units/kg in the evening
  • For children more than 5 years old in whom it is felt that compliance with management might be an issue – start on Tresiba (insulin degludec) on 0.3 units per kg once daily.

Bolus Insulin is Fiasp (insulin aspart)

  • Start patients on a Insulin to Carbohydrate ratio as follows
    • 1-3 years  1 unit for 30 grams of carbohydrates
    • 4-6 years 1 unit for 25 grams of carbohydrates
    • 7-9  years 1 unit for 20 grams of carbohydrates
    • 10-12 years 1 unit  for 15 grams of carbohydrates
    • More than 12 years 1 unit for 10 grams of carbohydrates

If a blood sugar before meal is within target (4-7mmol/l) and a child less than 3 years eats 10 or less grams of carbohydrates it is possible to skip insulin. The 2h post meal capillary blood glucose (CBG) should be checked.

Calculate insulin sensitivity (ISF)/ correction factor (CF)

  • Calculate total daily dose (TDD). This will be 0.7units per kg ( For a 20 kg child it will be 20 X 0.7 = approximately 14 units per day)
    • The correction factor will be 100 divided by the TDD = (100/14= 7)
    • So the Correction factor now is 1:7 mmols – one unit of insulin will reduce the blood glucose by 7mmols.
    • See Correction factor sheet (appendix 1) for the amount of extra insulin to be given according to CFs and blood sugar readings

Ketone dose

  •  Extra insulin for ketones should be given according to the ketone management guideline

Example 1: A 4year old weighing 15 kg admitted to the ward with diabetes

  • Long acting insulin  will be
    • Levemir  = 0.2units/kg/dose – 3 units at breakfast (7 am) and 3 units at and evening meal (7pm)
  • Fast  acting insulin with meals- fiasp
    • 1 unit of fiasp for 25g of carbohydrates
    • Insulin sensitivity/correction factor= 1 unit for 7mmol.
      • Correction doses should be given with meals and not more than 4 hourly. See attached correction factor sheet.
    • Extra insulin for ketones should be given according to the ketone management guideline

Example 2: A 15 year old weighing 60kg admitted to the ward with diabetes

  • Long acting insulin- Tresiba 0.3 units/kg once daily = 18 units daily
  • Fast acting insulin with meals- 1 unit of Fiasp with 10grams of carbohydrates.


  • Check capillary blood glucose(CBG)
    • Before each meal
    • 2 hours after meals
    • Before bed
    • 4  hourly overnight
    • If capillary blood glucose is >14mmol/l check ketones and manage using the  ketone guideline
      • If ketones  are more than 2mmol/l discuss with consultant on call and
      •  Continue to test for ketones every 2-4 hours till they are less than 1.0mmol/L.

Managing high blood sugars and ketones

  • Calculate the patients total daily dose as above
    • Give extra insulin as per Ketone correction guideline (appendix 2)
    • Consider informing the consultant on call

Managing low blood sugars <4mmol/l

Please use guideline on management of hypoglycaemia in patients with diabetes

Discharge and Follow up

  • Prescribe:
    • Insulin detemir 100 units per ml (3 ml cartridge)
    • Insulin aspart (fiasp) 100 units per ml (3 ml cartridge)
    • Insulin degludec (Tresiba) 100 units per ml (3 ml cartirdge)
    • needles 4mm  if <5years and 5 mm if >5years
    • 1 pack glucogel triple pack
    • 1 box lancets (Microfine plus)
    • GlucaGen hypoKit (glucagon) 1 kit
      • 500 microgram <25 kg, 1 mg >25 kg
    • 1 box blood glucose sticks- appropriate to blood glucose monitor
    • 1 box blood ketone sticks
    • Blood sugar diary

On discharge

  • Patient should:
    • Monitor blood sugar at least 5 times a day(in the morning on waking, before meals, and before bed)
    • Carry out a blood glucose profile once every 2week (usual blood sugar checks and 4 hourly blood sugar tests overnight)
    • Ensure patient/family has the Diabetes booklet and the Carbs & Cals Book
    • Ensure that the discharge tick list has been completed and the patient/family has received training on hypoglycaemia management and the glucagon injection.
    • Arrange clinical contacts as follows:
      • Every week for 4- 5 weeks following discharge for review by a member of the diabetes team.
      • MDT clinic appointment – within 4 weeks of discharge.
      • Diabetes specialist nurse –  48 hours after discharge and then weekly.
      • Dietitian clinical contact with in the week.


Diabetes teamDSN/DRAt diagnosis
What is diabetesDSN/DRAt diagnosis
All about blood testsDSNAt diagnosis
All about injections
– Insulin therapy
– How it works
– Mode of delivery
– Dosage and adjustments
DSNAt diagnosis
More about diabetesDRAt diagnosis + ongoing
What happens nowDSNAt diagnosis
Monitoring diabetes
– Frequency of monitoring
– Target levels
– HbA1C
DRAt diagnosis
Treatments for diabetesDRAt diagnosis + ongoing
Diet introduction
– Effects of diet
– Effects of physical activity
– Intercurrent illness
DieticianAt diagnosis
Carbohydrate countingDietitianAt diagnosis + ongoing
Schools and nurseryDSNAfter diagnosis
High blood sugars
– When to test for ketones
– Effects of hyperglycaemia
– Sick day rules
DSNAt diagnosis + ongoing
Low blood sugarsDieticianAt diagnosis
Annual ReviewsDRongoing
Meet the psychologistPsychologistAt diagnosis
Age related issuesDSN At diagnosis if appropriate
Home visitsDSNAt diagnosis
Food diaryDieticianAfter discharge
Life goalsDSNongoing
Leaflets/ Travel/ DLADSNongoing


  1. Diabetes (type 1 and 2) in children and young people: diagnosis and management. NICE guideline published 01 August 2015 last updated 29 June 2022: .  Last accessed 09 October 2022.
  2. World health organisation definition, diagnosis and classification of diabetes mellitus and its complications. Part 1:  Diagnosis and classification of diabetes mellitus. WHO/NCD/NCS/99.2.Geneva; 1999
  3. ISPAD guidelines for diabetes in childhood and adolescence  2018
  4. Hansa R (1998). Type 1 Diabetes in children, adolescents and young adults. 5th ed. london: class publishing. 1-388
  5. Rewers M, Pihoker C, Donaghue K et al. Assessment and monitoring of glycaemic control in children and adolescents with diabetes. Paediatric diabetes 2007:8:480-18