Editors

PäiviMiettinen

MariPulkkinen

Newly Diagnosed Type 1 Diabetes in a Child

The signs and symptoms should be recognised early: thirst and frequent urination, enuresis in a previously toilet-trained child, tiredness, abdominal pain and vomiting (note: the difference with gastroenteritis is absence of diarrhoea!), disproportionate dehydration and weight loss. In an infant, the only sign may be respiratory distress resembling an asthma attack.
Action should be taken immediately: test blood glucose (plasma glucose) with a glucose meter or test the urine for glucose with a reagent strip. Additionally, test for ketone bodies in the blood or urine.
A standing request should be placed with the laboratory to inform the treating or on-call doctor immediately if a child's blood glucose concentration is increased or urine tests positive for glucose.

If diabetes is suspected in a child, further measures must be taken on the same day. Laboratory results must never be waited for over the weekend.
If the child's urine tests positive for glucose, his/her blood must be tested immediately for glucose.
The investigation of an incidental finding of glucosuria in an asymptomatic child may be carried out in primary care, provided that the blood glucose values are normal Incidental Glucosuria in Children.

If the blood glucose value is increased (or if the result of a blood glucose measurement is not immediately available) the child must be sent as an emergency to a local paediatric hospital with a paediatrician on call and with paediatric in-patient facilities.
The initial treatment of a child aged less than six months, or who does not yet speak or walk, should be carried out in a major (teaching) hospital.
Rehydration and insulin therapy should only be started in primary care in the event that the journey to the paediatric hospital is likely to take considerable time (hours). If the child is very unwell, an on call paediatrician should be consulted by telephone.
In order to correct dehydration, fluid replacement therapy should be initiated in the hospital emergency department and continued in the ward until ketoacidosis has been reversed.
Insulin therapy should be started in conjunction with the initial fluid replacement, either as a continuous intravenous infusion or intermittent subcutaneous injections (but usually only after admission to hospital).
Family and child education regarding diabetes and its treatment should start without delay at the hospital ward. The length of the first hospital admission is usually approximately one week, but during that period the home treatment of diabetes is already practiced.
See also A Child or Adolescent with Type 1 Diabetes in Primary Health Care.