Type 1 diabetes kids being missed
Type 1 diabetes is the most common endocrine disease in childhood and adolescence. Unfortunately, diagnosis can be delayed resulting in children being admitted to hospital in diabetic ketoacidosis (DKA).
A recent study in the MJA (Volume 190 Number 4, 16 February 2009) shows that approximately 30% of children with newly diagnosed diabetes were not sent to hospital within 24 hours of GP presentation, and that 50% of children admitted to hospital in DKA were seen by a GP in the previous week.
Some children are either misdiagnosed with other conditions, or are not being referred speedily enough to an emergency department. As a consequence, DKA is the most common cause of death in newly diagnosed type 1 diabetes albeit the most preventable, if detected early.
All children suspected of having diabetes, or who have an elevated glucose from a finger prick, should be referred immediately to a hospital.
Performing a full urine test on children who present unwell is another simple and easy test to identify young children and adolescents with type 1 diabetes.
All children (including those who are overweight or normal weight) should be assumed to have type 1 diabetes until proven otherwise.
No child with symptoms should be made to wait another day for confirmation of hyperglycaemia or diagnosis. It is important to note that approximately 25% of children with type 2 diabetes also present in DKA.
A child or adolescent does not need an oral glucose tolerance test (OGTT) for the diagnosis of type 1 diabetes. A urine test can give valuable information about the presence of glucose and ketones.
Misdiagnosis occurs because some of the symptoms of DKA can mimic other conditions. For instance: nausea, vomiting and weight loss can be confused with gastro enteritis; abdominal pain and an acute abdomen can be misdiagnosed for appendicitis; and Kussmaul respirations can be mistaken for a chest infection, pneumonia or asthma.
Doctors or nurses in general practice must send a child or adolescent with glucose present in either the urine or blood above the normal BGL range to the closest emergency department for assessment and prompt management. It is important to notify the Endocrinology Registrar to alert them of your patient’s arrival.
Refer to the Clinical Practice Guidelines: Type 1 diabetes in children and adolescents for further information.
