Synopsis
Recognise new childhood type 1 diabetes before ketoacidosis, confirm hyperglycaemia promptly and establish safe specialist-led insulin, glucose-monitoring, nutrition, education, school and sick-day systems without delaying treatment for unnecessary diagnostic tests.
- Think type 1 diabetes when a child has polyuria, nocturia or new bedwetting, polydipsia, weight loss and fatigue; candidiasis, abdominal pain or vomiting may accompany presentation.
- Same-day first test is capillary glucose when symptoms are present. A high result requires urgent paediatric diabetes assessment; do not wait for fasting glucose or HbA1c.
- Check blood ketones, venous acid-base status and electrolytes immediately when the child is vomiting, dehydrated, breathing deeply, drowsy or markedly ketotic.
- Diabetic ketoacidosis is a medical emergency: use the current BSPED paediatric pathway, senior paediatric oversight, careful fluid calculation and intravenous insulin without an insulin bolus.
- For children and young people, offer a multiple daily injection basal-bolus regimen from diagnosis unless an individual reason supports pump therapy or another specialist plan.
- Insulin dose is individual and changes with age, weight, puberty, activity, illness, carbohydrate intake and residual insulin secretion; prescribe in units and verify device and concentration.
- Continuous glucose monitoring should be offered in line with NICE, with capillary testing available for confirmation, symptoms that do not match the sensor and ketone-risk situations.
- Never omit basal insulin during intercurrent illness. Increase glucose and ketone monitoring, maintain fluids and carbohydrate, give correction insulin according to the personal sick-day plan and seek help for persistent ketones or vomiting.
- Treat hypoglycaemia promptly with the child's agreed rapid-acting carbohydrate amount when conscious, recheck after 10 to 15 minutes and use glucagon or intravenous glucose if oral treatment is unsafe.
- Education includes injection or pump technique, carbohydrate counting, exercise, driving when older, school support, psychosocial health, contraception and planned transfer to adult services.
Key red flags
Deep sighing breathing, reduced consciousness, shock or severe dehydration with hyperglycaemia requires immediate DKA treatment.
Headache, irritability, unexpected slowing of heart rate, rising blood pressure or neurological change during DKA suggests cerebral injury.
A child with classic symptoms and high capillary glucose must not be sent home to obtain a fasting sample.
Repeated vomiting or rising ketones despite correction insulin indicates failure of home sick-day management.
Severe recurrent hypoglycaemia, unexplained dosing discrepancies or absent adult supervision requires urgent plan and safeguarding review.
Recurrent DKA can signal insulin omission, device failure, eating disorder, family crisis or inadequate access to supplies.
A very young infant or atypical family pattern should trigger specialist consideration of monogenic rather than autoimmune diabetes.
Deep sighing respiration, drowsiness, tachycardia and dehydration indicate acidosis requiring emergency paediatric management.
Investigation priorities
Detect symptomatic hyperglycaemia immediately in any healthcare setting and determine urgency.
Management branches
A child has osmotic symptoms and a raised capillary or laboratory glucose.
- Assess ABCDE, hydration, weight, ketones and features of acidosis without waiting for fasting testing.
- Arrange same-day paediatric diabetes-team assessment and use the DKA pathway when acidosis or systemic illness is present.
- Initiate insulin, monitoring equipment and family education in a supervised setting with written contacts and safety-netting.
The child attends routine paediatric diabetes follow-up or moves between life stages.
- Review CGM patterns, HbA1c, severe events, insulin delivery, growth, puberty, sites and associated autoimmune screening.
- Assess emotional wellbeing, school participation, family workload, food relationship, adherence barriers and safeguarding privately and jointly.
- Revise goals and technology collaboratively and prepare a named, supported transition to adult diabetes care before handover.