Type 1 diabetes in children - emergency management

Abstract

Background: Fifteen to sixty-seven percent of patients with new onset type 1 diabetes mellitus (T1DM) present in diabetic ketoacidosis (DKA), of which approximately 79% initially see their general practitioner. Diabetic ketoacidosis is the most common cause of diabetes related deaths, mainly due to cerebral oedema that occurs in 0.4-3.1% of patients.

Objective: The aim of this review is to provide information to improve the early recognition of DKA and to provide guidelines for the initial management of DKA in the nonspecialist setting.

Discussion: Recognition of DKA can be improved by increasing the awareness for early clinical symptoms such as polyuria and polydipsia. It is important to include urinalysis and 'fingerprick' blood glucose and ketone measurements in the early assessment of patients with suspected T1DM and known T1DM, particularly if risk factors for DKA are present, to minimise serious complications and prevent fatal outcomes. Urgent referral to specialist centres for suspected new onset T1DM/DKA is required. Specific steps should be followed to ensure successful initial management of DKA in the nonspecialist setting before transfer.