Diabetes Type 1

Clinical Description

• Insulin production absent because of autoimmune pancreatic beta-cell destruction
• Most children will have type 1 diabetes.
• Children with diabetes should be referred for proper management and treatment.
• Consider hydration while waiting for transport for referral
• These children need to be followed up every 3 months to monitor blood sugars and long-term complications of diabetes.

Signs and Symptoms

• As above for section 6.1

Investigations

• As above for section 6.1

Adults with no ketoacidosis or other acute Complication and have type 1 diabetes

Pharmacological

• Give NPH insulin Lente/Protaphane Insulin 2 doses daily

For proper management of diabetes mellitus refer to Clinical handbooks of QECH College of Medicine and KCH Intern Logbook as well as Pediatric handbook

• To decide the starting dose of Insulin:
• The total daily number of Insulin units will be approximately half the patients body weight, e.g., for a 60 Kg person give 30 units Insulin/day divided into 2 doses.
• Then give 2/3 daily dose half an hour before breakfast, give 1/3 daily dose half an hour before evening meal, preferably 12 hours apart.
• Adjust Insulin dose according to fasting blood sugar (FBS) or 2 hours post- prandial blood sugar; or symptoms of hypo or hyperglycaemia

Insulin requirements can go up when a patient is acutely ill, even if they are not eating. NEVER stop Insulin in a type 1 diabetic.

Diet

• Increase fibre intake
• Reduce refined sugar intake
• Insulin treated patients require 3meals a day containing complex carbohydrate to avoid risk of hypoglycaemia
• Advise patients to eat more before unaccustomed exercise

REFERRAL CRITERIA FOR SPECIALIST OPINION IF:

• Pregnant diabetic
• Acutely ill diabetic, particularly if vomiting or decreased Glasgow Coma Score (GCS)
• Treatable complications e.g., cataracts