Children at risk from delays in referrals on diabetes

Hundreds of children who get early onset diabetes each year are at risk of a further life- threatening condition because of delays in referring them for hospital treatment, Diabetes Ireland has warned.

Parents and GPs need to be aware of the importance of prompt referral of cases to specialist diabetes teams in order to reduce the risk of diabetic ketoacidosis (DKA), doctors say.

DKA occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin, and can result in a diabetic coma or even death.

Diabetes Ireland said that up to one in three children attending their GP with onset type 1 diabetes is not being referred to hospital promptly. As a result, half of them are also diagnosed with DKA.

The Irish figures are anecdotal but they tally with the results of a British study published in recent weeks which found that 34 per cent of children with type 1 diabetes suffered a delayed referral averaging two days.

Early recognition

“This study demonstrates the importance of the awareness and early recognition of the symptoms of type 1 diabetes in children and adolescents,” said Dr

Declan Cody

, a paediatric endocrinologist at Our Lady’s Children’s Hospital, Crumlin.

The most common reason for delays arises when the GP attempts to confirm the diagnosis by undertaking further tests, such as a fasting blood glucose test or oral glucose tolerance test.

"GPs ask parents to bring their child back for blood tests the next day or in a few days if they are not better, whereas an immediate urine or finger-prick glucose check is warranted," said Dr Anna Clarke of Diabetes Ireland.

Immediate care

UK guidelines say children with suspected type 1 diabetes should be offered same-day referral to a paediatric diabetes team with the skills to confirm diagnosis and provide immediate care. No such guidelines are in place here. In 2014, one in six children in Ireland diagnosed with type 1 diabetes admitted to hospital had DKA, although it is avoidable with early diagnosis.

Diabetes Ireland is targeting GPs, schools, crèches and pharmacies to increase awareness of the differences between type 1 and type 2 diabetes and the urgency in confirming type 1 diabetes and treating it early.

There are about 16,000 people with type 1 diabetes in Ireland, of whom almost 3,000 are under 16 years. Type 1 affects one in 500 children with a quick onset, occurring over days or weeks.

With DKA, the body, starved of insulin, begins to break down fat for energy. The person’s kidneys have to work harder to eliminate glucose in the blood, leading to thirst, tiredness, greater urination and weight loss.