Investigating and managing diabetes in children (Type 1 & Type 2) (Paediatric Guidelines)

If the child has symptoms of diabetes (polyuria, polydipsia, weight loss and lethargy) but has reduced oral intake, has been vomiting or bloods have been taken before breakfast, they may have a normal blood glucose.

• Therefore, if the clinical suspicion is high, DO NOT be reassured by a normal glucose level. Please refer in, as, on the ward, the child can be given a high glucose meal or drink and blood glucose testing repeated.
• Other signs of type 1 diabetes can include fungal infections, such as thrush and balanitis over the age of 1 year, and should prompt testing.
• A urine sample tested for glucose can be useful but is often harder to obtain in the younger child and can give falsely reassuring results. So, as above, if the clinical suspicion is high, please refer the same day.

NOTE: Fasting glucose, laboratory glucose or HbA1c are NOT suitable investigations, and delay diagnosis, increasing the chance of patients developing DKA while waiting for tests and results.

Screening for type 2 diabetes in young people under 16 years (based on ISPAD guidelines 2022)

Undiagnosed type 2 diabetes is rare in the adolescent population, even among high risk individuals. Generalised population screening of obese youth is therefore unlikely to be cost effective in most populations.

Testing to identify clinical cases of diabetes SHOULD be considered in obese children and adolescents (BMI > 85th centile for age and sex) after 10 years of age who have the following risk factors for diabetes:

• First or second degree family history of type 2 diabetes
• Maternal history of type 2 diabetes or gestational diabetes during child’s gestation
• High risk ethnicity (south east Asian/afro-Caribbean/middle eastern background)
• History, symptoms or signs of insulin resistance (polycystic ovarian syndrome, acanthosis nigricans, hypertension, dyslipidaemia, obstructive sleep apnoea, low birth weight or small for gestational Age)

Other co-morbidities of obesity such as metabolic dysfunction-associated steatotic liver disease (MASLD), dyslipidaemia, elevated BP and PCOS (polycystic ovary syndrome) are more prevalent than dysglycaemia and SHOULD be screened for if Type 2 diabetes is being considered.

Type 2 diabetes can be diagnosed using an HbA1c.

• Please ensure the request form says 'suspected Type 2 diabetes’, NOT Type 1, otherwise the laboratory may not process it as it would be an inappropriate test for possible Type 1 diabetes.