Paediatrics: Type 1 diabetes mellitus - management

2021-03-03 12:00 AM

The initial care and subsequent longterm management of patients with T1DM should be delivered by a specialist paediatric diabetes team.

Type 1 diabetes mellitus: management

The initial care and subsequent long-term management of patients with T1DM should be delivered by a specialist paediatric diabetes team. All newly diagnosed patients must start insulin therapy as soon as possible. An intensive programme of education and support is needed for the child and parents. The aims of management of T1DM are:

  • education of child and family about diabetes;
  • insulin therapy;
  • nutritional management;
  • monitoring of glycaemic control;
  • avoidance and management of hypoglycaemia;
  •  management of acute illness and avoidance of DKA;
  • screening for development of associated illness;
  • screening for diabetes-related microvascular complications;
  • prevention and treatment of microvascular complications.

Education, counselling, and support

An intensive programme of education and counselling is needed in the first few days/weeks to cover the fundamental principles about T1DM and its management.

  • Basic pathophyisology of T1DM.
  • Insulin therapy:
  • actions of insulin;
  • SC injection techniques;
  • dose adjustment principles, including carbohydrate counting techniques.
  • Home/self blood glucose monitoring.
  • Acute complications:
  • avoidance, symptom recognition, and treatment of hypoglycaemia and diabetic ketoacidosis.
  • ‘sick day rules’ during illness to prevent DKA.
  • Diet:
  • healthy, low-fat;
  • high complex carbohydrate.
  • Long-term complications: risk factors and avoidance.
  • Psychological issues.

A considerable amount of time and need for repetition is required to deliver this information. The process of education and support is a con-tinual one with a need for regular review and updates of knowledge.

Nutritional management

Diet and insulin regimen need to be matched to optimize glycaemic con-trol. Instruction on and application of carbohydrate counting techniques are required. A healthy diet is recommended with a high complex carbo-hydrate and relatively low fat content.

Daily dietary balance for a healthy diet

  • 50–60% carbohydrate (complex/high fibre)
  • <30% fat (<10% in form of saturated fat)
  • 15–20% protein
  • Refined sugars limited to <25g/day

Blood glucose monitoring

  • Regular daily blood glucose monitoring and testing when blood levels are suspected to be low or high is recommended.
  • Home blood glucose monitoring is normally carried out using a portable glucose meter and finger-pricking device.
  • Regular testing is required to assist with insulin dose-adjustment decisions and to learn and predict how changes in lifestyle, food, and exercise affect glycaemic control.
  • A minimal testing frequency of 4 times per day should be encouraged.
  • SC continuous glucose monitoring (CGM) devices are also now available and in certain select situations may offer some advantages and benefits to patients.