• Actions to consider when average glucose levels are high for paediatric patients with type 1 diabetes.

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

This plan has been put in place because you or your Childs HbA1c has been confirmed as 69mmol/mol (8.5%) or above. It is very important to maintain a HbA1c value as close to 48 mmol/mol (6.5%) as recommended by NICE (National Institute for Health and Care Excellence) guidelines (without experiencing significant hypoglycaemia). This will minimise the risk of long-term complications of diabetes, improve overall wellbeing and maximize growth potential.

1. If HbA1c >69mmol/mol:

Please follow flowchart.

2. If HbA1c >86mmol/mol:

Please follow flow chart.

Clinical psychology review in clinic, which may trigger a CAMHS referral.

If supervision is a concern, and their safety is not being maintained at home, or their management is detrimental to their health please involve social care

Set 2 goals for improving glucose levels

If there are any signs of self-harm, please refer to CAMHS with parent and the Child or Young Persons permission.

3. If HbA1c >96mmol/mol, in addition:

Please complete all of the actions from point 2.

Consider urgent hospital admission for stabilisation

Admission

A stabilisation admission will be considered if you or your child’s HbA1c does not decrease appropriately. This will be a planned admission for 3-5 weekdays and a parent/carer is expected to be available to stay with their CYP throughout the day. All injections/pump boluses, carbohydrate counting and blood glucose monitoring will be supervised by the ward nursing staff and a food diary will need to be completed daily throughout the admission period.

Expectations of the diabetes team during the admission:

• Send a letter detailing the admission.

• Create a care plan for the CYP, parents and ward staff to follow during the admission

• Carry out education and review blood glucose levels.

• Identify any barriers to optimising diabetes management and agree a plan of how to overcome these.

• Creation of a discharge plan identifying everyone’s role in supporting the CYP to achieve optimal diabetes management in the community setting

• Arrange a follow up telephone call and clinic appointment

Planned outcomes of admission

1. This should be individualised for each CYP.

2. The main outcomes are to improve the CYP and parents knowledge and understanding of diabetes.

3. Identifying any barriers and agree a plan to overcome them

The table below shows the relationship between mean blood glucose levels, HbA1c and risk of complication: