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If you are an Alder Hey patient and have not used the guidelines previously, or are struggling to manage a situation at home – please contact the diabetes team for help.
The guidelines have been grouped together for ease, if you cannot find the guideline you need (or would like to suggest another guideline) please contact your keyworker during office hours.
There are approximately 29 thousand children with diabetes in the UK. 97 percent of these children have Type 1 diabetes. Of the remaining 3 percent approximately half have Type 2 diabetes, the last 1.5 percent covers the rarer forms of diabetes such as monogenic causes and disease related causes such as Cystic Fibrosis related Diabetes and Steroid induced diabetes.
Signs of diabetes that should alert you to seek an appointment with your GP or out of hours medical services / Accident & Emergency department are:
Type 1 diabetes
Type 1 diabetes is the most common type of diabetes in children. It is caused by the body’s immune system attacking the cells within the Pancreas that produce insulin. Type 1 diabetes needs lifelong treatment with insulin injections to maintain normal blood glucose levels. Insulin doses are given to maintain normal blood glucose levels and to deal with the glucose content of each meal.
Type 2 diabetes
Type 2 diabetes is uncommon in children (but can be much more common in certain ethnic groups). Patients with Type 2 diabetes still make insulin, but their bodies are less able to make use of it. This form of diabetes can be controlled by adjusting the food and drink in everyday diet and sometimes needing tablets to make the body’s own insulin more efficiently. Sometimes insulin injections are required.
Steroid induced diabetes
This form of diabetes is found in children who have a medical condition that requires steroid medication to be given. Patients are often referred from other hospital departments such as Oncology, Rheumatology, Nephrology or Respiratory. Insulin is often required at the times steroid medication is being used for their primary medical condition.
Monogenic diabetes (Previously known as MODY)
Monogenic forms of diabetes used to be known as MODY or Maturity Onset Diabetes of the Young. This is a form of diabetes caused by a single gene defect that prevents the body’s cells from using glucose normally. There is a very strong inheritance pattern and the cause is usually found after genetic testing is performed. Some forms of monogenic diabetes require insulin injections, some are treated by oral tablets and others by lifestyle advice.
Cystic Fibrosis Related Diabetes (CFRD)
CFRD is a condition experienced by some children who have Cystic Fibrosis. This form of diabetes is caused by the underlying CF and affects both the digestive and blood glucose functions of the pancreas. These are damaged by the thick secretions typical of CF and the steroid medication used in treatment.
Year of care
Each year we expect to offer at least four clinic appointments, one of which is an annual review appointment. The appointments are usually evenly spaced throughout the year (every 3 months) unless there is a need to be seen more frequently. All diabetes clinic appointments are multidisciplinary and will include a diabetes doctor and nurse. Annual review appointments are often attended by one of our paediatric diabetes dieticians.
At each clinic appointment your HbA1c blood test will be performed – this is the marker of your blood glucose levels over the previous 2-3 months. At the annual review appointment we will ask you to go to the laboratory for your yearly blood tests. These tests look for any changes in your kidney and liver function as well as other conditions that are associated with diabetes such as Coeliac and Thyroid disease.
As well as the clinic appointments we will offer at least 8 additional contacts throughout the year in the form of telephone calls or text messages.
Each year (usually at the annual review appointment) you will be offered an invitation to meet with our diabetes dieticians to refresh your knowledge or discuss any issues you may be having.
Once you are aged 12 and over you will be eligible for annual eye screening at one of the three local screening centres (this is different to an eye test at your own Opticians). Annual eye screening is to check for the early signs of diabetic retinopathy and offer additional support or treatment if it is required.
Your feet will be examined at annual review clinic each year to ensure that they are in good health. We start to check your feet at clinic after you are 12 years old.Occasionally we will refer you onto our Podiatry team for further examination and treatment of your feet.
We currently hold 6 diabetes clinics a week, these are both annual review and regular diabetes clinics. In addition to this we also hold Diabetes nurse led clinics. Once a month Alder Hey hosts a Transition clinic which alternate between Aintree Hospital and The Royal, you will be invited to these appointments shortly after your 17th birthday (or earlier if you feel that you would like to start the transition process).
Here are a number of resources that provide useful information for both newly diagnosed and established patients / families.
“Dealing with diabetes can be daunting, whether you're newly diagnosed, an old hand, or even if it's someone you know who has the condition. Having someone to talk to can make all the difference”
“Whether you've just been diagnosed or you or your loved one have been living with type 1 diabetes for a while, we're here to give you information and support to effectively manage your condition, without changing your lifestyle”
“We offer a range of tools to help you manage your diet and keep up to date with the latest developments in coeliac disease”
“The Children and Young People’s North West Diabetes Network will aim to develop a care model for children and young people with diabetes that enables consistent access to high quality care no matter where it is delivered across the North West of England.”
(Downloadable PDF) Hypo Management Flow Chart - Glucose Tabs..
(Downloadable PDF) Hypo Management Flow Chart - Lucozade.
(Downloadable PDF) How to manage high blood glucose levels without ketones
(Downloadable PDF) Information about managing high blood glucose levels with ketones on Multiple Daily Injections (MDI / Insulin pens)
(Downloadable PDF) Hypoglycaemia Information for multiple daily insulin regimes
(Downloadable PDF) Hypoglycaemia Information for twice daily insulin regimes
How to adjust insulin doses on Multiple Daily Injections
How to install Diasend at home
Getting accurate readings from the Dexcom G4 CGM
How to link Dexcom G5 with Diasend and share information with your healthcare professional
How to check a basal rate
Converting from insulin pump therapy back to multiple daily injections
How to manage high blood glucose levels without ketones using insulin pump therapy
Insulin Pump Therapy information - Hypoglycaemia
Insulin Pumps at School – General Information
HbA1c @ Home Guidelines
Alder Hey Children's Charity