This document provides guidance for telephone advice to parents regarding diabetes-related queries about their children. It outlines protocols for handling urgent calls about hypoglycemia and intercurrent illness, as well as less urgent questions. Specific guidance is given on treating hypoglycemia, managing diabetes during illness, adjusting insulin doses, and addressing hyperglycemia. The document emphasizes safety, consistent advice, and encouraging follow-up as needed with diabetes specialists. It aims to standardize telephone support for parents while their children's diabetes is discussed remotely.

1. DIABETES AND
TELEPHONE
Dr ATIQUR RAHMAN KHAN
SPECILIST PAEDIATRIC
MCH,NAJRAN

2. Objective
 Provide consistent and safe advice to parents
when they call doctors with diabetes related
queries.
 This document is open for discussion .
 This is is a draft document all Suggestions
will be highly appreciated and incorporated in
the final document.

3. Four groups
 Urgent calls about Hypoglycaemia,
intercurrent illness and possible DKA.
 Less urgent questions regarding insulin dose
adjustment .
 Non urgent dietary and other advice.
 Question not related to Diabetes.

4. HYPOGLYCAEMIA

5. Known Diabetic : Severe
Hypoglycaemia
(unconscious/unrousable)
 What would be the response
 Ask parents to call 999
 Inj.Glucagon intra muscularly.
 Child SHOULD BE ASSESSED in A&E
immediately after giving Inj.Glucagon.
 Inj.Glucagon should be given when child is
comatose, has had a convulsion or is severely
disoriented or confused.
 Glucagon may induce vomiting-best to keep
child in hospital on IV fluids

6. Following an episode of
severe hypoglycaemia,
What would be your
advice regarding Insulin
dosage adjustment .

7.  Reduce the total daily dose of insulin by twenty
percent to prevent early recurrence.
 Common causes of Hypos which should be
looked for and addressed.
 Missed meals
 No extra food for extra exercise
 Too much insulin

8. Milder hypoglycemic episodes
 Shaky, sweaty, jittery, pallor etc
 Check the cap blood glucose first, if possible.
 Administer juice/glucose tablets/glucogel/dextrogel as
directed.
 about 15 gm of glucose e.g (120 mls of juice/regular
coke/ regular lucozade or dextrose tablets 3-4).
 Glucogel/Dextrogel On third to full tube depending on
age of child.
 Chocolate NOT ideal-its fat content slows down
absorption of glucose.

9. Mild-Moderate Hypoglycaemia
 They should wait 15 minutes and check the
cap glucose before further rapidly acting
glucose.
 Once recovering they need food containing
complex carbohydrate (sandwich, cereal,
starchy food)
 If not recovering after 2 lots of rapid-acting
glucose they need to come to A&E for
consideration of IV Dextrose.

10. Hypoglycaemia – The ’15’
Rule
 If blood glucose is less than 4 mmol/L
 ↓
 Give 15 grams of dextrose (e.g. 120 mls of juice/regular coke/ regular
lucozade or dextrose tablets 3-4). Detrogel/glucogel one-third to full tube
depending on age of child.
 Do not give starchy CHO
 ↓
 Repeat blood glucose test after 15 minutes
 ↓
 If blood glucose still below 4 mmol/L, give a further 15 grams of dextrose
 ↓
 Repeat blood glucose test after 15 minutes
 ↓
 If still low needs to come to A&E
 
 If recovering give starchy CHO

11. THE SICK DAY RULES

12. Children with Diabetes and Intercurrent
illness ‘The Sick Day Rules’
 Illness associated with fever tend to raise
blood glucose due to higher levels of
 Stress hormone
 Gluconeogenesis
 Insulin resistance.
 Illness associated with vomiting and
diarrhoea(for example Gastroenteritis) may
lower blood sugar and cause hypoglycemia.

13. General Principles of Management:
‘The Sick Day Rules’
 Check blood sugar and urine ketones every 3 to
4 hours AROUND THE CLOCK. (Blood ketones if
possible)
 NEVER STOP INSULIN: doses may need
adjustment BUT insulin is always required.
 Ensure fluid and calorie intake. If not eating,
change from usual diet to a liquid diet (fruit juice,
ribena, milk)
 If the child vomits twice or more in a 6 to 8
hour period or and has abdominal pain or
refuses to take oral fluids, they should be seen
in the A&E.
 Regular contact with the diabetes specialist
nurses.

14. Insulin adjustment during illness
 Blood glucose above 15 mmol/l , advise to
take 10% of total daily insulin dose in form of
rapid-acting insulin(Novorapid/Humalog) in
addition to usual insulin doses.
 If child having more than 2 vomits or
abdominal pain or unable to tolerate oral fluids
they will need to be brought to A&E and follow
DKA guideline as appropriate.
 If child is safe to manage at home advise
parents to give regular extra doses of rapid-
acting insulin 4 hourly until blood glucose

15. Child with Diabetes with vomiting
Blood sugar below 4 mmol
 Treat hypoglycaemia as in previous slides
 Reductions of Insulin dose by 20 % of total
dose may be required.
 If hypoglycaemia persists despite reduction in
insulin-child will needs to be assessed.

16. HYPERGLYCAEMIA IN WELL
CHILD

17. Well child with Diabetes and
persistent Hyperglycemia
 Child with Diabetes blood sugar persistently
12 mmols from four days, Otherwise well .
Receiving twice a day insulin. (10 units AM
and 5 units PM)

18. When on twice daily injections
 if high throughout the day, increase am and
pm insulin by 10%
 if high before evening meal, increase am
insulin
 if high in the morning, increase pm insulin
 Follow the same principle while addressing
the low readings. Blood sugar levels less than
4mmols

19. When on multiple daily injections:
 Persistently high blood glucose for more than
3 to 4 days: increase the bedtime long acting
insulin by 10% (round up to whole number; the
junior pens allow adjustment at 0.5 unit
intervals).
 Persistently low (<4) blood glucose for more
than 2 days: reduce bedtime long acting
insulin by 20%.

20. High blood glucose at meal times:
Child on MDI AND WELL
 High blood glucose at meal times
 correct the highs with additional rapid acting
insulin according to the correction factor
(110÷Total daily dose of insulin=X.
 1 unit of insulin will bring down the blood
glucose by this number x).

21. High blood glucose at mealtimes
Child on MDI AND WELL
For example
Total daily dose is 30 units.
Blood sugar AT MEAL-TIME is 21 mmols
Correction factor (x)= 110/ (total insulin dose)
110/30= 3.5 mmols.
One unit of insulin will bring down blood sugar
by this number .
In this example APPROXIMATELY 3 additional
units of insulin are required to bring glucose
level to 10 mmols.

22. MISCELLANEOUS

23. Well Child, Query not related to
DM
Please POLITELY suggest
Contact their GP the following day or
Discuss with the Diabetes specialist nurses.

24. Well Child, Family seeks
 Non-urgent advice such as adjustment of diet,
preparation for school trips/family holidays
etc.
 Please advise them to contact their diabetes
nurses the following day.

25.  Thank you for your attention.
 Open for discussion……