Endocrine Abstracts

Screening for coeliac disease is routine at annual review in the Oxfordshire Children’s Diabetes Service and oro-gastro-duodenoscopy (OGD) is carried out following positive serology. Our protocol for Diabetes management during Day Case Endoscopy for confirming CD was revised in 2002 following audit. We re-audited our current practice to check adherence to the protocol and degree of blood glucose control.

Data was collected from case notes, nursing notes and drug charts for 16 children (10 girls),mean age 10.83(4.4 – 18y), who had OGD between June 2007 and July 2009. 9/16 were on multiple injections, 3 on thrice daily and 4 on twice daily regimens. All children had their usual insulin dose the night before and their last meal 6 hours before OGD. 2 had squash till 2 hours before the procedure. 8/16 followed the morning insulin protocol, 7 did not, and one had insufficient information.The protocol dictates commencing intravenous fluids with Dextrose saline on admission; all but one did so. A sliding scale of intravenous insulin should start, but 4 did not. Mean blood glucose(BG) was 14.4(3.2–19.4) mmol/L initially, 6.6(4–18) at OGD and 10.8(4.9–18.6) at discharge 3 hours after completion of the procedure.Mean BG was 11.05(8.4–12.5) for people adhering to the protocol and 8.74 (5.3–15.2) for those who did not.14/16 had BG above 12 mmol/l of whom 7 followed protocol. 4/16 had BG less than 4.0 mmol/l of whom 3 followed the protocol.

The previous protocol failed to achieve good glucose control. Hypoglycemia was commoner in children who strictly adhered to the guidelines in all respects, prompting more use of intravenous glucose and distress to patients and parents. We have since simplified our hospital protocol to one which is less interventional and achieved better control in the few who had OGD on the new protocol.