Endocrine Abstracts

Background: Self-management of Type 1 diabetes (T1DM) is difficult and complex, particularly so during the transition period. Deterioration in glycaemic control is common, in part due to psychosocial and environmental changes (going to college or university), poor adherence to insulin regimens, risk-taking behaviours and family stressors. Transition to adult diabetes services can be a traumatic period for young people with diabetes, who commonly fall between services and are lost to follow up if appointments are not kept. Our Children’s diabetes service follows the NICE guidelines and cares for diabetic patients up to 18 years old. University students are handed over to the adult diabetes team of their university town. Two 18-year old boys are described here. One who just started university and was living in a medically supported flat (NB). The other was at home (NP) and had been independently travelling and self-caring at home on his own before.

NB: NB was diagnosed at the age of 11 years not in ketoacidosis. He was carbohydrate counting a year later. He was handed over to the adult diabetes team of his university town after numerous letters to support safe residence. HbA1c at handover was 8.1%. He contacted his family with gastroenteritis symptoms and abdominal pain and self managed as before. He was discovered by his flat mate the next morning.

NP: NP was diagnosed at the age of 7 years not in ketoacidosis. He was initially on pre-mixed twice daily insulin injections and subsequently on the basal bolus regimen 2 years later. He had high HbA1c (11.1% when transitioned) for several years. Flash continuous glucose monitoring was offered with self funding but he did not use it. He left a family holiday to return home to celebrate his 18th birthday with friends. He felt unwell with abdominal pain and went to bed and was discovered by a family member and died in intensive care 3 days later. His insulin pens were not unpacked.

Conclusion: Both boys never experienced diabetic ketoacidosis and were on an ultra long-acting basal insulin. Perhaps they never knew the red flags to call for help.