Endocrine Abstracts

ISPAD’s revised ‘sick day guidelines 2022’ highlighted the necessity to review Oxford University Hospital Guidelines. Prevention and correct management of ketosis is essential when children with Diabetes are unwell and involves confident management of advanced and increasingly common Diabetes Technologies. Inpatient admissions were reviewed over 1 year. Medical records were studied to assess monitoring of blood glucose levels and ketones. In the presence of ketosis, insulin dose accuracy and efficacy were evaluated and compared between guidelines. 22 children were admitted from 23 months to 17 years old. 21 children had Type 1 Diabetes, 1 child had Tacrolimus induced Diabetes. Illnesses varied, most commonly gastroenteritis (60%), but included upper respiratory tract infections, pneumonia, viral induced wheeze, febrile convulsions, appendicitis and joint involvement. Diabetes management regimes differed – 8 children on hybrid closed loop systems, 3 children on pump therapy with continuous glucose monitoring and 11 children on multiple daily injections. Blood Glucose monitoring was performed 1-2 hourly in 77% of children during admission. Ketones were checked regularly in 50% of children. 9 children were checked only when hyperglycaemic and 2 children had no recorded documentation. 8 children had ketosis (75% gastroenteritis). 5 children were on MDI, 2 children had T-slim pump with Libre and 1 child using Android APS. Only 4 children had clear documentation of ketosis management. Case 1 demonstrated same correction doses when comparing guidelines, however ISPAD emphasises intake of sugary fluids and extra carbohydrates. Insulin boluses are administered for extra carbohydrates only once blood glucose is stable (>5-6 mmol/l) to prevent hypoglycaemia, which was seen post correction in this child. Case 2 demonstrated that gastroenteritis with hypoglycaemia may need a reduction of total insulin, and ketones can be starvation ketones which needs treatment with extra carbohydrate (ISPAD). A further case highlighted the importance of changing pump sets to ensure adequate insulin administration. The final case established ISPAD guidance of 0.15U/kg which was higher than OUH recommendations, can correct ketosis quicker. This audit verified that OUH guidelines need updating. It also determined the need for improved education regarding regular blood glucose and ketones monitoring during acute admissions, to ensure optimal management.