'Ensure diabetes is not misdiagnosed in children'
Nurses are in a prime position to educate and raise awareness on the typical and atypical hyperglycaemic-related symptoms of type 1 diabetes.
The incidence of this condition in childhood is increasing by around 4% per year in the UK. Failure to consider the possibility of a diagnosis of type 1 diabetes increases the risk of a child or young person presenting with diabetic ketoacidosis (DKA).
DKA is a leading cause of death and disability in children and young people (Sundaram et al, 2009; Vanelli et al, 2008). Nurse awareness of the early symptoms of type 1 diabetes can reduce the impact of hyperglycaemia-related symptoms and decrease the incidence of DKA.
Typical hyperglycaemic-related symptoms of type 1 diabetes include: passing urine more often than usual (polyuria); increased thirst (polydipsia); weight loss; and lethargy.
Atypical symptoms include: bedwetting (when previously dry); headaches; constipation; vulval thrush; abdominal pain and vomiting.
Early symptoms can be under-recognised or misdiagnosed in very young children. In young people symptoms can be misinterpreted or ignored not only by the patient, but also by their parents and health professionals and, as a consequence, there can be a delay in diagnosis.
Many children and young people diagnosed with type 1 diabetes do not have a family history of diabetes. Polyuria and polydipsia are the main symptoms of the condition in all age groups, but often children and parents do don’t mention the symptoms when they first go to see their GP. About 30% of children with new-onset diabetes have had a least one related medical visit before diagnosis (Pawlowicz et al, 2008). This suggests that in these cases doctors are missing the diagnosis by not asking about specific symptoms or other suggestive symptoms, and by not carrying out appropriate investigations.
Diabetes can be simply diagnosed from either a single random capillary blood glucose test or a urine test for glucose and ketones. Nurses who suspect a diagnosis of diabetes should ensure appropriate questions are asked and, if required, arrange an immediate referral to the GP or hospital. No child or young person should finish a consultation with a medical practitioner until a diagnosis has been made or ruled out. Children should not have to wait for a fasting blood glucose test as the delay in diagnosis increases the risk of DKA.
Nurses are in an ideal position to work in partnership with the general public and health, education and social care institutions to raise awareness of the early typical and atypical symptoms of type 1 diabetes and, in doing so, prevent the number of children and young people presenting in DKA at diagnosis.
Marie Marshall, specialist practitioner - paediatric diabetes, Royal Manchester Children’s Hospital.
Pawlowicz M et al (2008) Difficulties or mistakes in diagnosing type 1 diabetes in children? The consequences of delayed diagnosis. Pediatriatric Endocrinology Diabetes, and Metabolism; 14: 1, 7-12.
Sundaram, PCB et al (2009) Delayed diagnosis in type 1 diabetes mellitus. Archives of Disease in Childhood; 94: 151-152.
Vanelli M et al (2008) Available tools for primary ketoacidosis prevention at diabetes diagnosis in children and adolescents. “The Parma campaign”. Acta Biomed; 79: 1, 73-83.