title: Management of children with type 1 diabetes during illness: a national survey.
abstract: OBJECTIVE
  Adequate sick-day management at home can reduce the risk of progression to diabetic ketoacidosis and admission to hospital. The aim of this project was to review the management of diabetes during illness.
  
  
  METHODS
  The Association of Children's Diabetes Clinicians (ACDC) carried out a questionnaire survey of all paediatric diabetes units. In addition, parents of children with type 1 diabetes completed an online questionnaire.
  
  
  RESULTS
  The survey of 127 units had a 73% response rate. Sick-day management guidelines were in place in 93%. All guidelines advised giving extra insulin during illness. In 67%, the extra dose was based on a fraction of total daily dose. 22% used units per kg body weight (U/kg). 21% used locally derived formulae to calculate extra dose of insulin. 3% of units advised only blood ketone monitoring. Although all units had an out-of-hours access policy for the families, 45% received advice from the general paediatric registrar. Only in 15%, the advice was directly from a member of the paediatric diabetes team. 680 parents completed the questionnaire. 86% reported receiving training on managing sick days. The majority (52.2%) receiving an informal session at diagnosis. 40% did not know what to do in the presence of raised blood glucose and high blood ketones.
  
  
  CONCLUSIONS
  There was a wide variation in the practice of monitoring and advice given during illness. Both surveys highlight need for national guidance as well and to improve quality of sick-day rule education programmes for parents of children with type 1 diabetes.
authors.affiliation: Department of Paediatrics, Southport and Ormskirk NHS Trust, Ormskirk, UK.
authors.forename: Astha
authors.initials: A
authors.lastname: Soni
authors.affiliation: Department of Paediatrics, Sandwell and West Birmingham NHS Trust, West Bromwich, UK.
authors.forename: Juliana Chizo
authors.initials: JC
authors.lastname: Agwu
authors.affiliation: Department of Endocrinology, Sheffield Children's Hospital, Sheffield, UK.
authors.forename: Neil Peter
authors.initials: NP
authors.lastname: Wright
authors.affiliation: Department of Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Moudiotis
authors.affiliation: Department of Endocrinology and diabetes, Birmingham Children's Hospital NHS foundation trust, Birmingham, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Kershaw
authors.affiliation: Department of Diabetes and Endocrinology, Oxford Children's Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Edge
authors.affiliation: Department of Endocrinology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Josephine Helen
authors.initials: JH
authors.lastname: Drew
authors.affiliation: Department of Paediatrics, Southport and Ormskirk NHS Trust, Ormskirk, UK.
authors.forename: Sze May
authors.initials: SM
authors.lastname: Ng
mesh_terms: D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D016883:Diabetic Ketoacidosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006306:Health Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D010290:Parents / Q000193:education* / Q000523:psychology; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Type 1 diabetes; illness; insulin; ketones; sick day