As with everything on this website, this section can be accessed by anyone but it is primarily for hospital staff looking after children and young people with diabetes in NHS Greater Glasgow and Clyde.
Referrals for patients to be seen by the diabetes team as an in-patient should be made by phoning the "Hot Phone". One of the diabetes nurses - the "Hot Nurse" - carries this phone and is available to see in-patients Monday to Friday from 8am, excluding Public Holidays. However, the Hot Nurse can be called at any time and a message left on their voicemail if outwith normal working hours.
Please phone the Hot Nurse as soon as you are able to do so. If a patient attends in the evening or overnight, for example, but the Hot Nurse does not hear about this until 8am the next day, it may delay them seeing the patient, carrying out education, and ultimately the patient's discharge from hospital.
A Note for GP's:
If a child presents with symptoms suggestive of diabetes, please refer them immediately to the Emergency Department at the Royal Hospital for Children.
Children living on the Western Isles can be referred to their nearest Emergency Department on Lewis, Benbecula or Barra, where they can liaise with the team in Glasgow about whether they can be managed locally or need to be transferred to Glasgow.
The New Diagnosis - Walking Wounded Presentation:
Where diagnosis of diabetes is likely, and the patient is not in DKA, venous bloods should be taken to confirm the diagnosis (see below). Only then should insulin be commenced as per the Walking Wounded Protocol. (Updated 2010)
Please note that due to the age of this protocol, which pre-dated the use of TrakCare in NHS GGC, the following order set should now be used to request the required bloods: Paeds ED New Diab - Set.
The New Diagnosis - DKA Presentation:
Please obtain confirmatory bloods as above and treat as described in the section on Diabetic Ketoacidosis.
Presentations where Diabetes in Unconfirmed:
Sometimes children present with few symptoms and/or their glucose on arrival at the Emergency Department does not meet the World Health Organization's diagnostic criteria. In these cases, please refer to these documents - Incidental Hyperglycaemia / Glycosuria and Intermittent / Borderline Hyperglycaemia. (Written March 2023)
Fluid Calculation Chart:
Individual versions of the Fluid Calculation Chart for printing or for completing online. (Updated 2011)
DKA Protocol:
This protocol covers all aspects of management of a child in DKA. (Updated 2009)
On the last page is a copy of the Fluid Calculation Chart. (Updated 2011)
Making an Infusion of Insulin:
A guide on how to make up an insulin infusion, and the pharmacy monograph for human soluble insulin. (Updated 2020)
Where possible, oral treatment of hypoglycaemia is best. In GGC we have adopted a policy of giving an initial treatment of either 5, 10 or 15 grams of glucose based on the child's weight. However, if unsure of their weight, it is reasonable to use a 10g treatment and repeat every 15 minutes accordingly.
Step 1:
Administer 5, 10 or 15 gram treatment of glucose as suggested below. Other equivalent treatments may be used.
Body weight
10.0-19.9 kg
20.0-34.9 kg
35.0 kg and up
Initial treatment
5 grams
10 grams
15 grams
Lucozade
60 ml
120 ml
180 ml
150 ml
100 ml
50 ml
Fruit juice
1.5 tubes
1 tube
1/2 tube
Glucose gel
If unable to take glucose orally then give 2 mls/kg 10% dextrose IV.
Step 3:
Once glucose is over 3.9 mmol/l, provide some starchy carbohydrate (e.g. digestive biscuit) or their regular meal or snack if due.
Surgical Protocol:
This protocol provides information on how to manage children with diabetes who require either elective or emergency surgical procedures. (Updated 2021)
Making an Infusion of Insulin:
A guide on how to make up an insulin infusion.
Insulin Pumps:
If a child uses an insulin pump device and requires admission to hospital, it is hoped in most cases that they may be able to remain on their insulin pump for the duration of their stay. This is on the understanding, however, that an appropriately-trained adult is able to remain with them at all times and takes full responsibility for use of the insulin pump. Ward nursing staff are not trained in how to use any of the pump devices provided by NHS GGC.
Should an adult be unable to remain with the child, or their condition warrants the removal of the pump, then they should either return to injection therapy or be commenced on an IV insulin infusion.
Converting from Pump Settings to Insulin Injections:
1. Calculate the average Total Daily Dose (TDD) of insulin for at least the last 3 days before the day of change.
2. Give 20% of the TDD as a Levemir injection every 10-12 hours.
3. Give 20% of the TDD as NovoRapid (or other rapid-acting insulin) before main meals or use the Carb Ratios from the pump settings with the main meals.
4. Correction doses of NovoRapid (or other rapid-acting insulin) may be given in addition to Point 3 above, and may be repeated every 4 hours if required.
Insulin Pump Therapy Guideline:
This guideline provides much more detail on insulin pump therapy in hospital. (Note that it was updated in 2014 so the guidance on changing to injection therapy differs from that above and the insulin pumps described are old models and no longer in common use)
Glucose Monitoring in Hospital:
It may be that a child attends hospital wearing a glucose monitor that reads the interstitial glucose rather than the blood. This could be a Continuous Glucose Monitor or a device like a FreeStyle Libre. Although they may continue to wear these devices in hospital (where their condition permits) the results obtained from them should not be used to guide clinical decisions. Interstitial glucose can differ from blood glucose and so only blood glucose measurements should be used to guide treatment in hospital.
The GGC Child & Adolescent Diabetes Service makes every effort to base their treatment protocols on the available evidence. National and international guidelines, along with the best available research, have informed these decisions.
The diabetes team regularly carry out education sessions for staff and other groups. Some of the presentations for these can be found here.
Step 2:
Check blood glucose after 15 minutes. Repeat Step 1 until glucose is over 3.9 mmol/l.
If vomiting or unable to take oral intake, commence dextrose-containing fluids and Variable Rate Insulin infusion (Sliding Scale).
If concerns, seek senior medical advice.
(Interim guideline - May 2022)
A Note for Prescribers:
It is not currently possible to prescribe Carb Ratios or Insulin Sensitivities on HEPMA so, in agreement with Pharmacy and the HEPMA team, a written Prescription Chart (Kardex) will remain in use for all insulin prescriptions. HEPMA should be used to record insulin types and frequency, but insulin doses (Basal Doses, Carb Ratios and Insulin Sensitivities) should only be prescribed on the paper Prescription Chart, to avoid duplication and administration error.
This guide shows how to prescribe insulin, both on a paper Kardex and on HEPMA. This should ensure consistent prescription of insulin, for both fixed and variable doses and reduce risk of prescribing and dispensing error. (Written September 2022)
A Note about Immediate Discharge Letters:
Writing an IDL can be a complicated task, with many potential problems. Errors can be made that those with only limited understanding of diabetes may not notice, but can have serious implications, especially when prescriptions are involved. Dr Kirsteen Low has developed this guide to help navigate these issues. (Written July 2024)
Guidelines for Ketones and Illness specific to Insulin Regimen:
Although the principles of managing ketones are the same regardless, different regimens or insulin pumps can allow for differences in what can be done. (Updated 2024)
