Paediatric diabetes annual review

Information for children, young people and their parents / carers

Introduction

All children and young people with diabetes should have an annual review to assess their overall health and to recognise any early signs of other health concerns which may be related to it.

At the annual review clinic you will be meeting some of the healthcare professionals involved in your diabetes care, such as the specialist doctors, diabetes educators (who may be paediatric specialist nurses or paediatric dietitians), paediatric psychologists, play specialists and other clinical staff.

This leaflet explains what to expect, who you will see, what will be checked and why, and how to prepare for your annual review appointment.

What does the annual review clinic involve?

The annual review clinic involves:

1. Completing a well-being questionnaire
2. Measuring your height, weight and blood pressure
3. Meeting your healthcare professionals and having a health checkup
4. Blood tests
5. Urine test and foot examination (if you are 12 years of age or older)

Discussion on sick day rules, hypoglycaemia / hyperglycaemia management and diabetic technologies.

Measuring and plotting

At your annual review clinic, your height and weight will be measured and plotted on a UK-WHO growth chart. This is important for checking how well you are growing.

Your blood pressure will be checked to ensure you have a normal blood pressure for your age.

Blood tests – What are we looking for and why?

1. HbA1c

HbA1c is a measure of your blood glucose levels over the last three months. A high value indicates that your blood glucose levels have been high. We aim for an HbA1c less than 48mmol/mol. We know that HbA1c above that target has been linked to potential future risk of diabetes complications.

2. Thyroid function test and coeliac disease screening test

Sometimes our immune system can mistakenly act against our own body cells, like the cells within the pancreas, thyroid and gut. This is called an autoimmune condition. As you probably know, type 1 diabetes is an autoimmune condition of the pancreas. During the annual review we make sure no such condition of the thyroid and gut is developing.

Thyroid function tests provide information about how your thyroid gland is functioning. The thyroid is a small gland at the bottom of your neck. About one-third of people with type 1 diabetes may have an underactive thyroid gland, which may cause symptoms like fatigue, weight gain, constipation, decreased growth. This condition can be treated by taking tablets that will replace the hormones normally produced by the thyroid.

Coeliac disease is a condition where the gut cannot digest gluten (a protein present in wheat and other grains) and may cause symptoms like diarrhoea, constipation, poor weight gain and abdominal pain. If the blood tests suggest coeliac disease, we ask the gastroenterologist for further evaluation. Coeliac disease once confirmed can be treated by excluding wheat from your diet.

If you have already been diagnosed with coeliac disease, you will continue to have a yearly blood test to check how well you are responding to a gluten free diet.

3. Blood Cholesterol and triglycerides

Cholesterol is a type of fat (lipid) present in our blood that is important for our body to function normally. There are two main types of cholesterol, the ‘good’ (HDL) and the ‘bad’ (LDL).

HDL cholesterol or the ‘good’ cholesterol is protective for you. It prevents blockage of your blood vessels (the little pipes that carry blood in your body). Higher HDL values are better.

LDL cholesterol (the ‘bad’ cholesterol) can cause blockage of your blood vessels if the values are higher than the recommended levels (<2.6 mmol/L). In medical terms this is called Atherosclerosis.

If your LDL cholesterol is between 2.6 mmol/L and 3.4 mmol/L we will advise you about changes that can be made in your diet and your lifestyle. However, if your LDL cholesterol is above 3.4 mmol/L, along with the dietetic and lifestyle changes we will consider starting medications.

We will also measure triglycerides, another type of fat (lipid) present in your blood to make sure the levels are normal. If high, we will advise to improve glycaemic control and provide you with some dietary advice.

Urine test

If you are 12 years of age or older, it is important to test your urine, to monitor the health of your kidneys. Prolonged high blood sugar levels can cause damage to the kidneys (organs that filter our blood to keep it clean and make urine), and some early signs can occur already during the teenage years. By testing a protein called albumin in your urine, we can check your kidneys are functioning well.

Meeting your healthcare professionals

In the clinic, you will be meeting a specialist doctor and a paediatric diabetes educator (specialist nurse or specialist dietitian), who may sometimes be accompanied by a psychologist, but not every team member may be meeting you at every appointment.

Preparing for your annual review clinic

Please download your device records (glucometer, sensor reader, pump data) before your appointment. This helps us to keep to the appointment time and to look at them before we meet in the clinic. During the clinic appointment, you can discuss with us any questions or issues related to your diabetes that you may have. Some examples of questions that young people and their families commonly ask us are related to:

• Day-to-day diabetes management
• Any new symptoms that you may be experiencing
• Any issues with your diabetes technology
• Your wellbeing and mental health
• Issues at school that may be affecting diabetes care or control.

Your paediatric diabetes specialist doctor will go through your latest download with you and your family and discuss any necessary adjustments to be made and answer various questions you may have about your recent glucose profile or insulin doses. You will receive a check-up which will involve looking and feeling your injection sites or sites used for the pump cannula or sensor, to make sure you are not developing lumps and bumps. The doctor will also ask you about your diet and your wellbeing and may offer separate appointments with our dietitians or a psychologist, if required.

If you are 12 years or older, the doctor will also examine your feet and test your feet sensations and check the feet pulses (circulation). Please be prepared to take off your socks or tights. This is to make sure that diabetes is not affecting your nerves and blood vessels.

Once you are 12 years of age, you should also have yearly diabetes eye screening (also called ‘retinopathy screening’) done. The small vessels at the back of your eye are very sensitive to high blood glucose levels and can show early signs of diabetes related changes. It is therefore important to check the back of your eyes regularly.

We will ask your GP to make sure you are registered with the National Diabetes Eye screening program to have your eyes checked. We recommend you bring the letter with the eye screening results to your clinic appointment, so we can add it to your electronic notes.

The paediatric diabetes educator will review with you your understanding of sick day rules and hypoglycemia management and other relevant issues. They will also discuss with you more about your diabetic technologies, any issues at school and the school support you receive for your diabetes management.

The paediatric psychologist will meet you if you require support with your wellbeing or mental health, or any psychosocial issues that might be affecting your diabetes. You are very welcome to request their help if you think you need support from them.

The paediatric dietitian: at your annual review appointment, you will be offered an appointment with a paediatric diabetes dietitian. This will be a separate appointment on a different day. Dietitians can provide advice and help support you with several aspects: including healthy eating for diabetes, carbohydrate counting, managing particular meals, weight loss or weight gain.

After the clinic

Once you have finished meeting your diabetes team and have had the necessary investigations you are free to leave. We will send a letter to you and your GP with a summary of what we discussed, the results of blood / urine tests and any agreed plan / goals.

If necessary, the doctor will arrange for you to be seen by another member of the diabetes team, You will receive any additional appointments through MyChart (if activated) or through the post.

Contact details

Email

Email paediatric diabetes

If you have any non-urgent clinical or other questions related to your annual review, please email the diabetes team. Please note it may take up to 5 working days for them to reply.

Phone

• Working hours (between 9am to 5pm Monday to Friday): 01223 274638.
• Out of Hours: If you require urgent diabetes advice outside working hours then please call 01438 285 000.

Clinic appointments

If you have a query about your clinic appointment or need to cancel it then please call reception on: 01223 348576

Paediatric diabetes psychology appointments

If your query relates to an appointment with the paediatric diabetes psychology team then please call: 01223 216878 or email paediatric diabetes psychology