Ambulatory Care for Children with Newly Diagnosed Diabetes

Type 1 or insulin-dependent diabetes mellitus (IDDM) is one of the most common chronic childhood disorders, the incidence for children aged under 15 years in the British Isles almost doubling from 7.7/100 000 per year in 1973–74 to 13.5/100 000 per year in 1988 (Metcalfe and Baum, 1991). The lack of insulin production in IDDM results in high blood glucose levels (hyperglycaemia), leading to increased micturition by day and night, sometimes with uncharacteristic bedwetting, increased thirst, fatigue and weight loss. If undetected, severe fluid, electrolyte and acid base disturbances lead to vomiting, dehydration, coma and death. The presentation at diagnosis can vary considerably, from the acutely ill, ketoacidotic child with severe dehydration to the relatively asymptomatic child where the disease has been recognised in the early stages of its development.