New diagnosis of type 1 diabetes in a child: the 4Ts, DKA warning signs and what happens next

The NHS gives the most common symptoms as peeing more than usual, especially at night, feeling very thirsty, feeling very tired and losing weight without trying, and says children may have heavier nappies or start wetting the bed. Diabetes UK describes how this looks in a family: a baby with heavier nappies or a child who is usually dry at night wetting the bed; a child asking for drinks more often or finishing them very quickly; a teacher noticing trouble staying awake; and clothes feeling looser.

Other symptoms the NHS lists are blurred vision, breath that smells sweet or fruity, slow healing of cuts, and frequent infections such as thrush or nappy rash. Diabetes UK adds changes in behaviour such as feeling more irritable. Because children may also be unwell with a cold, tonsillitis, tummy pain or nappy rash when symptoms begin, the NHS says diagnosis can be harder.

The NHS says to ask for an urgent GP appointment or call NHS 111 if you think a child has type 1 diabetes, and to call 999 or go to A&E if a child who has been peeing more, very thirsty and tired also has symptoms getting worse quickly, stomach pain, diarrhoea or sickness, sleepiness or confusion, or faster and deeper breathing than usual. These could be signs of diabetic ketoacidosis, which can be life threatening if not treated quickly.

Diabetes UK says that if symptoms are noticed they should be assessed on the same day by a GP, or a local hospital out of hours, and suggests telling the doctor you suspect diabetes and asking for a quick finger-prick test. The NHS suggests bringing a pee sample to the appointment.

The NHS says a GP will do a finger-prick test for high blood glucose and may test a sample of pee. If tests suggest type 1, the child needs to see a specialist in hospital to start treatment and have more tests, usually the same day. A diabetes specialist will usually confirm the type based on age, weight and symptoms, and extra blood tests may be needed if it is not clear.

The NHS says a team of specialists will help with treatment and support and a diabetes nurse will show the family what to do to start managing the condition. It acknowledges that a diagnosis can feel overwhelming.

The NHS says the main treatment is insulin to manage blood glucose, injected several times a day with a pen or delivered by a pump. The diabetes care plan covers courses to learn about the condition and carbohydrate counting, which type of insulin, how and when to check glucose and targets, HbA1c reviews 2 to 4 times a year, how to recognise and treat low and high glucose, advice on diet, exercise and sick day rules, and support for wellbeing and mental health. The family is given a glucose meter and insulin equipment, and people with type 1 diabetes are entitled to free prescriptions.

The NHS says a person should also be given a continuous glucose monitor, and it is recommended to check glucose at least 4 times a day, or at least 5 times for children, including before meals and before bed. Insulin doses and targets are set individually by the diabetes team.

The NHS says pumps are recommended for children under 12 who cannot easily have injections several times a day, and other people may qualify if hypos are a serious problem or HbA1c remains too high despite careful management. Hybrid closed loop systems link a pump with a continuous glucose monitor and, the NHS says, are gradually being made available, with people under 18 among those who may be offered one if a pump or sensor alone is not working well enough.

The NHS says a hypo usually needs to be treated if glucose is below 4mmol/L, with symptoms such as hunger, dizziness, sweating and shaking, and that mild hypos are common and do not usually cause lasting problems. It should be treated quickly with a sugary drink or snack. The NHS advises carrying something that raises glucose quickly, making sure family and friends can recognise a hypo, carrying medical ID, checking glucose before, during and after exercise, and following sick day rules.

As a guide the NHS gives target ranges for children of 4 to 7mmol/L when waking and before meals, and 5 to 9mmol/L at least 90 minutes after meals, noting that it is not possible to achieve them all the time but that spending around 70% of the time within range reduces the chance of future complications. Individual targets come from the diabetes team.

The NHS says type 1 diabetes can increase the chance of problems such as heart disease, nerve damage and sight problems, though care is aimed at preventing them, and that children under 12 will not need all the tests adults have. It says children and adults will have tests for high blood pressure and that those aged 12 or over will be offered diabetic eye screening every year. Constantly trying to meet glucose targets can lead to burnout, and the NHS recommends mental health and wellbeing support. With the right treatment and support, the NHS says, you can eat normally and keep doing the things you enjoy.