Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in section 1.

Education and information for children and young people with diabetes

  • Take particular care when communicating with and providing information to children and young people with type 1 and type 2 diabetes if they and/or their family members or carers (as appropriate) have, for example, physical and sensory disabilities, or difficulties speaking or reading English. [2004, amended 2015]

Insulin therapy for children and young people with type 1 diabetes

  • Offer children and young people with type 1 diabetes multiple daily injection basal–bolus insulin regimens from diagnosis. If a multiple daily injection regimen is not appropriate for a child or young person with type 1 diabetes, consider continuous subcutaneous insulin infusion (CSII or insulin pump) therapy as recommended in continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (NICE technology appraisal guidance 151). [new 2015]

Dietary management for children and young people with type 1 diabetes

  • Offer level 3 carbohydrate‑counting[2] education from diagnosis to children and young people with type 1 diabetes who are using a multiple daily insulin injection regimen or continuous subcutaneous insulin infusion (CSII or insulin pump) therapy, and to their family members or carers (as appropriate), and repeat the offer at intervals thereafter. [new 2015]

Blood glucose and HbA1c targets and monitoring for children and young people with type 1 diabetes

  • Advise children and young people with type 1 diabetes and their family members or carers (as appropriate) to routinely perform at least 5 capillary blood glucose tests per day. [new 2015]

  • Offer ongoing real‑time continuous glucose monitoring with alarms to children and young people with type 1 diabetes who have:

    • frequent severe hypoglycaemia or

    • impaired awareness of hypoglycaemia associated with adverse consequences (for example, seizures or anxiety) or

    • inability to recognise, or communicate about, symptoms of hypoglycaemia (for example, because of cognitive or neurological disabilities). [new 2015]

  • Explain to children and young people with type 1 diabetes and their family members or carers (as appropriate) that an HbA1c target level of 48 mmol/mol (6.5%) or lower is ideal to minimise the risk of long‑term complications. [new 2015]

Hyperglycaemia, blood ketone monitoring and intercurrent illness in children and young people with type 1 diabetes

  • Offer children and young people with type 1 diabetes blood ketone testing strips and a meter, and advise them and their family members or carers (as appropriate) to test for ketonaemia if they are ill or have hyperglycaemia. [new 2015]

Psychological and social issues in children and young people with diabetes

  • Offer children and young people with type 1 and type 2 diabetes and their family members or carers (as appropriate) timely and ongoing access to mental health professionals with an understanding of diabetes because they may experience psychological problems (such as anxiety, depression, behavioural and conduct disorders and family conflict) or psychosocial difficulties that can impact on the management of diabetes and wellbeing. [2004, amended 2015]

Diabetic kidney disease in children and young people with type 2 diabetes

  • Explain to children and young people with type 2 diabetes and their family members or carers (as appropriate) that:

    • using the first urine sample of the day ('early morning urine') to screen for moderately increased albuminuria (ACR 3–30 mg/mmol; 'microalbuminuria') is important, as this reduces the risk of false positive results

    • if moderately increased albuminuria is detected, improving blood glucose control will reduce the risk of this progressing to significant diabetic kidney disease

    • annual monitoring (see recommendation 1.3.43) is important because, if diabetic kidney disease is found, early treatment will improve the outcome. [new 2015]

Diabetic ketoacidosis

  • Measure capillary blood glucose at presentation in children and young people without known diabetes who have increased thirst, polyuria, recent unexplained weight loss or excessive tiredness and any of the following:

    • nausea or vomiting

    • abdominal pain

    • hyperventilation

    • dehydration

    • reduced level of consciousness. [new 2015]



[2] Level 3 carbohydrate counting is defined as carbohydrate counting with adjustment of insulin dosage according to an insulin:carbohydrate ratio.

  • National Institute for Health and Care Excellence (NICE)