Management of first presentation of hyperglycaemia in children and adolescents

A presentation of hyperglycaemia with or without symptoms of diabetes (eg polyuria, polydipsia, weight loss) in a child or adolescent is a medical emergency. Immediate specialist assessment and management is required to avoid development of life-threatening complications of acute insulin deficiency, such as diabetic ketoacidosis (DKA). Refer the patient to the local emergency department, or phone the nearest children’s hospital or major healthcare service for specialist endocrinology advice.

Children and adolescents should be presumed to have, and be treated for, type 1 diabetes unless proven otherwise by specialist assessment.

Hyperglycaemia can quickly progress to life-threatening DKA in children and adolescents. DKA has significant acute- and long-term consequences; even after recovering from DKA, a child’s brain function can be impaired for up to 6 months.

Always test an unwell child for hyperglycaemia; they may not show typical symptoms of diabetes at presentation. Use a blood glucose meter or urine dipstick to test for hyperglycaemia and the presence of ketones in children and adolescents.