Cases of DKA in children on the rise

The number of children newly diagnosed with type 1 diabetes who present with diabetic ketoacidosis (DKA) is on the increase in Ireland, Diabetes Ireland has warned.

It has launched a new campaign aimed at healthcare professionals and the general public, to raise awareness of the symptoms of type 1 diabetes, and to reduce the risk of DKA.

Around 25 children are diagnosed with type 1 diabetes every month in Ireland and last year, over 40% of these new admissions had DKA, compared with 31% in the period 2011-2015.

As the symptoms of type 1 diabetes are subtle, they are often missed or mistaken for a viral or urinary infection. This can lead to a delay in diagnosis, which increases the risk of DKA.

Consultant paediatric endocrinologist at CHI Tallaght University Hospital, Prof Edna Roche, developed and leads the Irish Childhood Diabetes

National Register (ICDNR). She worked with the National Register Steering Group and students from TU Dublin to develop a simple acronym – TEST - to help people recognise the symptoms of type 1 diabetes in a child.

TEST represents:

-Thirst (increased)

-Energy (reduced),

-Sudden (weight change)

-Toilet (trips increased).

Ciara Tuke’s son, Lucas, was just three years old when he ended up seriously ill in hospital with DKA in 2019. She had noticed he was more thirsty than usual and was going to the toilet more often, but was unaware that these were signs of type 1 diabetes. One weekend, his health suddenly deteriorated.

“On the Saturday, he was very lethargic and then on the Sunday, things took a turn for the worse. He wasn’t eating and he wasn’t really drinking. Then he started vomiting and his breathing seemed laboured. He was awake but seemed spaced out.

“We brought him to CHI at Tallaght University Hospital where he ended up in a high dependency unit because he was in full DKA. We had never heard of this,” she recalls.

Healthy ketone levels are considered lower than 0.6mmol/L. Lucas’s levels had been at 6.6mmol/L.

According to Diabetes Ireland chairperson, Prof Hilary Hoey, “delays in the diagnosis of type 1 diabetes are an ongoing problem in Ireland”.

“What we are campaigning for is that if you as a parent recognise these symptoms, or as a healthcare professional feel type 1 diabetes may be present, do a simple blood glucose finger prick test, which can greatly help make the diagnosis of type 1 diabetes immediately,” she said.