Paeds Cases · endocrinology-diabetes-and-growth
Type 1 diabetes: insulin therapy, technology and ambulatory care — structured clinical encounter
Structured encounter testing the ambulatory care of a seven-year-old on an insulin pump who presents with abdominal pain, vomiting and ketones, with a normal-looking cannula site: recognition of the pump-cannula pitfall, the immediate pen correction and site change, the sick-day education that reinforces never stopping insulin, the HbA1c and time-in-range targets, and the communication with a frightened family about a near-miss.
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The child has type 1 diabetes controlled on a continuous subcutaneous insulin infusion pump. Her rapid onset of ketosis with a normal-looking cannula site and a half-full reservoir is the classic presentation of pump-site failure. Because a pump delivers only a rapid-acting analogue with no long-acting depot, a blocked or dislodged cannula removes all insulin within hours, and ketones climb far faster than in a child on injections. [2]
References4ShowHide
- [1]Phelan H; Hanas R; et al Sick day management in children and adolescents with diabetes. Pediatr Diabetes, 2022.PMID 36093857
- [2]Biester T; Berget C; et al ISPAD Clinical Practice Consensus Guidelines 2024: Diabetes technologies — insulin delivery. Horm Res Paediatr, 2024.PMID 39657603
- [3]Cengiz E; Danne T; et al ISPAD Clinical Practice Consensus Guidelines 2024: Insulin and adjunctive treatments in children and adolescents with diabetes. Horm Res Paediatr, 2024.PMID 39884261
- [4]de Bock M; Agwu JC; et al ISPAD Clinical Practice Consensus Guidelines 2024: Glycemic targets. Horm Res Paediatr, 2024.PMID 39701064