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Child and Adolescent Health Service

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Princess Margaret Hospital

Information for professionals

Information for professionals

Information for GPs, nurses, health care professionals and teachers who are providing care and assistance to children with diabetes or endocrinology diseases and disorders.

Healthcare professionals

Diabetes

If you suspect that a presenting patient has a new diabetes diagnosis, please direct the family/patient to promptly attend the Emergency Department at PMH.

If you are unsure regarding a diabetes diagnosis, or if the child is acutely unwell or from a regional area, please call 9340 8222 and ask to speak with the on call Endocrinologist for advice.

Please do not refer new a new diabetes patient for assessment via the Central Referral Service.

If you are reviewing a child with known diabetes in your practice who is a new resident to WA, please refer to the Department of Diabetes and Endocrinology via the Central Referral Service. This applies to all children up to 18 years of age with all forms of diabetes.

Endocrinology

All referrals to the Endocrinology Service should go through the central referral service (CRS). Please consider the condition that you are referring for specialist care and provide as much supporting information as possible including relevant testing as failure to do so will delay referral processing and increase wait times for families.

Healthy Weight Service

Referral to the Healthy Weight Service (HWS) can only be made by a Doctor. Inclusion criteria apply and you should carefully assess if the child is eligible to receive care through the HWS. It is critical that all information supporting referral for tertiary level lifestyle care be provided as failure to do so will delay referral processing and increase wait times for families

Please refer to the Healthy Weight Service referral pack and the Healthy Weight Service referral criteria and guidelines.

Teachers

The PMH Diabetes Service and the Department of Education Western Australia endorse use of the diabetes management and action plans listed below for implementation in all early years, primary and secondary school settings.

Please visit Diabetes WA for more information on Diabetes Action and Management Plans.

Teacher seminars

Digital technology for diabetes

There is an increasing range of digital technology available in the treatment of a student living with type 1 diabetes (T1D). This technology is to support students / parents and will be managed by parents.

Some examples of current and developing technology include:

  • Flash monitoring (Libre) – not yet approved for distribution in Australia
  • Digital insulin pens (adjustable in 0.1 increments) – such pens are expensive and not readily available in Australia
  • A variety of mobile device apps which assist recording / tracking BGL and insulin doses
  • Blood Glucose Meters which allow results to be viewed remotely by parents in real time
  • Insulin pump plus CGM
CGM (Continuous Glucose Monitoring Systems)

The Federal Health Department made an announcement on April 1st 2017, fully subsidising continuous glucose monitoring (CGM) technology to monitor blood glucose levels in young people. Students/families who request and are approved for CGM will receive the product and information to begin use through their healthcare provider (in most cases the PMH Diabetes Service), at which time the child with T1D will also receive a CGM summary which must be attached to their Diabetes Management and Action Plan at their school. It will be specific to the technology device they are using and provide the school with more detail on the use of the device.

Students who use CGM should have their monitor (which may be a phone) within range and accessible at all times when at school, including during assessments. Medical authorisation letters may be provided if needed. However, the individual needs of the child and other children in the classroom must be considered. Teachers and school staff are not expected to do more than the routine checks explained in the current Diabetes Management and Action Plan (that is pre meal and pre snack BGL / checks) to monitor control.

Parental Distant Monitoring of Blood Glucose

This technology which transmits the CGM results via the smartphone to other phones is increasing in popularity and can, when correctly used, be very useful in allowing parents to view the blood glucose of their child when not with them. It should not lead to frequent phone calls to the school to make adjustments that would not ordinarily be required for any student with diabetes and schools should maintain their duty of care during the school day and respond as per a student’s Diabetes Management and Action Plan.

Insulin Pumps linked to CGM

Some CGMs are able to transmit glucose level readings to an insulin pump. In addition, some newer pump and CGM systems allow the pump to automatically halt insulin delivery for a certain period when the CGM system detects that glucose levels have dropped below a certain level, and resume insulin delivery when levels recover. These devices are largely reliable and it is likely their use will increase and become more sophisticated in years to come. However, once more, it is not part of the role of the teacher to check any pump suspension or override/reset the pump linked to CGM.

Flash Monitoring (Libre)

This is a device recently introduced to Australia though it has been used overseas for several years. It consists of a round patch worn on the arm that can give information about the pattern of blood glucose readings when scanned by a patient or family.

Importantly, it currently does not have TGA approval for use in children in Australia. However, it can be purchased online and was cheaper than CGM sensors prior to the recent subsidy (see above), so is being adopted by a number of families. It cannot be recommended by health professionals before TGA approval is gained and is therefore used solely at the discretion of the patient or family.

It is not sufficiently accurate to determine a blood glucose level at any given time and so any potential high or low reading (or symptoms suggestive of high or low glucose) should prompt the self-monitoring of blood glucose as currently applies.  It does not replace finger-prick blood checks in the calculation of insulin doses. It is not part of a teacher’s role to be asked to scan the device in the school setting.

If a school has concerns about use of any of these devices they should discuss with the parents, or seek advice from the student’s Diabetes Team.

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