BNF for Children 2011-2012

BNFC 2011–2012 6.1.6 Diagnostic and monitoring devices for diabetes mellitus 363and prove positive, the result should be confirmed bylaboratory analysis of a urine sample. Microalbuminuriacan occur transiently during puberty; if it persists (atleast 3 positive tests) treatment with an ACE inhibitor(section 2.5.5.1) or an angiotensin-II receptor antagonist(section 2.5.5.2) under specialist guidance should beconsidered; to minimise the risk of renal deterioration,blood pressure should be carefully controlled (section2.5).ACE inhibitors can potentiate the hypoglycaemic effectof insulin and oral antidiabetic drugs; this effect is morelikely during the first weeks of combined treatment andin children with renal impairment.For the treatment of hypertension in diabetes, see section2.5.Diabetic neuropathyClinical neuropathy is rare in children whose diabetes iswell controlled.UrinalysisTests for glucose range from reagent strips specific toglucose to reagent tablets which detect all reducingsugars. Clinitest c is rarely used now; Clinistix c issuitable for screening purposes only. It is rarelynecessary for children to test themselves for ketonesunless they become unwell—see also Blood Monitoring,above.Microalbuminuria can be detected with Micral-TestII c D but this should be followed by confirmation inthe laboratory, since false positive results are common.GlucoseClinistix c (Bayer Diabetes Care)Reagent strips, for detection of glucose in urine. Net price50-strip pack = £3.27Clinitest c (Bayer Diabetes Care)Reagent tablets, for detection of glucose and other reducingsubstances in urine. Net price 36-tab pack = £2.00Diabur-Test 5000 c (Roche Diagnostics)Reagent strips, for detection of glucose in urine. Net price50-strip pack = £2.87Diastix c (Bayer Diabetes Care)Reagent strips, for detection of glucose in urine. Net price50-strip pack = £2.786.1.6 Diagnostic andmonitoring devices fordiabetes mellitusBlood monitoringBlood glucose monitoring using a meter gives a directmeasure of the glucose concentration at the time of thetest and can detect hypoglycaemia as well as hyperglycaemia.Carers and children should be properly trained inthe use of blood glucose monitoring systems and theappropriate action to take on the results obtained.Inadequate understanding of the normal fluctuationsin blood glucose can lead to confusion and inappropriateaction.Children using multiple injection regimens shouldunderstand how to adjust their insulin dose accordingto their carbohydrate intake. With fixed-dose insulinregimens, the carbohydrate intake needs to be regulated,and should be distributed throughout the day tomatch the insulin regimen.Note In the UK blood-glucose concentration is expressed inmmol/litre and Diabetes UK advises that these units should beused for self-monitoring of blood glucose. In other Europeancountries units of mg/100 mL (or mg/dL) are commonly used.It is advisable to check that the meter is pre-set in the correctunits.If the blood glucose level is high or if the child is unwell,blood ketones should be measured according to localguidelines in order to detect diabetic ketoacidosis (section6.1.3). Children and their carers should be trained inthe use of blood ketone monitoring systems and to takeappropriate action on the results obtained, includingwhen to seek medical attention.Medi-Test c Glucose (BHR)Reagent strips, for detection of glucose in urine. Net price50-strip pack = £2.33Mission c Glucose (Spirit)Reagent strips, for detection of glucose in urine. Net price50-strip pack = £2.29KetonesKetostix c (Bayer Diabetes Care)Reagent strips, for detection of ketones in urine. Net price50-strip pack = £2.95Ketur Test c (Roche Diagnostics)Reagent strips, for detection of ketones in urine. Net price50-strip pack = £2.76Mission c Ketone (Spirit)Reagent strips, for detection of ketones in urine. Net price50-strip pack = £2.50ProteinAlbustix c (Siemens)Reagent strips, for detection of protein in urine. Net price50-strip pack = £4.10Medi-Test c Protein 2 (BHR)Reagent strips, for detection of protein in urine. Net price50-strip pack = £3.27Other reagent strips available for urinalysisinclude:Combur-3 Test c D (glucose and protein—RocheDiagnostics), Clinitek Microalbumin c D (albumin andcreatinine—Siemens), Ketodiastix c D (glucose andketones—Bayer Diagnostics), Medi-Test Combi 2 c D(glucose and protein—BHR), Micral-Test II c D(albumin—Roche Diagnostics), Microalbustix c D(albumin and creatinine—Siemens), Uristix c D(glucose and protein—Siemens)6 Endocrine system