Objective: To compare low dose (0.05 units/kg/h) with standard dose (0.1 units/kg/h) intravenous insulin infusion for the treatment of diabetic ketoacidosis (DKA) in children with type 1 diabetes.Study design: Data from five paediatric centres were compared in children who received 0.05 (41 episodes) or 0.1 units/kg/h (52 episodes).Results: In the low vs. standard dose group, at 6 h following admission, the fall in blood glucose levels [11.3 (95% confidence interval 8.6 to 13.9) vs. 11.8 (8.4 to 15.2) mmol/L, p = 0.86] and rise in pH [0.13 (0.09 to 0.18) vs. 0.11 (0.07 to 0.15), p = 0.78] were similar. These changes were comparable between doses in relation to: severity of initial acidosis, children newly diagnosed with diabetes or aged less than 5 years. After adjustment for other clinical and biochemical covariates, insulin dose was unrelated to the change in pH and blood glucose levels at 6 h following admission. Comparisons of safety data, particularly in relation to abnormal Glasgow Coma Score, were inconclusive.Conclusion: In this observational study, low dose was as effective as standard dose intravenous insulin infusion in the initial treatment (less than 6 h) of DKA in children with type 1 diabetes. A randomised controlled trial is required to show true equivalence between doses and to evaluate potential safety benefits.

Aim The aim of this study is to review how efficiently hospital paediatricians are identifying, assessing and managing children with overweight or obesity in out-patient setting when they were referred for obesity or any other health problems. Method The authors conducted this prospectively in two hospitals, one, a district general and the other a children9s hospital. The clinical notes and letters on all patients attending paediatric out-patients, over a selected period of time, were reviewed in detail. The authors specifically looked at the identification, any kind of assessment or management of the weight. The authors used the body mass index (BMI) of 98th centile or above for obesity and BMI above 91st centile for overweight as recommended by National Institute of Clinical Excellence guideline 1. Results Of the 105 children audited in a district general hospital (DGH) 31% were found to be obese (21%) and overweight (10%). In the children9s hospital (CH) 24% were obese and 5% overweight, out of the 42 children we audited. None of the overweight children in both hospitals were identified as overweight and did not have any type of tailored intervention or assessment. 47% of the obese patients in the DGH and 62% of them in CH were identified and had some sort of assessment. Comorbidities were assessed in 75% of patients who were recognised to be obese in CH and only in 18% in DGH. Conclusion Overweight children are not identified appropriately, be it in a children9s or district general hospital. There is higher recognition and assessment of obese children in CH than district general though more than 40% are still not identified. Training and the importance of recognition, assessment and management of obesity and overweight has to be improved, even by Paediatricians working in hospitals, considering the fact that it is a modifiable risk factor and has a potential risk of major chronic health problems like hypertension and diabetes.

ObjectiveTo determine the effect of coeliac disease and treatment with a gluten-free diet on growth and glycaemic control in asymptomatic children with Type 1 diabetes.MethodsData were compared in children with coeliac disease diagnosed by annual antibody screening and jejunal biopsy and treated with a gluten-free diet (n = 49) against individuals who were antibody negative (n = 49) matched for age, sex and duration of diabetes.ResultsNo differences in growth were observed. In the years prior to diagnosis of coeliac disease, mean glycated haemoglobin (HbA(1c)) was lower in cases compared with control subjects [8.3 +/- 1.1% vs. 8.7 +/- 0.9%, P = 0.02 (mean +/- sd)]. In cases, HbA(1c) deteriorated 12 months from the start of a gluten-free diet to levels similar to control subjects (8.9 +/- 1.5% vs. 8.8 +/- 1.5%, P-value for analysis of variance = 0.9). In regression analysis, the diagnosis of coeliac disease and start of a gluten-free diet was associated with a rise in HbA(1c) in the first year of treatment [odds ratio 1.56 (95% confidence intervals 1.16-2.10), P = 0.003] after adjusting for insulin dose and regimen and other variables.ConclusionsIn children with Type 1 diabetes, lower HbA(1c) prior to diagnosis of silent coeliac disease rises following treatment with a gluten-free diet to levels similar to those without coeliac disease. Although unproven, these observations may relate to abnormalities at the small bowel mucosa before the appearance of circulating coeliac antibodies.