5. At GP surgery: BGL 25mmol/L – referred to ED In ED: Capillary blood gas: pH 7.18, bicarbonate (HCO3) 12 mmol/L, BGL 25 mmol/L, Na 136 mmol/L (corrected = 142), K 4.9 mmol/L Corrected Na = measured Na + 0.3 (glucose – 5.5)

6. Management: 10ml/kg bolus Normal saline Re-assessed: PR 118, RR 36, BP 96/58 IV insulin infusion: 0.1U/kg/hr Fluids: N/S + 40mmol/L KCL at maintenance + 5% replacement over 48 hrs Transferred to HDU – further management as per DKA protocol

8. Diabetes Care 2013;36(suppl 1):S11.

9. A1C ≥6.5% OR Fasting plasma glucose ≥7.0 mmol/L OR 2-h plasma glucose ≥11.1 mmol/L during an OGTT OR A random plasma glucose ≥11.1 mmol/L Diabetes Care 2013;36(suppl 1):S13; Table 2.

10. Categories of increased risk for diabetes (prediabetes) IFG: 5.6–6.9 mmol/L OR IGT: 2-h plasma glucose in the 75-g OGTT 7.8–11.0 mmol/L OR A1C 5.7–6.4% *For all three tests, risk is continuous, extending below the lower limit of a range and becoming disproportionately greater at higher ends of the range. Diabetes Care 2013;36(suppl 1):S13; Table 3.

12. Diabetic Medicine 2009; 26(6): 596-601 Australian incidence (NDR) in children 0-14 years between 2000-2006

16. Cow’s milk protein exposure (bovine serum albumin and β-lactoglobulin) Vitamin D deficiency Viruses: coxsackie A or B, enterovirus, rubella, cytomegalovirus, ECHO virus, EBV, mumps, retrovirus Drugs & toxins: eg alloxan-like or streptozotocin- like agents that induce oxidant beta-cell damage Stress The Environmental Determinants of Diabetes in the Young (TEDDY) study

17. Diabetes Care 2009;32:2269-74

18. Cell Mol Life Sci 2007;64:865-72 Ann Intern Med 2004;140:882-6 J Clin Endocrinol Metab 2004;89:3896-902. Diabetes 1999;48:460-8

19. Atkinson MA & Eisenbarth GS. Lancet 2001; 358; 221-229

20. Meal

22. Fasting blood glucose is not an appropriate screen test for T1DM

23. The EURODIAB study Diabetologia 2001;44(Suppl 3):B75-80.

25. DCCT/EDIC Research Group. JAMA. 2002;15;287:2563-2569. Intensive treatment should be started as soon as is safely possible after the onset of T1DM and maintained thereafter

27. ISPAD Clinical Practice Consensus Guidelines 2006–2007

29. Rapid (Humalog, Novorapid, Apidra) Hours Long (glargine) Short (Humalin R, Actrapid) Intermediate (NPH, Protaphane) Long (detemir) Insulin Level 0 2 4 6 8 10 12 14 16 18 20 22 24 N Engl J Med. 2005;352:174-183.

30. Pre-mix Twice- daily MDI Increased Complexity Better control Less Hypoglycaemia Increased Complexity Better control Less Hypoglycaemia CSII

31. INSULIN DOSING CARD Ezy-BICC SMART-METER Accu-Chek Aviva Expert INSULIN DOSING APP Insulin Pro

33. Diabet Med 2013. doi: 10.1111/dme.12252 Pediatr Clin N Am 2011; 58 : 1301–1315

34. ISPAD Clinical Practice Consensus Guidelines 2006–2007

43. ISPAD Guidelines Pediatric Diabetes 2009: 10(Suppl. 12): 134–145

44. ISPAD Guidelines Pediatric Diabetes 2009: 10(Suppl. 12): 134–145

45. Diabetes Care. 2005;28:2372-2377.

46. Garg S, et al. Presented at 5th International Conference on Advanced Technologies & Treatment for Diabetes, Barcelona, 2012.

47. J Pediatr. 2002;141:490-495.

48. Health Psychol. 1992;11:135-138 Diabetes Care. 1996;19:876-879; Diabetes Technol Ther. 2008;10:69-80. Glucose variability Reluctance to intensify therapy High A1C Complications Morbidity Mortality Complications Morbidity Mortality Quality of life Fear of hypoglycemia Severe hypoglycemia Controversial

49. DEXCOM MEDTRONIC HYPOMON

51. STRESS COUNTER- REGULATORY HORMONE COUNTER- REGULATORY HORMONE INSULIN RESISTANCE INSULIN RESISTANCE KETOSIS HYPERGLYCAEMIA Also hypoglycaemia with ketosis eg gastroenteritis

52. Paediatric Diabetes 2009; 10 (Suppl. 12): 134-145