In this section
Type 1 diabetes is a condition that occurs when the body loses its ability to produce a hormone called insulin. This life-long autoimmune condition affects over 120,000 people in Australia alone and is predominately diagnosed in childhood. Insulin is normally produced by the pancreas and allows glucose (sugar) to move from the blood to tissues such as muscle where it is required for energy.
Type 1 diabetes may cause some of the following symptoms. If you think you or someone you know has these symptoms, seek medical help immediately, and drink sugar-free fluids to prevent dehydration.
When there is not enough insulin the blood glucose levels build up and eventually "spill over" into the urine. This results in excessive urine production and thirst. Thus, prior to treatment, affected children and adolescents have usually had the symptoms of thirst and increased urination for some time (usually 2-3 weeks). If this situation is allowed to progress unchecked, fat stores begin to break down, weight loss occurs and the blood becomes increasingly acidic. Eventually affected people become dehydrated, start vomiting and lose consciousness. This is called diabetic ketoacidosis (DKA).
The treatment of type 1 diabetes involves replacement of insulin. Insulin can be replaced in the body either via insulin injections (twice daily insulin or four injections per day) or with insulin pump therapy. Checking blood glucose levels provides information on how much glucose is currently in the bloodstream and is a crucial part of managing diabetes. It is the only way to know if the body is getting the correct amount of insulin that it needs. Managing diabetes involves balancing insulin, food, and exercise.
When people are first diagnosed with type 1 diabetes, they will be medically stabilised and start on insulin injections. They will usually be required to stay in hospital for a short period of time to commence diabetes education which can then be finished as an outpatient after discharge. These education sessions will be with a diabetes nurse educator (approx. three-four sessions), dietitian (approx. two sessions), and social worker (approx. one session).
The goal of diabetes education is to provide the needed support to young people and their families to feel comfortable and confident with diabetes management in their day to day life.
A young person with diabetes will have an appointment with an endocrinologist (diabetes doctor), diabetes educator and dietitian a few weeks after their diagnosis. Following this appointment, diabetes care involves an outpatient appointment every 3-4 months with the endocrinologist.
Diabetes nurse educators, diabetes dietitians and social workers are available to be contacted in between the young person’s doctor appointment for support with diabetes management.
It’s important to note that despite our best efforts, blood glucose levels (BGLs) will not always be in our target of 4-7 mmol/l pre meals. Variations will happen on a daily basis, sometimes they will be low i.e. less than 4mmol/l and other times high i.e. greater than 7 mmol/l. Often we can account for blood glucose levels that are out of the target such as the impact of food which may raise BGLs or exercise that may lower BGLs.
Every 3 – 4 months, children with type 1 diabetes will have a blood test called an HbA1c. These blood tests measure the amount (as a percentage) of haemoglobin in red blood cells that has glucose attached to it. The higher the glucose levels in the blood (the more BGLs out of target per day/week) the more will become attached to the haemoglobin.
At the RCH we aim for any HbA1c 7% or less. If a child has any HbA1c higher than this on a regular basis, their risk of developing complications will increase dramatically.
Remember: BGLs in target range = HbA1c in target range.
At the RCH we expect our children to enjoy long and healthy lives so the aim of our diabetes management during childhood and adolescence is to allow day to day activities and quality of life whilst minimising the risk of long-term diabetes related complications. We do this by encouraging regular reviews of your child’s BGL’s, adjusting insulin doses in response to patterns and performing the HbA1c test every three months in clinic.
Targets can be achieved by ongoing contact with a dedicated paediatric diabetes care team, education and motivation to maintain a healthy lifestyle with particular emphasis upon diet and exercise. The diabetes team can teach you how to adjust your child’s insulin and support you to become independent with this over time.
All children who have been diagnosed with type 1 diabetes at the RCH will have a fingerprick blood test done in clinic every three months to test their HbA1c. This test is the best measure for long-term blood glucose control. It can tell us about how much glucose has been circulating in the blood stream on average over the last three months which tells us about the relative risk of complications associated with chronically (long term) elevated blood glucose levels. (See graph below)
This can be achieved by ongoing contact with a dedicated paediatric diabetes care team, education and motivation to maintain a healthy lifestyle with particular emphasis upon diet and exercise. The diabetes team can teach you how to adjust your child’s insulin.
A blood glucose level (BGL) measures the concentration of glucose in the blood at the time of the test. Performing blood glucose test is the only way you will know how to determine the correct dose of insulin to give. You need to know how to adjust insulin doses.
The target range BGLs is 4.0mmol/L – 7.0mmol/L prior to main meals.
An assessment of blood glucose levels tell you if you are getting the correct dose of insulin. Growing children will require regular insulin dose adjustment.
All BGL readings and insulin doses should be recorded in a record book. Keeping a detailed record of your BGL’s allows you to assess if you need to make changes to your insulin doses.
Always wash and dry hands before taking a BGL as food on your fingers can alter the BGL reading.
The ACCU-CHEK FastClix lancing device has been proven to be the least painful and overall easiest to use. This should have been provided for you to use at diagnosis. For video instructions on how to use the lancing device please
click here. NOTE: the RCH advices that lancets should only be changed once a day not at each BGL test as per the video
Or, there may be no obvious reason.
People affected by hypoglycaemia may start to experience symptoms when the blood glucose level is less than 4mmol/l, or more commonly when the BGL is less than 3.4mmol Sometimes the blood glucose level can be lower than this and no symptoms are experienced, this is referred to as "hypo unawareness".
All BGLs less than 4mmol need to be treated, regardless of their signs and symptoms.
Mild hypoglycaemia is common and is an expected to occur in good diabetes care.
Note: The treatment must be taken to the person having the hypo. Never make them walk to get treatment as this may exacerbate the hypo.
A blood glucose test should be done to confirm the hypoglycaemia before treating. Treat the hypo if the blood glucose level is 3.9mmol or lower. Do not delay treatment.
Give 5-10grams of high GI (quick acting) carbohydrate to raise the blood glucose levels quickly
Treatment options are based on age
5 years old or younger, or less than 25kg give 5 grams
6 years old and older, or more than 25kg give 10 grams
If BGL remains under 4mmol/L : REPEAT Step 1.
If BGL is above 4mmol/L : Proceed to Step 3
Give 10-15 grams of a sustaining (low GI) carbohydrate to keep the blood glucose in the target range.
If a hypo occurs within 20 minutes of meal time, please use the meal as your STEP 3, low GI carbohydrates.
You can see in the picture below, hypo’s must be treated with high GI carbohydrates immediately to raise blood glucose levels quickly. Following on with low GI carbohydrates, will minimise the chance of repeated hypoglycaemia once the initial fast acting high GI food has worn off.
Over treating hypoglycaemia can be a problem for many families. If you are experiencing high BGLs after treating a hypo, please contact the diabetes allied health team to discuss hypo treatment.
The treatment of a hypo changes on an insulin pump. There is less circulating insulin in the body, which means less carbohydrate needs to be consumed to treat the hypo.
Mild Hypoglycaemia: BGL between 2-4 mmol/L
Moderate Hypoglycaemia: BGL below 2.0 mmol/L
* If BGL still Below 2.0 mmol/L repeat the above treatment
* If BGL between 2-4 mmol/L give QUICK ACTING serve of carbohydrate
When BGL is above 4.0 mmol/L all carbs eaten must be bolused. (Do not enter BGLs for one hour after initial hypo entry)
A severe hypo has occurred if your child’s BGL is less than 4mmol and is unconscious, is having a seizure (fitting), is too drowsy to eat or drink or is being uncooperative. If this occurs, please do not attempt to administer anything by mouth.
Call 000 for an ambulance
Glucagon is a hormone that raises the blood glucose level by making the liver release its store of glucose into the bloodstream. This medication can be used to treat your child if they are having a severe hypo.
Glucagon is a very safe medication to give and is injected into either the subcutaneous tissue or the muscle to raise blood glucose levels. If it is possible to do a blood glucose check before administering Glucagon, please do so.
Glucagon may take 5 to 15 minutes to work, therefore don't expect an immediate improvement.
Glucagon can cause nausea, vomiting and headache.
Once your child is rousable, encourage high GI carbohydrates fluids such as juice or lemonade. Because Glucagon depletes glycogen stores, you must be give your child sugary food or drink by mouth as soon as they have roused and are able to take it. This will prevent the occurrence of secondary hypoglycaemia.
Within the hour it is important to give a low GI carbohydrate, such as bread or milk in order to prevent recurrence of the hypoglycaemia and assist in return to normal eating. The liver needs to replenish its store of glycogen before glucagon can work again
Monitor blood glucose levels every 15 minutes for the first hour then every hour for 4 hours.
If you have had to use glucagon, please contact the Royal Children's Hospital to discuss further management over next 24 hours.
Blood glucose levels are often elevated following a severe hypo. Any high blood glucose levels after a severe hypo requiring glucagon should not be treated with extra insulin.
Novo Nordisk provides a service with the ability to register to activate a reminder for when your hypoglycaemia medication is due to expire.
Please follow this link to register your glucagon.
Ketones are produced when the body breaks down fat for energy when there is insufficient insulin for cells to access glucose. Ketones occur most commonly when there is not enough insulin in the body. They are acidic and are dangerous if they build up in the blood as they cause a life threatening condition called Diabetic Ketoacidosis DKA.
Small amounts of ketones are normal ( 0.0 – 0.6mmol).
Diabetic Ketoacidosis (DKA) is a life threatening condition that occurs when there is insufficient insulin and blood ketones are abnormally high. High ketones are often associated with very high BGLs as well. The high ketones cause imbalances in body fluid and salt levels, leading to dehydration and build-up of acids in the blood. Vomiting and increasing drowsiness result. DKA requires urgent medical assistance.
DKA can develop rapidly and requires urgent medical assistance. Signs and symptoms may include
Urine ketones are positive if a colour change occurs (+, ++ or +++). If positive urine ketones check blood ketones.
Ketones do not need to be checked more frequently than every four hours if they are less than 1.0mmol/L
Action is required if keytones are greater than 1.0mmol/l
Positive ketones = 0.6 mmol/L or higher.
If you have ketones you have not been receiving adequate insulin.
Insulin pump therapy carries a much higher risk for developing ketones than injected insulin because if there is interruption to insulin delivery, there is no background or long acting insulin
Insulin pump users need to have access to injected insulin at all times.
A ketone reading of 0.6mmol/L and higher is positive and needs immediate treatment:
Please update and record your PTDD regularly and keep it with your emergency pack.
Pump total daily dose (PTDD) can be found in the pump or on the download.
In utilities menu, daily totals, daily average, 7 days to average, total insulin: Page 2 of download, right hand side – statistics box
History menu, summary, 7 days, TDD: Page 2 of download, right hand side – statistics box
Options, history, summary, 7 days, total daily dose.
Options, pump history, delivery summary, 7 day average, total insulin
With type 1 diabetes, the body does not produce insulin. This means that giving insulin injections is a vital part of managing type 1 diabetes in children and adolescents.
Insulin is usually made by the beta cells in the pancreas. In type 1 diabetes, the beta cells are destroyed and can no longer make enough insulin to meet the body’s requirements.
Insulin is the hormone needed to move the glucose from the bloodstream into the cells. Insulin is the “key” which opens the door of the cell, allowing glucose to flow inside. Without insulin most of the organs cannot take up glucose.
When there is not enough insulin in the body the glucose stays in the bloodstream. The blood glucose level rises very high because it cannot move into the cells. The body tries to clear the glucose from the bloodstream by offloading glucose in the urine.
"When glucose cannot be used for energy the body uses fat instead. If fat is used for energy, some harmful substances called ketones begin to build up in the blood. The ketones that build up will make the person with diabetes very sick"
- Diabetes in Children and Adolescents, 3rd ed, 2010
When a person is diagnosed with type 1 diabetes, insulin needs to be replaced by an injection of manufactured insulin. This insulin is made in a laboratory and does not use any animal products.
Insulin is essential for survival. There is never a time when the body should be without insulin. There is no alternative treatment to insulin.
There are a number of different types of manufactured insulin available: rapid-acting, short-acting, intermediate-acting and long-acting.
The types and combination of insulin will be advised by your treating Endocrinologist.
When you have a child with type 1 diabetes, it’s important you know how to change insulin doses in response to ‘patterns’ of hyperglycaemia (highs) and hypoglycaemia (lows), whether this be a dose adjustment for injections or setting changes on insulin pumps.
The Diabetes Allied Health Team understands that making changes to insulin doses can be daunting to begin with, but with support and guidance from the team we aim to build your confidence in making independent changes at home.
See > Management of T1D > Dose adjustment
Insulin is injected into the subcutaneous layer (fat layer) just underneath the skin. This is done by pinching up the skin and injecting the syringe or pen on an angle. For pen insulin this should be a 90 degree angle and for syringes a 45 degree angle.
Insulin injection site rotation is extremely important in good diabetes management. It will help prevent lumps from forming under the skin and ensure good insulin absorption. If insulin is injected into the same spot repeatedly, fatty lumps will form. This is called Lipohypertrophy (or lipo).
Lipos don’t absorb insulin in the same way as healthy tissue and can lead to increased insulin doses and more glycaemic variation.
98% of people who have lipo, don’t rotate correctly!
People with lipo use on average 15 units more of insulin than people without lipo!
Sites that can be used for insulin injections include stomach, hips, arms and legs.
If your child has little or no fat tissue in the stomach area please do not use.
Exercise increases insulin absorption so the arms and legs may need to be avoided on days when young people are very active with sport.
Unopened insulin needs to be stored in the fridge.
Open insulin needs to be stored in a dry cool place and can be used for up to a month after opening.
Insulin can lose its effectiveness and should be discarded if exposed to direct sunlight, heat, frozen or shaken.
Throughout life your insulin requirements will change and doses need to be adjusted accordingly in order to keep BGLs in target. Growth, sport, activity, lifestyle and food all play a part in affecting blood glucose levels.
To maintain diabetes control it is important to adjust insulin doses when BGL’s start to drift outside the target range.
This advice does not apply if your child is on sick day management
9345 6661 8.30am – 4pm for non-urgent advice (routine dose adjustment)
9345 5522 out of hours for all urgent/sick day advice
Your goal is to be able to make rate and ratio adjustments independently.
Throughout life insulin requirements will change. Growth, sport, activity, lifestyle and food all play a part in affecting blood glucose levels. To achieve a target HbA1c (measure of complications risk) it is important to change pump settings when BGL’s start to drift outside the target range. If you have tried making changes but are still having problems you can call or email the diabetes nurse educators during office hours for advice.
Your BGL target is 4.0 mmol/L- 7.0mmol/L. before main meals
Your HbA1c target is
< 58 mmol/mol (<7%)
Is it basal rate or bolus ratio?
Refer to initial pump education documents for more detailed information.
9345 6661 8.30am – 4pm for non-urgent advice (routine dose adjustment)
9345 5522 out of hours for all urgent/sick day advice
Children with well controlled diabetes have no greater risk of contracting infections than anybody else. Having diabetes introduces the need for closer monitoring during sick days. Good management during illness can prevent diabetic ketoacidosis and hospital admissions
Both situations will require the child to stay home from school with adult supervision.
Regardless of the situation NEVER stop insulin even if you are unable to eat.
Viral and bacterial infections can cause stress hormones to raise BGL’s and cause insulin resistance.
Vomiting, diarrhoea, nausea and decreased appetite can all lead to hypoglycaemia.
If you have not used this protocol please call the RCH for advice.
This is used for:
The RCH switchboard 9345 5522
The diet used in the treatment of diabetes is a healthy, well-balanced diet, that allows all the necessary foods to meet your nutritional requirements. Young people with diabetes do not need to follow a special diet or use any special foods or products. The healthy food pyramid can be used as a
good guide for healthy food choices (see pyramid below).
It is important to eat three regular meals throughout the day i.e. breakfast, lunch and dinner. Snacks are optional for children on multiple daily injections (MDI) and pumps, but may be necessary for children on twice daily insulin (i.e. Novorapid and Levemir, OR Novomix, injected at
breakfast and dinner). If children on MDI or pumps choose to eat snacks, they should be small (
<8g carbohydrates for young children, or <15g for older children). Children on pumps should bolus insulin for their snacks. All meals and snacks should include some carbohydrates, because children require
carbohydrate foods for growth and energy. Foods containing carbohydrate include bread, breakfast cereals, potato, rice, pasta, crackers, fruit, milk and yoghurt.
A good understanding of carbohydrates is essential for families of children with diabetes. Regular contact with Dietitian experienced in Diabetes care is highly recommended for children with diabetes. Your Dietitian can help with all aspects of nutrition and food including issues with
food patterns and carbohydrate spread, growth and development, appetite, physical activity, or just further education and advice on food and diabetes.
People living with diabetes should have a good knowledge of how to count or measure the carbohydrates in the foods they eat, regardless of what type of insulin regimen they are on. This is because the amount of carbohydrates you eat will have a direct impact on the amount of insulin you
need to inject or deliver. Carbohydrates can be counted using several different methods, none being more superior to the rest. For example, many people count carbs in ‘serves’: one serve being about 15 grams of carbohydrate (e.g. 1 slice of bread, 1 medium piece of fruit, 250mL plain milk etc). People using insulin
pumps tends to count carbs in grams. Your dietitian can help you with your carb counting skills.
It is important to try and include at least one low-glycaemic index (low GI) food at every meal and snack. Low GI foods let the blood sugars rise more slowly and steadily and are more sustaining than foods with a higher GI. Check out the low GI food checklist below. Sugar and foods
containing added sugars can be included in moderation in a healthy low-GI based diet without upsetting diabetes control.
Does that mean I
should only eat low GI foods?
No. There are some foods that have a high glycaemic index value that provide other important nutrients (vitamins and minerals) and are found in the base of the healthy food pyramid (the "eat most" section). These foods (e.g. watermelon and other tropical fruits) should not be
excluded and can be eaten in conjunction with other low glycaemic index foods. Combining low and high GI foods together results in a moderate GI effect.
There are also many foods that have a low glycaemic index but are high in fat or have poor nutritional value and are therefore found in the top section of the healthy food pyramid (the "eat least" section). These foods are not recommended to be eaten on a regular basis.
So remember, glycaemic index value alone does not determine the suitability of a food - the guidelines of a healthy diet (as illustrated by the healthy food pyramid) are the most important considerations. Stick to the guidelines of the healthy food pyramid and select low glycaemic index food
choices where practical.
For up to date information on glycaemic index go to
Unrefined cereal such as rolled oats, muesli or a low GI processed cereal such as Guardian™, Special K™, or All Bran™
Temperate fruits e.g. Apples, stone fruit and citrus fruit
Some apps that might be useful when on the go and trying to count/ estimate carbohydrate content of mixed meals include;
This app generates a nutrition panel similar to that seen on product packaging. The beauty of the app is the ability to manipulate the portion size consumed while the app calculates the amount of each nutrient (carbohydrate in this case) for you! If the specific brand is unknown the app
can generate an average for all brands. If the specific brand is known, you can scroll down the list to find it for more accurate information. Available on both Apple & Android.
This app is great for people who like a visual reference for their portion sizes. You choose a food and then get to look at different serving sizes labelled with how many carbs are in each. Available on both Apple & Android.
This app is useful for a number of its functions, most relevant to diabetes is the ability to input your own recipes to assist with carbohydrate counting. Once the recipe ingredients and quantities have been entered, along with the number of serves produced by the recipe, the app
automatically generates a nutrition panel similar to those seen in apps mentioned above. Only available on Apple.
The diabetes social work service is available to support children and families in dealing with the impact of diabetes on their lives. The support is available while the child is a patient at RCH, from diagnosis through to the time when a young person transitions to adult services.
Social workers provide a range of support and assistance that may be needed when a child is admitted into hospital or managing a chronic condition as an outpatient.
This is done through:
When your child is diagnosed with type 1 diabetes it affects the whole family as this is a period of adjustment. There is significant grief and loss around the diagnosis and this takes time to process. While your child is an inpatient at the RCH you may feel tired and overwhelmed processing all the information you are given to support your child at home. The Diabetes Allied Health Team are here to support you during this stressful adjustment period.
A new diagnosis of diabetes may create difficult emotional issues for young people. Children look to their parents for support and cues about how to manage their own reactive emotions. This can be difficult for parents as they are also struggling with their own feelings and it is important that parents get support from family members, friends, support groups and the Diabetes Allied Health Team.
Each child is individual and may experience different emotional responses at different times: Some examples can be:
It is important that once children and young people go home from hospital they return to school/kinder, sports, afterschool care, having playdates etc. as soon as possible. Returning to familiar activities that were enjoyed before the diagnosis brings a sense of relief to children and young people and highlights that they are ‘well’. It can also distract them from being excessively preoccupied with thoughts and feelings about their condition. It allows them to access informal support through friends and family which will be highly beneficial at this time.
Tips for helping your child
Siblings often worry a lot and should be spoken to about the diagnosis of diabetes and what the treatment entails in basic age-appropriate language, so they are prepared and understand as much as possible.
Siblings of children with diabetes often feel that they get less attention, care and support than their sibling with diabetes. Where possible try and find time to spend with siblings away from ‘diabetes’!! Young children may like to help so give them a task e.g. “can you get a tissue for your sister?” or “can you get the iPad for them?”
Juno Health is an initiative set up by doctors to explain medical information to children and have developed a comic book discussing what type 1 diabetes is to siblings.
Click here to be taken to this resource.
Parents go through a wide range of emotions when their children have a chronic condition and these feelings often come in waves, e.g. denial, anger, frustration, sadness, guilt, fear and depressed mood. How parents learn to cope with their own emotions and their own needs will determine how they can best support their child. To care for your child you must first care for yourself!
As if parenting wasn’t hard enough! When your child has diabetes parenting can be even more difficult and require more planning, routine and involvement in your child’s life. Children and young people can often rebel against this and it is important to have all carers on the same page to support the child and for them to feel safe. Parental anxiety is often transferred to the young person so it is important that you have a space to talk away from your child as not every conversation is developmentally appropriate for a child to hear.
Your child is still the young person they were before their diagnosis and can achieve goals, play sports, get a job etc. It is important that there are times at home and while out and about that there is no (or limited) ‘Diabetes talk’. Diabetes does not define who they are and this is important to remember. For instance, it is not helpful to say to your child when they first arrive home from school “what is your BGL?”A better question might be ‘how was your day at school?”
Sometimes it is helpful to talk to other people who understand what it is like to live with diabetes or be a parent of a child with type 1 diabetes. Group support often makes people feel less isolated and alone.
Read information about Diabetes Camp.
See the section on camp on the type 1 diabetes page for more information.
eHeadspace provides free online and telephone support and counselling to young people 12 – 25 and their families and friends.
Free app designed to help adolescences and young adults cope with anxiety and shift their thinking. Offers a range of strategies to manage excessive worries, stress, anxiety and panic. Also offers mindfulness and relaxation techniques.
Free app that offers mindfulness and meditation exercises for young people 7 years and older. Australian designed app to help de-stress and stay calm, a range of different programs for different age groups.
Free app that offers meditation exercises to help people de-stress and switch off from current stressors and anxieties. There is also a Headspace for Kids app, that is more appropriate for young people under 12 years of age.
JDRF has developed a support program that
provides practical advice and help for people who have been affected by a diagnosis of type 1 diabetes.
Diabetes Victoria has
information for people affected by type 1 diabetes.
This program is run for young people age from 12-25. The focus is to connect with other young people who get what it’s like to live with a chronic illness.
Please see the website for further information and if you would like to be part of this program please talk to the diabetes allied health team.
http://www.diabeteskidsandteens.com.au - It has learn and play games and additional child and teenage friendly ways of discussing type 1.
Joe Eldridge, Professional Cyclist - Member of Team Type 1 Check out
Team Novo Nordisk for some inspiration and tips about diabetes and sports. Team Novo Nordisk is a global all-diabetes sports team of cyclists, triathletes and runners, spearheaded by the world’s first all-diabetes professional cycling team. The team’s mission is to inspire, educate and empower people affected by diabetes
Dale Weightman, AFL Player – Dale runs yearly presentations at the Richmond football in June each year.
Ben Cocker- Soccer player.
Jeremy Irvine, Actor- starred in War Horse movie.
Sonia Sotomayor- Supreme court judge.
Jack Fitzpatrick- AFL player.
Sam Reid- AFL Player.
Brandon Jack- AFL Player.
Paddy McCartin- AFL Player.
Carers Allowance and Health Care Card for people under 16 years of age.
The Carers Allowance is an additional benefit to the Health Care Card provided by the Commonwealth Government. A submission may be made to obtain the Carers Allowance from Centrelink. It is means tested and families who meet residency requirements are eligible if the family household income in lesser
then $250, 000. It is only available for children up to age 16 year of age.
Applications for the Carers Allowance are made through Centrelink. Eligibility for the Carers Allowance is determined on criteria based on the medical report that can be signed by the Treating Doctor, Credentialed Diabetes Nurse Educator or your local GP.
To apply for the carers allowance
Please send forms to :
[Your diabetes nurse educator]
Department of Endocrinology and Diabetes
The Royal Children’s Hospital
50 Flemington Road
Once completed it can be returned to you to submit with all the forms or if all forms are sent in we can submit it on your behalf to Centrelink. The process to claim takes about 4-6 weeks.
Centrelink reviews all payments when your child turns 16 years old. Carers allowance is ceased at this point. If you are a previous recipient of carers allowance and cared for child with type 1 diabetes before they turned 16 years of age you will be eligible to apply for a ‘health care card for
former recipient of carers allowance health care card’. Centrelink will sometimes advise you that you need to complete documentation, otherwise you will need to contact Centrelink regarding applying for ‘health care card for former recipient of carers allowance health care card.’
It is beneficial for the young person to wear some form of identification that says they have diabetes, like a necklace, bracelet or diabetes ID card.
Young people also can put medical details in the health app on their phone and paramedics can access these details without a pin number. This is important just in case someone doesn't know they have diabetes and they have a hypo or get sick.
If you have a Health Care Card (HCC), this entitles you to discount parking. Present your HCC to security on lower ground near emergency department before returning to your car.
If you live more than 100 Km away from the hospital, you may be eligible for travel and accommodation assistance from the
Keeping active is an important part of your diabetes management. Having diabetes shouldn’t stop you from performing sports at your best! National guidelines encourage children to participate in physical activity for at least 60 minutes on most days of the week. This can be smaller sessions added together e.g. 30mins of walking plus a 30min tennis lesson.
Limiting your time in front of a screen (e.g. TV, computer, iPad, mobile) to less than two hours a day and walking to school are easy ways to increase your daily activity levels.
Exercise can affect blood glucose levels and insulin requirements. Everyone is individual and the response to exercise can vary from person to person.
In general, exercise lowers your blood glucose levels (BGLs). This is because your body uses glucose as an energy fuel. Sometimes BGLs can rise just before or during an activity due to the release of a hormone called adrenaline. This is usually short lived, with BGLs returning to target range without requiring extra insulin. If your BGLs are above 15mmol/L and you have ketones then activity should be postponed. Exercising when your BGLs are this high could further raise your levels and increase your ketone production.
Management of your diabetes during exercise will depend on the type, duration and intensity of exercise.
To get a better understanding of your blood glucose response during exercise, it is important to keep a record of your blood glucose levels and types of exercise performed. This includes testing before, during and after exercise. It is important to aim for target blood glucose levels (4-8 mmol/L) to maximise performance during exercise. Hyperglycaemia before exercise can impact on your performance during exercise.
Additional carbohydrate “activity food” should be used for sport/exercise.
Insulin doses may also need to be adjusted because of increased insulin sensitivity from the muscles used during exercise. Your diabetes nurse educator and dietitian will help you work out carbohydrate intake and/or insulin dose adjustment when planning exercise.
Injecting in the lower tummy/abdomen or hips is preferable prior to exercise.
As a general rule for every 30-45mins of moderate to intensive physical activity you need to consume one extra serve of carbohydrate (approximately 15-20grams), preferably low GI. This is just a starting point, the amount of carbohydrate you require may differ depending on your level of fitness and the type/length of activity you are doing.
Examples of 1 carb serve activity snacks;
It is usually best to have the extra carbohydrate 30mins before exercising. This is in addition to the carbohydrate you usually have.
You do not need extra carbohydrate during recess and lunch breaks at school (even if you are very active). Your daily insulin doses and carbohydrate serves are based on your usual activity levels.
If you are doing long periods of high intensity activity then you might need to have extra fast acting (high GI) carbohydrate during the activity e.g. sports drink or juice. Your diabetes team can advise you on this.
When swimming, have one extra serve of ‘fast acting’ carbohydrate just before starting (e.g. 5 jelly beans or 125ml glass of lemonade or juice) and for every 30mins you are in the water. This is to ensure BGLs stay above 4mmol/L as hypoglycaemia can be harder to detect in the water.
Delayed hypo’s can occur, often up to 12-16hours after being active. This is because your muscles continue to use glucose during recovery and your body is more sensitive to insulin after exercise.
Testing BGL’s prior to bed and overnight is necessary after prolonged exercise. If you are experiencing regular hypoglycaemia during or after activity then a reduction in insulin might be necessary.
Exercise affects everyone differently. Monitor your BGLs carefully to look for patterns and learn how your body responds to different sports. Testing your BGLs before activity is important and can give you an idea as to which direction your BGLs are heading and how much extra carbohydrate you require.
If BGL is less than 12mmol/L
1 serve before, followed by 1 serve every 30-45 minutes of exercise
May not need a carbohydrate serve prior to exercise however may require 1 serve after 30-45 minutes during exercise to maintain normal BGL’s
Exercise should be avoided if ketones are above 1mmol/L on injections or 0.6mmol/L on insulin pump therapy. Less carbohydrate may be needed if insulin has been reduced before the activity.
Before getting your learners or probationary license your Diabetes specialist will need to declare you ready to drive.
As with everyone with Type 1 or insulin treated diabetes, obtaining and ongoing renewal of your drivers’ license will be conditional on achieving and maintaining certain standards of self-care and wellbeing. Certification of being medically fit to drive must therefore be provided by your treating diabetes doctor at the time of your first licence application and 2-yearly thereafter. It is your responsibility to ensure that this is done in a timely manner.
If a severe hypoglycaemic event occurs the person should not drive for a significant period of time and will need to be urgently assessed. The minimum period of time before returning to drive is generally six weeks because it often takes many weeks for patterns of glucose control and behaviour to be re-established and for any temporary ‘reduced awareness of hypoglycaemia’ to resolve. The non-driving period will depend on factors such as identifying the reason for the episode, the specialist’s opinion and the type of motor vehicle licence. The specialist’s recommendation for return to driving should be based on patient behaviour and objective measures of glycaemic control (documented blood glucose) over a reasonable time interval.
Reduced awareness of hypoglycaemia exists when a person does not regularly sense the usual early warning symptoms of mild hypoglycaemia such as sweating, tremulousness, hunger, tingling around the mouth, palpitations and headache. It markedly increases the risk of a severe hypoglycaemic event occurring and is therefore a risk for road safety. A person with persistent reduced hypoglycaemia should speak with their treating endocrinologist for assessing if they are fit to drive.
This information has been adapted from Assessing Fitness to Drive, a joint publication of Austroads and the National Transport Commission (NTC), which details the medical standards for driver licensing for use by health professionals and driver licensing authorities. For more information or to download the full document please visit
Below are links to the Vic Roads website for more information on driving with diabetes and reporting your medical condition to Vic Roads
For more information on driving with diabetes
Blood glucose record book
Printable blood glucose record sheets
Every child who attends school will attend a school camp at some point. A camp plan is required to provide diabetes information to the child’s care givers whilst they are on camp. Most children will also require a reduction in insulin for camp.
If the camp is more than 30 minutes from an emergency service we recommend that an adult attending knows how, and is willing, to give Glucagon. We also recommend overnight BGL testing at 2am.
We require two weeks notice to put together a camp plan. We need the following information:
email@example.com with the above information
Diabetes Camp are a separate camp for children/adolescents with Type 1 Diabetes. They are coordinated by the consortium of the RCH, Monash Children’s and Diabetes Victoria. For more information please use the following link
Diabetes Victoria Camps
Travelling and holidays should not be restricted because your child has diabetes. However, you will need to make sure that you have planned ahead to ensure your time away is safe and enjoyable.
Please call the RCH Diabetes Service (urgent only):0061 3 9345 5522 if you need further advice
Insulin pump flight tips
An insulin pump is a small computerised device powered by batteries. It delivers rapid-acting insulin continuously in small amounts into the subcutaneous tissue. The pump is about the size of a deck of cards and is worn by clipping it onto a piece of clothing or worn in a pocket. Insulin is delivered through a thin plastic tubing attached to a syringe in the pump. At the end of the tubing there is a small needle which is used to insert the infusion set under the skin into the fatty tissue and is secured by a waterproof dressing. The needle is then removed leaving a small, hollow, flexible plastic tube, called a cannula. These infusion sets are changed every 2-3 days. The pump can be removed for up to 1.5 hours, to enable you to have a shower, go swimming or participate in contact sport. Insulin pumps are not automatic and not an ‘artificial pancreas’. It must be interacted with to give insulin when needed. Blood glucose levels must be checked 6-8 times a day for pump therapy to be safe and effective. The pump does not monitor blood glucose levels! You can purchase continuous glucose monitoring (CGM) separately to work with your insulin pump.
An insulin pump tries to replicate what normally happens in the body. It can deliver insulin in exact amounts as small as 0.025units per hour. Insulin is delivered in two ways:
Basal: insulin that is delivered continuously 24 hours a day in the background. The job of the basal insulin is to keep blood glucose levels stable when you aren’t eating food. Basal rates can be programmed to change over the day based on individual needs.
Bolus: Insulin needs to be given in a larger amount when you are eating or when your BGL is above target. These boluses cannot be pre-programmed into the pump. A pre-meal bolus is given based on the amount of carbohydrates about to be consumed. A correction bolus is given when blood glucose levels are above target to try and bring them back down. The pump is able to calculate the amount of insulin required based on BGL and/or carbohydrate grams being entered by the user. It cannot work independently. It requires the user to enter BGLs and amount of carbohydrate to be consumed.
All rates and ratios are set by the diabetes team at the commencement of pump therapy based on individual needs. With assistance, families are then taught to adjust their own pump settings when required.
Pump therapy is not for everyone. Discuss your options with your Endocrinologist at your next appointment and clarify with them if insulin pump therapy is suitable for you.
The following need to be considered before commencing on a pump:
The pump devices are approx $9,025. Private health insurance should cover this cost and should be confirmed with your health fund before considering insulin pump therapy. Confirmation in writing is preferred.
For the private health insurance company to cover the cost of an insulin pump, the membership is required for a minimum of 1 year.
The other costs involved in pump therapy are the consumables; the line, cannula and insulin reservoir/cartridge. Most consumables are covered by NDSS. The costs of consumables are approximately $30-40 per month.
In order to have a thorough knowledge and expertise of the devices, at RCH we have limited the pumps we support to the following:
Medtronic 640G and 670G
AMSL Tandem t:slim
For more information refer to the
AMSL Diabetes web sites.
The first step is to speak with your Endocrinologist at your next appointment. If you meet the criteria for pump therapy, your doctor will write you a referral to the Diabetes Allied Health team for a pump information session. This appointment will take place with a diabetes nurse educator and one other family.
If you decide that pump therapy will suit your family you will be allocated a series of appointments for your ‘pump start’. The current waitlist from the time of your information session is 6-9 months. The appointments following your information session include:
These clinics are run on set days and may be with one or two other families
JDRF provide funding for families who meet certain criteria. For further information visit the
- Confirm your attendance to the appointment via phone or email
- Whilst we are reducing face to face encounters with COVID-19 these appointments will be via Telehealth. Ensure the appropriate platform has been set up on your home computer and you have access to the invitation details
- Watch the videos on how to insert a pump infusion set:
AMSL Tandem t:slim
Medtronic Sure T infusion Set - How to Guide
This information can also be found on your appointment letter.
If you have any further questions please speak with your Endocrinologist at your next appointment or contact the Diabetes office on 9345 6661
There are currently two CGM systems available in Australia- the Medtronic and the Dexcom.
The FreeStyle Libre system is not a continuous glucose monitor but a flash glucose monitor (FGM). This means that it will only give you a reading when you scan the sensor with a reader or smart device. FGM has some similar benefits to the CGM.
NDSS fact sheet on CGM and FGM
CGM is a small button like device that sits against the skin and records subcutaneous tissue (not blood!) glucose. Tissue glucose levels and blood glucose levels are not always the same. When you use the current CGM devices under optimal conditions the CGM glucose is usually within a 10-13%
Both the Dexcom and the Medtronic systems require calibrating. This is done by fingerpricks and testing blood glucose on a meter as you have always done. The amount of times that this needs to be done can vary between 2-4 BGLs per day depending on the system that you are using.
Tissue glucose readings are taken by the CGM every 10 seconds and averaged out over 5 minutes. It is the 5 minutely average reading that is recorded and displayed
CGM sensors vary in terms of how long they last. Under ideal conditions they will last between 5-13 days depending on the brand. Some people find that electrodes can last longer than this, though the accuracy of the sensors is not guaranteed by the manufacturers once the sensor is used beyond
Tissue glucose levels that have been measured by the CGM can be seen in ‘real-time’ either on a purchased receiver, a mobile phone or on an insulin pump depending upon the specific device. Displays include the current glucose level and a graph of previous glucose levels over several hours
For more information:
Medtronic and the Dexcom CGM systems, please refer to the
AMSL Diabetes (Animas) web sites.
For more information on
Abbott Freestyle Libre (FGM)
The short answer is yes, no and maybe.
CGM devices have become much more accurate over recent years and they measure tissue glucose extremely well. But does this translate to better diabetes control?
Studies performed on CGMs have shown a variety of results. These range from no benefit to only a small benefit in reducing a patients HbA1c, reducing hypoglycaemia and improving quality of life. Individuals anecdotally report a variety of responses in relation to wearability, comfort
One of the reasons behind these conflicting results is because people use CGMs for a variety of situations. Some patients use CGM with injections, some use it with insulin pumps and others use it linked to the pump where it has limited control over the delivery of insulin in certain
Studies show that the amount of time the CGM is in use is critical. To gain any benefit in reducing HbA1c, CGM devices need to be used more than 70-80% of the time (i.e. > 5 days per week). Research suggests that for a variety of reasons most adolescents are unwilling to wear CGM more
The motivation of the user has shown to also significantly affect the benefits of wearing a CGM. If the aim is simply to avoid hypoglycaemia and not to improve metabolic control then HbA1c levels may worsen.
Finally, for some, CGM provides too much information. Adolescents in particular and some parents find the constant feedback from CGM overwhelming, causing them to switch off and ignore readouts and alarms, particularly if the CGM readings give false-alarms.
Research is currently underway into CGM as part of a “closed loop” systems. This will predict where a blood glucose level is heading and inform a pump ahead of time about how much insulin to deliver. Being able to change insulin delivery ahead of time rather than in real time is what most clinicians think
Medtronic Guardian Connect or Guardian Link 3
information sheet to learn more about using the Hybrid Closed Loop insulin pump that connects with the Medtronic 670G
Abbott Freestyle Libre (FGM)
Complete the following NDSS form and email it to firstname.lastname@example.org -
Continuous and Flash Glucose Monitoring Eligibility Assessment form
NB- YOU MUST be registered with the NDSS to access the CGM program.
Webinar recorded 10th May and was presented by Professor Fergus Cameron (Endocrinologist) and Rebecca Gebert (Diabetes Nurse Educator)
In this webinar we will introduce you to the world Continuous Blood Glucose monitoring. What is CGM? Will it improve diabetes management? Is it all it's cracked up to be?
Blood Glucose (BG) and Sensor Glucose (SG) - What is The Difference
Diabetes Complication Screening is offered to children and adolescents with diabetes as a routine screening tool. Screening allows for the detection of very early signs of complications, where changes can be put in place to stop or reverse that complication.
The Diabetes Complication Screening Clinic assessments includes a photo of the back of the eye, to check for nerve damage to the eyes, blood tests to screen lipids, coeliac, thyroid and thyroxine levels and a urine test to check kidney function, a postural blood pressure and an assessment of
Your doctor has to refer you child to the Diabetes Complication Screening Clinic. Usually the screening appointment will be booked in alongside your next endocrinology appointment. At times, there can be waiting list, if this is the case it will be booked in alongside your
appointment in 6 months’ time.
When should my child be getting Diabetes Complication
Screening at RCH?
If diagnosed with diabetes under the age of 10 years old first diabetes complication screening at approximately 5 years after diagnosis. And then every 2 years until 15 years old and then annually.
If diagnosed over 10 years of age, first comps screen approximately 3 years after diagnosis, every two years until 15 and then annually.
Who organises when my child needs a complication
Your Endocrinologist will refer your child to the Diabetes Complication Screening Clinic. It will be booked in alongside your next diabetes appointment, on either a Tuesday or a Wednesday afternoon.
How will I get notified of my appointment?
An appointment letter with instructions will be sent to your home address. As part of the screening, your child will need to get a sample of the first urine of the day. The reason for this is that an early morning sample gives a much more accurate result than one done during the day. If you
forget to do the morning sample a midday sample can still be used. You can collect a yellow collection container from your local pharmacy or pathology. You can keep it in the fridge at home until the appointment.
What happens when my child gets their Diabetes
Your blood tests will be ordered and waiting for you at pathology (A6) where you usually get your HbA1c. Please do not use a kiosk to check in. Remember to tell the check in personal that your child is having a Complication Screening which requires a blood test.
What tests are done as part of the Diabetes Complication
· Urine test to check the amount of protein being passed via the kidneys into the urine
· Blood test to check blood lipids, thyroid function and coeliac antibodies
· Blood pressure both lying and standing
· Vision testing including retinal photo and a visual acuity assessment
· Nerve testing of the foot
My child has been asked to do 3 early morning urine
samples- what does this mean?
It is very common to have mildly increased levels in your urine if the test is done from a midday sample. If this happens we need to check the levels more closely and we will mail out a request for your child to get three early morning samples to check
if it is a consistent result. On your appointment letter there is instructions about getting a sample from the first urine of the day.
When do I get the results?
Your endocrinologist will go through the results with you at your next appointment.
This page is still being updated, please check back at a later date