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 4-8 mmol/l. 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 8 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 7.5% 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 – 8.0mmol/L
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 : 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 2, 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
History, total daily dose. TDD done individually so need to average 5-7 days: Compilation page, average daily dose
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 8am – 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- 8.0mmol/L.
Your HbA1c target is
< 58 mmol/mol (<7.5%)
Is it basal rate or bolus ratio?
Refer to initial pump education documents for more detailed information.
9345 6661 8am – 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
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 (see below). 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 please visit Diabetes Victoria
Request a school plan by an RCH diabetes nurse educator.
The Department of Education and Training (Victoria) require the Diabetes Victoria Diabetes Action and Management Plans (found at the link below) be used in all early childhood education and care services, primary and secondary schools in the government, Catholic and Independent sectors in Victoria. These action and management plans are based on current best practice evidence for diabetes care for young people with type 1 diabetes.
Please click on the link below to be taken to Diabetes Victoria website where you will find all action and management plans in PDF to be printed and completed by your diabetes nurse educator.
School and management plans
Seminars are run each month by Diabetes Victoria to offer teachers and school support staff the opportunity to expand their knowledge and become more confident in supporting and facilitating the day to day school experience on children with type 1 diabetes. Sessions will include information about diabetes and diabetes management and practical workshops covering a variety of specialised topics in more detail including monitoring, pumps, and camps.
Seminars are run in Melbourne and Geelong as well as across regional Victoria.
For more information please click on the link below
Diabetes Victoria workshops
Most schools are very supportive of children with special needs, however communicating clearly with the school and your child’s teacher is vital. The following PDF documents have been developed to assist you in giving your child’s teacher the information they will need to keep your child happy and well. Being aware of some of the common misconceptions about diabetes and problems that may occur at school can guide you in what to discuss.
A note for parents
Duty of care
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
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 $9,500. Private health insurance should cover this cost. This should be confirmed with your health fund before considering insulin pump therapy. Confirmation in writing is preferred. If you intend to join a private health
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 $30.00 per month.
There are two insulin pumps that we recommend for children and young people. Both are comparable in their features and functions.
For more information refer to the
AMSL Diabetes (Animas) 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
The Australian Government's Insulin Pump Program provides subsidies to very low income families who have children with type 1 diabetes. The Program aims to improve access and and affordability of insulin pumps for limited income families who have children (up to 18 years of age) with type 1 diabetes, and do not have access to other means of reimbursement, such as private health insurance. Since its inception in 2008, the Program has provided over 800 subsidised pumps to children with type 1 diabetes. For more information on whether you meet the criteria to have a pump funded for your child, please visit the
If you have any further questions please speak with your Endocrinologist at your next appointment or contact the Diabetes office on 9345 6661
There is currently a lot of attention and marketing activity around the use of CGM (continuous glucose monitoring) in diabetes management. There are currently two systems available in Australia- the Medtronic iPro and the Animas Dexcom. Abbott has also released the FreeStyle Libre systems which is not a CGM but has some similar benefits.
click here). Please note that this device is currently used in Europe for children, but is not TGA approved in Australia for use in children under the age 18 years. We are hopeful that this may change in the future.
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 Animas Dexcom and the Medtronic iPro 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 on both the Medtronic iPro and the Animas Dexcom CGM systems, please refer to the
AMSL Diabetes (Animas) web sites.
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.
It is important to understand that regardless of how the insulin is delivered, it is difficult to respond to CGM in real time by varying your insulin doses. Once insulin has been injected it cannot be removed. Rapid-acting insulin that has been delivered under the skin will take an hour
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
Currently it appears that the benefits of CGM depend heavily on the needs of an individual patients and family and their particular situation. Depending on your needs and situation, CGM may or may not be of benefit to you. Given the significant financial commitment that CGM requires
On April 1 the Federal Government announced that continuous glucose monitoring (CGM) would be fully subsidised for many children and young adults up to 21 years of age (
Press Release). There is specific criteria for the subsidy to apply (
Criteria), however we anticipate that many of our patients will be eligible.
The RCH has received a lot of interest in CGM from our families. This interest has ranged from families confident in the device they would like to use for their child as well as families who are looking for more information about CGM and the device that would most suit their needs. We currently do not have the resources to put all families onto the device straight away. In order to speed up this process, we have applied for more funding to employ a Credentialed Diabetes Educator to run this program. Getting the funding to employ this nurse may take some time but we hope it will only be a matter of a few weeks. In the interim, we will be using the resources which we have available to start a CGM clinic, however we ask for your continued patience and understanding whilst we work through an extensive list.
All families who have registered interest (with or without the forms) have been placed on a CGM start list. We will notify you regarding the signing of the form and the date of your CGM start. If you are unsure if a CGM is right for your family, please read the information we have provided on our website and discuss with your treating doctor at your next outpatient appointment. If you would like to be added to this list to commence on a CGM, please email firstname.lastname@example.org with the relevant forms completed.
For further information on whether a CGM is right for you or if you have not yet decided which device you would like to order please refer to the webinar section of this website where you will find webinars regarding CGM from Diabetes Australia. These have been held in recent weeks and are ongoing for the next month. The RCH also has an upcoming webinar on the 10th May which you can register for
Dexcom G4 Platinum
Dexcom G5 Mobile
Medtronic Guardian Connect
Medtronic Guardian Link 2
To assist all parties we suggest that you familiarise yourself with the eligibility criteria via the link below. Please note that this link includes access to an application form you will need to complete.
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?