**3. Management**

Management of diabetes involves diagnosis of diabetes, which consists of taking history, conducting a physical examination and testing blood to confirm the high level of blood glucose.

Clinical features suggestive of diabetes with random blood glucose (RBG) of 11.1 mmol/L or more confirm diabetes. If there are suggestive clinical features but RBG is less than 11.1 mmol/L, fasting blood glucose test or oral glucose tolerance test (OGTT) and HbA1C are done. Fasting blood glucose of 7 mmol/L or more confirms diabetes. OGTT of 11.1 mmol/L or more after 2 hours confirms diabetes. It is important to do urine routine examination to look for ketone because in Africa many children with diabetes may present for the first time to hospital in diabetic ketoacidosis.

*The African Face of Childhood Diabetes DOI: http://dx.doi.org/10.5772/intechopen.108723*

For first-time diagnosis, admit the patient to the ward and stabilize blood glucose with 0.1 units/kg of short-acting insulin until blood glucose level falls to 10 mmol/L or less. Then, put the patient on a multiple dose injection regimen; the total dose is divided over long-acting and short-acting insulin in a ratio of 1:1, that is, 50% each. The short-acting portion is divided into three portions and given at breakfast, lunch, and supper, 30 minutes before meals. The long-acting portion is usually given once a day usually at bedtime. Where an intermediate-acting insulin is given as long acting, the dose is divided into two, and each portion is given in the morning and evening. If there is no food, the patient should skip the shortacting insulin at that specific time. Patients and families are usually taught how to draw the dose, give injection, and adjust the insulin dosage. They are also taught about injection sites and how to rotate the injection sites to prevent ulcers and lipodystrophy.
