Type 1 diabetes in childhood is one of the commoner long term conditions of childhood. It is treated by specialist teams in secondary care using increasingly intensive insulin regimens, but the onset is generally diagnosed by primary care physicians, sometimes later than is ideal. #### Case scenario A 7 year old boy with acute abdominal pain and vomiting is brought to see his general practitioner by his mother. He was being bullied at school, and because his mother attributed his recent onset of bed wetting to stress she did not mention this symptom to the GP. The GP considers appendicitis a possibility but first decides to rule out a urinary tract infection. A urine dipstick test is positive for glucose and ketones. She refers the child at once to the paediatric team for immediate management of his diabetic ketoacidosis. #### How common is it? About 30% of children with newly diagnosed diabetes have had at least one related medical visit before the diagnosis, suggesting that medical practitioners are missing the diagnosis.5 Drinking a lot and …