This document should act as a framework for specialist registrars training in paediatric diabetes. Doctors should feel reasonably well-equipped to run a children's diabetes service when the various components have been addressed. This is likely to take between one and two years although the duration will depend upon the nature and intensity of the training obtained.

• To achieve an understanding of the broad based, multifaceted nature of diabetes care.
• To gain experience of working in a multi-disciplinary team.
• To appreciate the purpose and logistics of running a diabetes clinic.
• To understand the nature and effect of diabetes, a chronic illness, on children and families.
• To understand the element of partnership with families in the management process and to recognise when this is faltering.
• To appreciate the elements of the education process.
• To understand the biochemical basis of diabetes.
• To be familiar with the various forms of diabetes in young people and the key differences between them. This includes types I and II diabetes, MODY and diabetes in pateints with illness's such as cystic fibrosis.
• To gain experience of diabetes at different ages.
• To gain experience of the various insulin preparations, regimens and their potential advantages and disadvantages.
• To be familiar with different glucose monitors and insulin delivery systems.
• To gain experience and an understanding of the effects of illness and exercise.
• To clearly understand the assessment and management of DKA.
• To understand the management of cerebral oedema
• To clearly understand the aetiology and the management of hypoglycaemia.
• To be able to manage other 'emergencies' such as a missed or incorrect insulin dose.
• To clearly understand the management of diabetes at the time of surgery.
• To be familiar with the long term complications of diabetes and their relationship to factors such as glycated haemoglobin concentrations.
• To be familiar with the different approaches to the detection of complications and to be aware of their limitations.
• To be able to conduct an annual review.
• To experience the process of audit with reference to diabetes.

• Sit in with consultants.
• Attachment to Diabetes specialist nurse for hospital and home visits.
• Attachment to the paediatric dietician for one or more clinics.
• Attachment to biochemistry department to learn about HbA1c assay.
• Visit one other diabetes clinic.
• Attend visual screening session.
• Attachment to adult diabetes clinic at least once each month.
• Attachment to adult eye clinic.
• Take part and run an education session.
• To undertake an audit project.
• To attend a 'diabetes holiday'.
• Review computer education packages for children.
• To attend and contribute to clinic/team meetings
• Attendance at diabetes interest groups.
• Case presentations.
• Journal club presentations.
• Audit presentation.
• Self directed learning.

*Pickup JC, Williams G. Textbook of diabetes. Blackwell Scientific Publication, Oxford.

*Kelnar CJ. Textbook of childhood and adolescent diabetes. Chapman Hall, London.

*Court & Lamb. Textbook of childhood and adolescent diabetes. Wiley, 1997.

*Alberti et al. International Textbook of Diabetes Mellitus. Wiley, 1997.