Paediatric diabetes specialist nurses are still overstretched in England's primary care trusts, says Diabetes UK.
A report shows that some paediatric diabetes specialist nurses look after 160 children each when the recommended caseload for one nurse is to care for no more than 70 children.
Chief executive of Diabetes UK Douglas Smallwood said: "The government has to wake up and understand the vital role of specialist nurses.
"With some nurses coping with more than double the recommended number of children, it is no wonder four out of five children have poor blood glucose control."
Paediatric diabetes nurse caseloads have increased in 41% of primary care trusts (PCTs) over the last two years.
Only 7% of paediatric diabetes nurses have improved their caseloads since 2006.
Douglas Smallwood added: "Most (children) are struggling to even see a specialist nurse, so any additional support is out of the question.
"The government promised five years ago to improve specialist care and ensure a healthy future for all children with diabetes.
"It's high time they delivered on that promise."
Related story: Children with diabetes get a raw deal at school
Do you agree that specialist diabetes nurses are overstretched? What should be done? Your comments: (Terms and conditions apply)
"I believe parents with a better stand financially need to be charitable to those with less money by dipping into their pockets in order to buy weighing scales, fruits, cordials. We need the finances to train parents on how to manage their children's diabetes." - S Mwaule, Bromley
"Yes. We have a case load of 130 patients 0-18 years, and 41 specialist nusing hours. Cover a wide geographical area." - Sandra Singleton, Blackpool area
"I do not think the DSN can do the job to any level of satisfaction if their caseload is too high. They are meant to be your support, the person in the front line for questions and emergencies such as illness, etc. I have learned to care for my two children with type 1 without troubling anyone on my team, as they do not have the time to give to my family or me. I am one of those parents who go out and learn more. I stand in for my children's' care team. But what of those who don't have one of me? In my area the numbers are even worse than those described on your site. Part of the problem must be the general way in which type 1 diabetes is regarded. It is kept as part of the paediatric care budget rather than having its budget ring-fenced, like childhood cancers. That means though the numbers of children increase, the budget is prone to fall, with nurses bearing the brunt of the lack of funding. Until diabetes is given higher status as a chronic life-long disease needing constant care and attention, the nurses will not be recognised as the valuable component of care that they are. We parents have to stop being silent about this, putting up with poor care, and recognise that it is not right to criticise individuals on our teams, but to say that we are being failed in the duty of care toward our children" - Jacqui Double, Whitstable, Kent
"South Devon Healthcare Trust is our local hospital (Torbay Hospital, in Devon). We have 2 PDSN making up I think a full time equivalent for paediatric patients however one does adults too. The nurses are overstretched, under funded and only put two patients a year on a pump regardless of NICE guidelines (they simply do not have the time to do anymore). Under funding in paediatric diabetes is taking away our children's future. With the knowledge and equipment available, no child should be allowed to run high HbA1c's and should be given the knowledge to control their diabetes by the time they reach adulthood. Unfortunately this is still light years away from being the reality and shame on the PCTs and government for letting it happen. Nursing staff do not have the time to encourage children and parents to look at pumps but this is the ultimate weapon that can be used to gain good control of sugars. Only enlightened parents or those that have found the website children with diabetes gain this knowledge. Shame on all professionals for allowing this to continue" - Name and address supplied
"Yes, definitely overstretched. As well as advising on insulin doses, sickbays and blood sugar control there are so many other things the DSNs have to do, the care plans for schools for example are very time consuming. The answer is very simple really employ more PDSNs and ensure they themselves have ongoing training to keep up with new regimes and research. Ensure the ratios of PDSNs to children is the appropriate recommended ratio" - Julie Langdon, Rotherham, South Yorks
You are currently leaving the Nursing in Practice site. Are you sure you want to proceed?