Diabetes

Question 1

What type of diabetes do most children have?

Answer 1

Type 1

Question 2

Pediatric Plasma Glucose level for diabetes diagnosis

Answer 2

11.1 or higher with symptoms

Question 3

Pediatric Fasting Glucose level for diabetes diagnosis

Answer 3

Greater than or equal to 7

Question 4

Pediatric Oral Glucose Tolerance Test level for diabetes diagnosis

Answer 4

Greater than or equal to 11

Question 5

Pediatric Random Plasma Glucose level for diabetes diagnosis

Answer 5

Greater than or equal to 11.1

Question 6

Purpose of A1C in pediatric diabetes

Answer 6

Monitoring, not diagnosis

Question 7

When is the peak incidence of type 1 diabetes

Answer 7

4-6yrs and 10-14yrs

Question 8

Type 1 Diabetes Definition

Answer 8

Autoimmune destruction of insulin producing beta cells resulting in complete insulin deficiency

Question 9

What are the main therapy for type 1 diabetes?

Answer 9

Insulin injections

Question 10

Describe the incidence of T2DM in Saskatchewan

Answer 10

increasing, disproportionately affecting Indigenous, women > men

Question 11

Projected global T2DM adolescent increase

Answer 11

49% in next 3 years

Question 12

What ethnic groups are disproportionately affected by T2DM?

Answer 12

Asian, Indigenous, African

Question 13

Recent research found that Indigenous youth with diabetes experience higher long-term risks for ________________ and ____________ than non-first Nation

Answer 13

end stage renal disease and death

Question 14

What is important to consider about young people with diabetes in regards to their metabolism?

Answer 14

They have prolonged exposure; within 10 years of diagnosis complications develop

70 yr old developing complications at 80 vs 8 year old developing complications at 18

Question 15

Why is coverage for diabetic devices and medication not covered in treaties?

Answer 15

Formed before diabetes was in Indigenous populations; treatment not covered by treaties

Question 16

What is the most important risk factor for T2 diabetes?

Answer 16

Obesity

Question 17

Following obesity, what is the next most significant risk factor for diabetes?

Answer 17

family history

Question 18

Why might complications of T2DM occur more quickly in adolescents than adults?

Answer 18

loss of B-cell function is accelerated in young type 2 diabetes, leading to premature development of complications, with adverse effects on quality of life and long-term outcomes

Question 19

What 5 things are those with T2DM at increased risk for?

Answer 19

Kidney Disease
Retinopathy
Neuropathy
Dyslipidemia
Hypertension

Question 20

What is glycosylated hemoglobin?

Answer 20

What the A1C test measures;
a form of hemoglobin used primarily to identify the average plasma glucose concentration over prolonged periods of time.

Question 21

Why is there a higher parameter for pediatric A1C values?

Answer 21

To assure hypoglycemia doesn’t occur r/t children’s increased metabolism

Question 22

Explain the pathophysiology of DKA

Answer 22

• occurs when there isn’t enough insulin (T1DM) so glucose is in the blood, not being used by cells
• body breaks down fat for energy creating ketones
• ketones can make the blood acidic, which causes dehydration and confusion

Question 23

Why does dehydration occur in DKA?

Answer 23

1. Body tries to get rid of ketones through osmotic diuresis
2. Increased urination leads to increased thirst

Question 24

What is the leading cause of morbidity and mortality in children with diabetes?

Answer 24

DKA

Question 25

What is a complication of DKA leading to death in pediatric patients?

Answer 25

Cerebral edema

Question 26

Why are there less stringent glycemic goals for pediatric patients with diabetes?

Answer 26

Risk for hypoglycemia r/t increased metabolism

Question 28

Signs of hypoglycemia

Answer 28

Cool, diaphoretic, confused, shakey

Question 29

Signs of hyperglycemia

Answer 29

increased hunger, thirst, urination, dehydrated, fruity/SOB, blurry vision, confusion

Question 30

Target A1C for T1DM

Answer 30

less than or = to 7.5

Question 31

Target FG for T1DM

Answer 31

4-8

Question 32

2hr PG for T1DM

Answer 32

5-10

Question 33

Role of insulin

Answer 33

Alters permeability of cell membranes so glucose can be used for energy, while inhibiting glucose release from the liver

Question 34

What are the advantages of the Insulin pump?

Answer 34

1. continuous subQ infusions mimicking normal pancreatic function
2. maintains BG/decreases A1C
3. less injections
4. allows kids to eat with less adherence to a schedule

Question 35

What of insulin pump covered by SAIL

Answer 35

1 every 5 years

Question 36

Treatment for emergency presentation of DKA in hospital

Answer 36

1. ABC
2. Fluid/electrolyte replacement (child is dehydrated)
3. Continuous SC insulin (child is hyperglycemic)

Question 37

Treatment for emergency hypoglycemia presentation in hospital

Answer 37

1. ABC
2. Bolus dextrose 10% (short term)
3. IV infusion matching normal glucose production after bolus

Question 38

5 Nursing Interventions for Diabetes

Answer 38

1. Optimize normal G+D
2. Promote optimal serum glucose regulation
3. Assess S+S hyper/hypoglycemia
4. Hx of events
5. Prevent LT complications