Diabetes in Children

Question 1

Answer 1

Acanthosis Nigricans

Question 2

most common type of diabetes in children

Answer 2

type I. results from pancreatic beta cell destruction.

Question 3

Insulin resistance with relative insulin deficiency

Answer 3

type2

Question 4

outline alternative classes of DM besides type I and II

Answer 4

Question 5

ethnic groups at higher risk for T2DM

Answer 5

first nations, hispanic, african-american, asian.

• multiple risk factors often present
• obese adolescent or teenager

Question 6

comorbid findings along with type 2 DM

Answer 6

obese, family history, PCOS, acanthosis nigricans on PE, indolent history not uncommon

Question 7

PE/Lab findings that may cue you into identifying seconadry diabetes

Answer 7

• nontype I/type II– secondary diabetes
• an oncologic or rheymatologic patient
• hyperglycemia picked up during workup or management of another condition
• striking clinical features of Cushings, Acromegaly

Question 8

identifying inherited diabetes

Answer 8

Question 9

3 P’s of typical presentation of Type I diabetes

Answer 9

3P’s : polyuria, polydipsia, and polyphagia.

+ unexplained weight loss, fatigue, blurred vision, vandidiasis, ketoacidosis

Question 10

initial lab investigations when suspecting T1DM

Answer 10

in office: urine dip for glucose and ketons. Meter glucose.

Lab: urinalysis Rand M, random serume glucose, serum electrolytes, possible capillary blood gas.

• oral glucose tolerance test: contraindicated if symptomatic patient or if fasting or random hyperglycemia.
• HbA1c: long term management tool, not indicaetd at diagnosis in children.

Question 11

T/F: you need to monitor HbA1c in children with T1DM suspecting

Answer 11

long term management tool, not indicaetd at diagnosis in children. FALSE.

Question 12

When is an oral glucose tolerance test contraindicated as an initial laboratory investigation?

Answer 12

• symptomatic patient
• fasting or random hyperglycemia

Question 13

Stabilization of T1Dm

Answer 13

• diet and insulin
• education (knowledge, skills) for parental and child.

Question 14

Diabetes Routine: bloog glucose monitoring

Question 15

how often should you follow up after T1DM diagnosis

Answer 15

follow up visits every 4 months

Question 16

Characteristic bump that can happen on the arm of insulin injection site

Answer 16

lipohypertrophy

Question 17

4 aspects of foot care when doing a PE with someone who has had diabetes <5 years

Answer 17

foor care:

1. pulses/circulation
2. light touch to 10g monofilmanet
3. vibration sense
4. tenodn reflexes

Question 18

routine laboratory follow up when managing T2DM

Answer 18

1. HbA1C every3. months. recall, this is not a diagnostic tool for children, but it should be done once you’re in the management phase.
2. lab vs meter blood glucose comparison every 6-9 months to ensure readings are accurate
3. serum TSH annnulay.

Question 19

Explain how A1C helps assess diabetc control.

Answer 19

Red cell lifespan is approximately 120 days. Therefore with complete turnover of RBC population in 120 days the A1c reflects approximate degree of RBC exposure to glucose during that span

Question 20

methods of assessing diabetic control

Answer 20

1. HbA1C
2. variability of glucose values throughout the day are predictable
3. frequency of hypoglycemia (should not happen often)
4. frequency of diabetic ketoaciosis ( should not happen often)>

Question 21

When to Initiate Complication Screening? What is involved in complication screening?

Answer 21

accoring to clinical practice guidelines, you should assess for complications when the duration of diabetes >5 years AND theres chronological age more towards puberty (kid is getting older)

complication screening:

1. foot and neuro exam (peripheral and autonomic exam)
2. urine albumin/creatinine ratio
3. dilated pupil eye examination : proper exam requires mydriasis.