Type 1 Diabetes

Question 1

Compared to adults, children with T1DM are at increased risk of

Answer 1

cerebral edema

Question 2

Poorer cognitive function is associated with

Answer 2

1) age <7 yo at dx
2) episodes of severe hypoglycemia
3) chronic hyperglycemia

Question 3

Improved glycemic control is associated with

Answer 3

patient/parent knowledge of targets and consistent target setting by team

Question 4

The honeymoon period can last up to X years and is characterized by insulin

Answer 4

2, 0.5

Question 5

Dose for glucagon in severe hypoglycemia

Answer 5

10ug/year of age min 20 max 150 with additional doubled dose if no rise in glu in 20 min

Question 6

BG targets for <6yo, 6-12yo, 13-18yo

Answer 6

6-10, 4-10, 4-7

Question 7

HbA1C targets for <6yo, 6-12yo, 13-18 yo

Answer 7

<8, < or equal to 7.5, less than or equal to 7

Question 8

Recommended carbs amount for mild-mod hypoglycemia in >15kg, 15-30kg and >30kg

Answer 8

5g, 10g, 15g

Question 9

g carb in 1 glu tab, 1 dex tab and 1 juice

Answer 9

glu - 4g, dex - 3g, juice - 40 mL ~ 5g

Question 10

DKA occurs in what percentage of new dx T1DM

Answer 10

15-67%

Question 11

Increase risk DKA with

Answer 11

new onset, poor compliance, previous dka, adolescent girl, pump/long acting basal, psych or social issues

Question 12

pediatric DKA is complicated by cerebral edema in x %

Answer 12

0.7-3

Question 13

Risk factors for cerebral edema

Answer 13

age <5yo, new onset, high initial urea, low initial pCO2, rapid adminstration hypotonic fluids, IV insulin bolus, early IV insulin infusion (within 1h), failure of serum sodium to rise during treatment, use of bicarbonate

Question 14

Percent adolescent girls with AN, T1DM versus general population

Answer 14

10% vs 4%

Question 15

Thyroid screening guidelines

Answer 15

All patients TSH and anti-TPO at dx and q2years, 10-30% with T1DM

Question 16

Addisons screening guidelines

Answer 16

Recurrent hypoglycemia (unexplained) and decreasing insulin requirements - am cortisol and lytes

Question 17

Celiac screening guidelines

Answer 17

4-9% in children with T1DM, GI sx, poor growth, poor weight gain, fatigue, anemia, freq hypogylcemia, poor control - TTG and IgA

Question 18

Nephropathy screening guidelines

Answer 18

yearly starting at 12yo if duration T1DM >5 years, am or random ACR, if abnormal confirm 1 month later if abnormal follow with timed, overnight or 24h urine for albumin excretion. Repeat sampling q3 months over 1 year to demonstrate persistence. Treat only if persistent, could be normal if transient esp in adolescents. Tx is Acei

Question 19

Retinopathy screening guidelines

Answer 19

yearly starting at 15yo if length T1DM >5years, stretch to q2years if good control and T1DM >10yes/no retinopathy

Question 20

neuropathy screening guidelines

Answer 20

postpubertal, poor control - screen yearly after duration T1DM >5yrs - screen for numbness, pain, cramps, paresthesia, skin sensation, vibration sense, lighttouch and ankle reflexes tx is glycemic control

Question 21

DLPD screening guidelines

Answer 21

screen after dx but when metabolic control stable, at 12 and 17 years old, <12 years old screen if BMI >95th%/fhx DLPD or premature CAD - fasting lipids, (cholesterol, LDL, TGs, HDL) tx is statin

Question 22

HTN screening guidelines

Answer 22

twice yearly, 16% of kids with T1DM