Children Type 1 Flashcards
Children with new onset diabetes who present with DKA require what type of initial management?
Short period if hospitalization to stabilize metabolic and initiate insulin therapy. Then outpatient preferred once stable.
Outpatient education is less expensive and has slightly Better outcomes.
What is the honeymoon period and how long can it last?
Can last up to 2 years where glycemic control is good and insulin needs are low. Eg. 0.5 units/kg/day
At what age can insulin pump therapy begin?
Any age
What is the preferred insulin regimen for kids?
Has to be individualized. Some studies show improvement with basal bolus over NPH-bolus.
Some show CSII better than basal bolus.
Recommendation is they should be started on AT LEAST 2 injections of bolus combined with 1injection of basal.
Eg. If trying to reduce number of inj per day could use pre-mix bid.
What type of nutrition therapy is recommended For kids with type 2? Is insulin CHO ratio required?
Children should follow Canada’s food guide and individualize according to nutritional needs, eating habits, lifestyle ability and interest.
Do NOT need insulin:CHO ratio but matching insulin to CHO content may allow more flexibility and better control
Children under which age should be careful to avoid hypo to reduce risk of cognitive impairment.
Less than age 6
How should severe hypoglycemia be treated in children?
In hospital: IV dextrose 0.5 to 1g/kg should be given over 1 to 3 minutes
At home: glucagon
If older than 5 years use 1mg. If 5 or younger use 0.5mg.
How should mild or impending hypo be treated in a child who refuses CHO by mouth?
Inject glucagon at 10micrograms per year of age. Minimum 20micrograms to max of 150micrograms
Double the dose if BG is not increased within 20 minutes.
Why does D control often worsen during adolescence? 4 reasons from guideline
- Adjustment issues
- Psychosocial distress-eg. Depression.
- Intentional insulin omission-eg eating disorder.
- Physiological insulin resistance.
What is the leading cause of morbidity and mortality in children with type one?
DKA
15-67% of kids with new onset D
While most cases of DKA are corrected without event, 0.7-3% are complicated by….
Cerebral edema which had significant morbidity and mortality.
Can be reduced by ensuring rehydration prior to insulin infusion. Do not start with an insulin bolus
Are eating disorders more common in diabetics or same as non diabetic children?
More common. 10% verses 4 %.
They have a higher risk of microvascular complications due to poor metabolic control.
***psychological screening is as important as microvascular screening.
When is hypothyroidism most likely to develop?
In girls, at puberty.
More frequent than the general population.
What are two public health initiatives to reduce DKA in children?
Targeted Public awareness eg: teachers on signs of Diabetes to enable early identification prior to a DKA Episode
Comprehensive education and support services plus a 24 hour telephone service.
How often should a type one child be screened for HTN?
At least twice per year. Different than type two!
Type two is at every clinical visit but at least twice annually.
How often should a type one child be tested for TSH and thyroid antibodies?
Every 2 years or more often if positive for antibodies.
When and how should a type one child be screened for Dyslipidemia?
Age 12 and 17. Age less than 12 if: Family Hx Dyslipidemia BMI in 95th percentile Family Hx of premature CVD
Delay screening until metabolic control
How much CHO should be given for mild to moderate hypo for the following weights?
Less than 15kg
15-30kg
Over 30 kg
Less than 15kg use 5g CHO or 1 glucose tab or 2 dex tabs
15 to 30kg 10g CHO
> 30kg use 15g CHO or 4 glucose tabs which is 5 Dex tabs
Can school Personnel perform BG testing?
Only if there is mutual agreement with parent as indicated in students ICP
What are risk factors for DKA? (once already dx with diabetes as a condition)
- Children with poor control or previous episodes of DKA
- Peripubertal and adolescent girls
- Children on pumps or long-acting insulin analogs
- Children with psychiatric disorders, and those with difficult family circumstances
how can cerebral edmea be reduced when treating DKA?
- Do NOT administer hypotonic fluid rapidly
- Do NOT give IV insulin bolus
- Start IV insulin infusion 1 hour AFTER fluid resuscitation has begun
Should sodium bicarb be used in DKA treatment in children?
administration of sodium bicarbonate should be AVOIDED except in extreme circulatory compromise, as this may CONTRIBUTE to cerebral edema
Autoimmune Thyroid Disease (AITD) occurs in what % of individuals with type 1 diabetes
15 to 30%
Celiac disease can be identified in what % of children with type 1 diabetes
4 to 9%
In 60 to 70% of these children, the disease is asymptomatic
when should nephropathy screening begin in t1dm children?
annual screening starting at 12 yrs and if DM more than 5 years. If abnormal, confirm in 1 month or later.
first morning urine albumin to creatinine ratio (ACR) has high sensitivity (random ACR may be compromised due to higher fre of exercise induced proteinuria)
when should retinipathy begin screening in t1dm children?
rare in prepubertal
screen at age 15 + greater than 5 yrs duration of DM
screen annual
when should screening for neuropathy begin in t1dm children?
subclinical in most
Postpubertal adolescents with poor metabolic control should be screened yearly after 5 years’ duration of DM
what % of young adults have no medical follow-up during the transition
25% to 65% of young adults have no medical follow-up during the transition
