Diabetes in Pediatrics

Question 1

What are the 3 p’s of pediatric diabetes?

Answer 1

Polyuria, Polydipsia, polyphagia
DKA pH < 7.3
ACUTE onset
Candidal vaginits/balanitis
pyogenic skin infections

Question 2

What is the lab Dx criteria of pediatric diabetes?

Answer 2

1. Random BG > 200 mg/dl with Sx
2. Fasting BG >126 mg/dl
3. 2hr BG on OGTT >200
4. A1C > 6.5%

must confirm with second test

Question 3

What are the two forms of Type 1 Pediatric DM?

Answer 3

B cell destruction:

1. type 1a = Autoimmune
2. type 1b = Idiopathic

Question 4

What are some difference of pediatric DM in:

1. Type 1
2. Type 2

Answer 4

1. Ketotic, Acute onset

2. Acanthosis, Insidious onset

Question 5

What are 4 antibodies present in Type 1 Diabetes?

Answer 5

1. Islet cell antibody (ICA 512)
2. Anti Insulin antibody (AIA)
3. Anti Glutamic Acid Decarboxylase (anti GAD)
4. Anti IA-2 (islet cell-associated phosphatase)

Question 6

What HLA is related to T1DM?

Answer 6

HLA DR3, DR4

Question 7

Which parents has higher chance of passing T1DM family hx to kid?

Answer 7

Father (7%)

Question 8

What are some T1DM risks?

Answer 8

1. born April-July
2. early introduction of cows milk
3. early gluten
4. viral infections (rubella, enterovirus, rotavirus)

Question 9

How does leaky gut progress to T1dM?

Answer 9

1. GI inflammation
2. food intolerance
3. immune system issues
4. autoimmunity

Question 10

What are two ways to differentiate T1 from T2DM?

Answer 10

1. T1 = low C peptide with high blood glucose

2. Autoantibodies (ICA 512, CAD 65, AIA, 2)

Question 11

What are signs of DKA?

Answer 11

1. Insulinopenia w hyperglycemia

2. Ketones produced

Question 12

What is the management of Type 1 DM?

Answer 12

1. Fluids (in vomiting, give IV)

2. Insulin

Question 13

What is a therapeutic goal of pediatric T1DM?

Answer 13

A1C <7.5

Question 14

what are 3 rapid acting insulin boluses?

Answer 14

1. Aspart
2. Glulisine
3. lispro

Question 15

What is an intermediate length insulin?

Answer 15

NPH

Question 16

What are two long acting insulin?

Answer 16

1. Glargine

2. Detimer

Question 17

What are the 2 parts of intensive insulin management?

Answer 17

1. rapid insulin before meals, snacks (aspart, glulisine, lispro)
2. Long acting insulin (Glargine, detimer)

Question 18

What causes 10-20% of hypoglycemic episodes in kids with T1DM?

Answer 18

exercise

Question 19

What are two causes of hyperglycemia in T1DM pediatric patients?

Answer 19

1. a and b adrenergic stimulation

2. Increased hepatic gluconeogenesis and glycolysis

Question 20

What are 4 comorbities of pediatric T1DM?

Answer 20

1. Autoimmune thyroid disease
2. Celiac disease
3. Autoimmune adrenal hypofunction
4. Eating disorders

Question 21

What is the initial and secondary treatment of pediatric T2DM?

Answer 21

1. Lifestyle modification

2. Metformin

Question 22

What are 3 screening recommendations at diagnosis of T2DM?

Answer 22

1. MACR (microalbumin creatinine)
2. Dilated eye exam
3. lipids

Question 23

What are 5 Comorbities for T2DM?

Answer 23

1. Polycystic Ovary syndrome (PCOS)
2. Sleep apnes
3. Hepatic steatosis
4. Orthopedic complications
5. Eating disorders

Question 24

What is the leading cause of blindness in adults?

Answer 24

diabetic retinopathy

Question 25

What is the earliest marker of diabetic nephropathy?

Answer 25

microalbuminuria

Question 26

What is a good predictor of coronary heart disease?

Answer 26

A1C