Module 11. Peds II Flashcards
What are the recommended glycemic targets for children and adolescents with type 1 diabetes?
A1c = 7.5
Fasting plasma glucose = 4.0-8.0
2-hour postprandial PG = 5-10
In type 1 diabetes for children what routine screening for comorbid conditions is required?
At the time of diagnosis and every 2 years screen for:
Autoimmune Thyroid Disease (TSH, thyroid peroxidase antibodies)
If the patient has positive thyroid antibodies, symptoms of thyroid disease or goitre, screen TSH levels q6-12 months
What comorbid conditions are children with T1DM prone to ?
Autoimmune Thyroid Disease
Primary Adrenal Insufficiency (Addison’s Disease)
Celiac disease
Please list all the screening for complications you must perform on a child with type 1 diabetes
nephropathy: annually @ 12 yrs of age for patient who have had diabetes for more than 5 years
Retinopathy: commencing @ 15 for children with diabetes for more than 5 years, screening can be increased to every 2 years if good glycemic control, and duration of diabetes is less than 10 years and no retinopathy at inital visit
Neuropathy: older than 15 w poor metabolic control should be screened yearly after 5 years of having diabetes
dyslipidemia
HTN
How often do you screen for nephropathy in a child with type 1 diabetes?
annually @ 12 yrs of age for patient who have had diabetes for more than 5 years
How often do you screen for retinopathy in a child with type 1 diabetes?
commencing @ 15 for children with diabetes for more than 5 years, screening can be increased to every 2 years if good glycemic control, and duration of diabetes is less than 10 years and no retinopathy at inital visit
How often do you screen for neuropathy in a child with type 1 diabetes?
Children ≥15 years with poor metabolic control should be screened yearly after 5 years of type 1 diabetes
How often do you screen for Dyslipidemia in a child with type 1 diabetes?
Delay screening post-diabetes diagnosis until metabolic control has stabilized
Screen at 12 and 17 years of age
children less than 12 years of age: screen only those with BMI >97th percentile, family history of hyperlipidemia or premature CVD
How often do you screen for Hypertension in a child with type 1 diabetes?
Screen all children with type 1 diabetes at least twice a year
What are the risk factors to T2DM in children?
a history of type 2 diabetes in a first- or second-degree relative (1–4,22),
being a member of a high-risk population (e.g. people of African, Arab, Asian, Hispanic, Indigenous or South Asian descent)
obesity (2);
impaired glucose tolerance
polycystic ovary syndrome
exposure to diabetes in utero
acanthosis nigricans
hypertension and dyslipidemia
and non-alcoholic fatty liver disease
true or false?
A1C should not be relied upon as the sole diagnostic test to screen for type 2 diabetes but rather used in combination with FPG and/or 2-hour OGTT.
true
we recommend using a combination of A1C and fasting or random blood glucose to screen for type 2 diabetes in children and youth with risk factors.
When would you screen a child for type 2 diabetes, and how often would this screening occur?
Screening for T2DM can occur every 2 years for a child that has more than :
3 risk factors beginning at the age of 8
Or 2 risk factors in pubertal children
What is the diagnostic criteria for Type 2dm or type 1DM in children?
Symptoms of diabetes: polyuria,polydispia, weight loss AND hyperglycemia ( random blood glucose above 11.1)
OR two of the following on one occasion:
Fasting glucose above 7.0
2 hour Oral glucose Challenge 11.1
Random glucose higher than 11.1
Or any of the following above on two separate occasions
What are the symptoms of hypoglycemia?
cold sweat
tremors
pale/grey skin
irritability/moodiness
blurred vision
For a child with diabetes how often would you screen for psychiatric conditions
you should screen your patient for depression or disordered eating at the time of diagnosis and every anual appointment moving forward
What are risk factors for Congenital hip dysplasia?
Female
First born
Breech
Family hx of congenital hip dysplasia
lower extremity swaddling
When can you diagnose congenital hip dysplasia?
Diagnostics: 2-4 wks of age: referral to orthopedic surgeon
6-8 wks: ultrasonography
In congenital hip dysplasia there will be an Increased acetabular index. What are normal values for the acetabular index?
normal values for the acetabular index are as follows:
<35° at birth;
<25° at 1 year;
<20° at 2 to 3 years;
<15° at 6 to 7 years;
<11 to 12° at 10 years;
and <10° at 15 years
What is the Klisic test?
It tests for congenital hip dysplasia
you place two fingers at the anterior ilic spine, and the middle finger on the greater trochanter
if an imaginary line is below the umbillicus then the hip is likley dislocated
What is Osgood Schlatter Disease?
Inflammation of the patellar ligament at insertion point on the tibial tuberosity
Repetitive stress on the insertion of patellar tendon over the tibial tuberosity cuases minor avulsion at the site of the subsequent inflammatory rxn
What age group would you see osgood schlatter disease, and what symptoms would you see?
More common in males 12-5
Female 8-12
Tender lump on tibial tuberosity
pain when extending knee, worse with jumping or kneeling, relieved by rest
You may order xray of the lateral knee which can show fragmentation of the tibial tuberosity
What are the symptoms of patellarfemoral syndrome?
anterior knee pain
deep aching knee pain worsened by prolonged sitting (theatre sign)
strenuous athletic activity
**pain with firm compression of the patella of medial femoral groove is pathogenic of patellarfemoral syndrome
What differentials could you write for children knee pain?
- Osgood Schlatter Disease
- Patellarfemoral syndrome
- Patellar Tendonitis
What causes posterior chronic inflammation by activity or poorly fitted footwear?
Achilles
