Pediatric DM type 1

Question 1

Age <18

target A1C
target fasting/preprandial PG
target 2 hour postprandial PG

Answer 1

A1C 7.5 or under

preprandial: 4.0-8.0
postprandial: 5.0-10.0

**individualized targets
consider higher targets if at high risk

Question 2

how is chronic poor metabolic control defined?

Answer 2

A1C>10%

*should be assessed by multidisciplinary team to see re: barriers to control

Question 3

what is the recommendation for physical activity for kids with type 1 DM?

Answer 3

minimum 3x/week for 60 min each time for all kids with diabetes

Question 4

what are risk factors for DKA?

Answer 4

Previous episodes of DKA

• peripubertal and adolescent girls
• children on CSII or long acting basal insulin
• ethnic minorities
• kids with MH disorders
• difficult family circumstances

Question 5

DM type 1 is associated with higher risk of which MH conditions?

Answer 5

depression
anxiety
eating disorders
externalizing disorders

**strongly affected by caregiver/family distress (esp maternal anxiety and depression)

Question 6

DM type 1 is associated with what co-morbid conditions?

screening?

Answer 6

Autoimmune thyroid disease

• TSH and TPO Ab at time of dx
• TSH q2years after if TPO neg
• TSH q6-12 months if TPO positive

Primary adrenal insufficiency (rare)
*AM cortisol and lytes if clinical sx

Celiac disease

• highest risk in first 10 years after dx
• up to 70% asymptomatic
• TTG and IgA

Question 7

DM type 1
screening for complications

NEPHROPATHY

• test?
• frequency?

Answer 7

morning ACR
*abnormal ACR needs repeat in 1 month

annual
start at age 12 if duration DM >5 years

Question 8

DM type 1
screening for complications

RETINOPATHY

• test?
• frequency?

Answer 8

diabetic eye exam

annual
start at age 15 if duration DM >5 years

*can be q2years if good glycemic control, no retinopathy on previous exams and duration DM <10 years

Question 9

DM type 1
screening for complications

NEUROPATHY

• test?
• frequency?

Answer 9

history and physical

• numbness, pain, cramps, paresthesia
• sensation, vibration, light touch, ankle reflex

annual
start at age 15 if poor control duration DM >5 years

Question 10

DM type 1
screening for complications

DYSLIPIDEMIA

• test?
• frequency?

Answer 10

fasting or nonfasting lipids
-nonfasting if TG normal

at 12 and 17 years
-delay until good control

screen earlier if BMI >97%, family hx hyperlipidemia or premature CVD

Question 11

DM type 1
screening for complications

HYPERTENSION
frequency?

Answer 11

all kids at least twice a year

Question 12

DKA

signs and symptoms

Answer 12

• vomiting
• abdo pain
• dehydration
• Kussmaul respirations
• altered LOC

Question 13

initial signs and symptoms of DM1

Answer 13

trial: polyuria, polydipsia, polyphagia

• Most consistent sign: increased urination at night
• weight loss

Question 14

what are the diagnostic values for diabetes type 1 in children and adolescents?

Answer 14

fasting PG=/> 7.0
random PG =/> 11.1
2h OGTT PG =/> 11.1

A1C not used as diagnostic test for children