Peds Flashcards
What can kids w/ T1DM do to reduce risk of HYPO before, during, & after exercise?
- do not exercise if BG <90
- have CHO easily acccessable before exercise
- 10-15 g CHO snack or 0.5-1 g CHO/kg/hour (30-60 g)
- decrease prandial insulin at meal/snack before exercise
- temporarily suspend basal insulin or reduce rate by 10-50% for 1-2 hrs
- eat bedtime snack
- decrease basal by 20% after exercise
- monitor BG before, during, and after exercise
Ideal BG range for T1DM kids before exercise
90-250
When should T1DM kid not exercise?
BG >350 w/ moderate to large ketones
when hypoglycemic
when B-OHB >1.5 mmol
When to first assess kid w/ T1DM for DM distress?
Start @ age 7-8
When to screen for ED in T1DM kids?
10-12 years old initially use DEPS (diabetes eating problem survey)
When should kids have time alone w/ HC provider?
Starting @ age 12
What is the physical activity goal for kids w/ T1DM & T2DM?
- 60 minutes MIPA/VIPA/day
- 3 days/week muscle & bone strengthening exercise (vigorous) such as jumping
When should preconception counseling for girls start?
@ puberty
What is appropriate WL goal for T2DM kid?
7-10%
What are the medication MGMT recommendations for kids w/ T2DM?
- IF A1c <8.5%, not in ketosis, no s/s of hyper- start Metformin
IF A1c 8.5% and BG >250, start basal insulin + Metformin
IF high A1c, s/s of hyper and ketosis/ketoacidosis, sub Q insulin or insulin drip; do not give metformin until metabolic derangement resolves
Can slowly taper insulin over 2-6 weeks by decreasing dose 10-30% every few days if goals are met at home
How often should kids w/ T1DM monitor?
6-10x/day pre-meal before bed before driving, exercising when suspecting a low BG
How often should A1c be checked in kids w/ T2DM?
q 3 months
What are A1c goals in T1DM kids?
<7% for most
<6.5% may be appropriate if it can be done w/o DM distress, hypo, or undue burden; may be feasible during honeymoon period
<7.5% if unable to recognize or verbalize hypo, hypo unaware, lack access to analog insulin, unable to check BG often
<8% if severe hypo, low life expectancy
What are A1c goals in T2DM kids?
<7% for most
<6.5% if on oral meds, if they’ve lost weight intentionally, shorter duration DM, less B-cell dysfunction
<7.5% if at risk for hypo
What autoimmune conditions are of upmost concern for T1DM kids?
When and how to test?
Thyroid- check when clinically stable then q 1-2 years
Celiac- check at dx, 2 years after dx, and 5 years after dx
If IgA +, confirm with bowel biopsy before starting restrictive diet
How often should BP be checked in kids?
How to dx elevated BP vs. HTN
at each visit
confirm elevated value 3x on separate days before dx
elevated >90% if <13; >120-129/<80
HTN >95% if <13; >130/>80
How to treat elevated BP vs HTN in kids?
Elevated- diet, PA, WL x 3-6 months, if no improvement start meds
HTN- start ACE or ARB
When to monitor lipids in T1DM?
once pt stable IF >2 years old
if normal, test again 9-11 years
if normal, check q 3 years
When to monitor lipids in T2DM?
when initial BG control is achieved
then annually
What is LDL goal in peds?
<100
What are other lipid goals in T2DM?
HDL >35
TG <150
When to start statin
T1DM- LDL >130 + CVD risk factor or >160
T2DM- >130 despite 6 months of lifestyle changes
AND age 10 or older
What to give a kid w/ high TG?
What is high TG?
> 400 fasting
1000 non-fasting
fibrate
What lipid test is predictive for atherosclerosis in kids?
non-fasting non-HDL cholesterol
What dietary changes are recommended for elevated cholesterol v. elevated TG?
chol- 25-30% total fat, 10% MUFA, 7% SFA, no trans fats
TG- decrease simple CHO, increase omgea-3
When to test for kidney issues in T1DM?
annual UACR @ puberty or age 10, assuming dx x 5 years
When to test for kidney issues in T2DM?
@ dx & annually
UACR, eGFR
When to consider foot exam in T1DM?
puberty/10 or after 5 years dx
When should T2DM kids get foot exam?
@ dx & annually
When should kids w/ T1DM get eye exam?
once dx for 5 years or >11/puberty
then every 2 years;possibly 4 if very good BG control
When should kids w/ T2DM get eye exam?
@ dx, annually
possibly every 2 years if A1c <8%
How to screen kids for T2DM?
OV/OB (>85% or 95%) + 10 years or older + at least 1 risk factor
if normal, repeat q 3 years
What % kids w/ T2DM present with DKA
6%
% of kids w/ T2DM expected to _______ in 40 years
quadruple
When should ALT/AST be tested in T2DM?
dx, annually
refer to GI if chronically elevated
Girls w/ PCOS should be offered what meds?
Metformin
birth control
When should transition from peds to adult care start?
why?
early adolescence but at least 1 year before transition
transition associated w/ worsening outcomes
At what BMI can bariatric surgery be offered to T2DM kid?
35
What non-insulin meds are approved for T2DM kids?
Metformin
Liraglutide
Age 10 or up
When to start prandial insulin in T2DM kid?
Already on metformin
basal insulin >1.5 units/kg/day
What DM distress screening tool can be used in T1DM kids and their parents?
PAID-T and P-PAID-t
Problem areas in diabetes
starting age 12
Why should pancreatic autoantibodies be checked in kids?
Kids w/ T1DM may present w/ s/s of T2DM (obesity, acanthosis nigricans)
Although uncommon, T2DM can occur in kids who are <10/ not yet @ puberty
What tech should be considered for T1DM kids?
CGM regardless if on CSII or MDI
Automated insulin delivery systems- decrease hypo, improve BG control
Protein needs in kids w/T2DM & elevated UACR
0.8 g/kg/day
