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CDCES > Peds > Flashcards

Peds Flashcards

1
Q

What can kids w/ T1DM do to reduce risk of HYPO before, during, & after exercise?

A
  • 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
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2
Q

Ideal BG range for T1DM kids before exercise

A

90-250

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3
Q

When should T1DM kid not exercise?

A

BG >350 w/ moderate to large ketones
when hypoglycemic
when B-OHB >1.5 mmol

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4
Q

When to first assess kid w/ T1DM for DM distress?

A

Start @ age 7-8

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5
Q

When to screen for ED in T1DM kids?

A 
10-12 years old initially
use DEPS (diabetes eating problem survey)
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6
Q

When should kids have time alone w/ HC provider?

A

Starting @ age 12

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7
Q

What is the physical activity goal for kids w/ T1DM & T2DM?

A
  • 60 minutes MIPA/VIPA/day

- 3 days/week muscle & bone strengthening exercise (vigorous) such as jumping

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8
Q

When should preconception counseling for girls start?

A

@ puberty

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9
Q

What is appropriate WL goal for T2DM kid?

A

7-10%

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10
Q

What are the medication MGMT recommendations for kids w/ T2DM?

A
  • 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
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11
Q

How often should kids w/ T1DM monitor?

A 
6-10x/day
pre-meal
before bed
before driving, exercising
when suspecting a low BG
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12
Q

How often should A1c be checked in kids w/ T2DM?

A

q 3 months

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13
Q

What are A1c goals in T1DM kids?

A

<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

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14
Q

What are A1c goals in T2DM kids?

A

<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

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15
Q

What autoimmune conditions are of upmost concern for T1DM kids?

When and how to test?

A

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

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16
Q

How often should BP be checked in kids?

How to dx elevated BP vs. HTN

A

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

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17
Q

How to treat elevated BP vs HTN in kids?

A

Elevated- diet, PA, WL x 3-6 months, if no improvement start meds
HTN- start ACE or ARB

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18
Q

When to monitor lipids in T1DM?

A

once pt stable IF >2 years old
if normal, test again 9-11 years
if normal, check q 3 years

19
Q

When to monitor lipids in T2DM?

A

when initial BG control is achieved

then annually

20
Q

What is LDL goal in peds?

A

<100

21
Q

What are other lipid goals in T2DM?

A

HDL >35

TG <150

22
Q

When to start statin

A

T1DM- LDL >130 + CVD risk factor or >160
T2DM- >130 despite 6 months of lifestyle changes
AND age 10 or older

23
Q

What to give a kid w/ high TG?

What is high TG?

A

> 400 fasting
1000 non-fasting
fibrate

24
Q

What lipid test is predictive for atherosclerosis in kids?

A

non-fasting non-HDL cholesterol

25
Q

What dietary changes are recommended for elevated cholesterol v. elevated TG?

A

chol- 25-30% total fat, 10% MUFA, 7% SFA, no trans fats

TG- decrease simple CHO, increase omgea-3

26
Q

When to test for kidney issues in T1DM?

A

annual UACR @ puberty or age 10, assuming dx x 5 years

27
Q

When to test for kidney issues in T2DM?

A

@ dx & annually

UACR, eGFR

28
Q

When to consider foot exam in T1DM?

A

puberty/10 or after 5 years dx

29
Q

When should T2DM kids get foot exam?

A

@ dx & annually

30
Q

When should kids w/ T1DM get eye exam?

A

once dx for 5 years or >11/puberty

then every 2 years;possibly 4 if very good BG control

31
Q

When should kids w/ T2DM get eye exam?

A

@ dx, annually

possibly every 2 years if A1c <8%

32
Q

How to screen kids for T2DM?

A

OV/OB (>85% or 95%) + 10 years or older + at least 1 risk factor
if normal, repeat q 3 years

33
Q

What % kids w/ T2DM present with DKA

A

6%

34
Q

% of kids w/ T2DM expected to _______ in 40 years

A

quadruple

35
Q

When should ALT/AST be tested in T2DM?

A

dx, annually

refer to GI if chronically elevated

36
Q

Girls w/ PCOS should be offered what meds?

A

Metformin

birth control

37
Q

When should transition from peds to adult care start?

why?

A

early adolescence but at least 1 year before transition

transition associated w/ worsening outcomes

38
Q

At what BMI can bariatric surgery be offered to T2DM kid?

A

35

39
Q

What non-insulin meds are approved for T2DM kids?

A

Metformin
Liraglutide
Age 10 or up

40
Q

When to start prandial insulin in T2DM kid?

A

Already on metformin

basal insulin >1.5 units/kg/day

41
Q

What DM distress screening tool can be used in T1DM kids and their parents?

A

PAID-T and P-PAID-t
Problem areas in diabetes
starting age 12

42
Q

Why should pancreatic autoantibodies be checked in kids?

A

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

43
Q

What tech should be considered for T1DM kids?

A

CGM regardless if on CSII or MDI

Automated insulin delivery systems- decrease hypo, improve BG control

44
Q

Protein needs in kids w/T2DM & elevated UACR

A

0.8 g/kg/day

CDCES (13 decks)

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