Type 1 Diabetes Flashcards
Compared to adults, children with T1DM are at increased risk of
cerebral edema
Poorer cognitive function is associated with
1) age <7 yo at dx
2) episodes of severe hypoglycemia
3) chronic hyperglycemia
Improved glycemic control is associated with
patient/parent knowledge of targets and consistent target setting by team
The honeymoon period can last up to X years and is characterized by insulin
2, 0.5
Dose for glucagon in severe hypoglycemia
10ug/year of age min 20 max 150 with additional doubled dose if no rise in glu in 20 min
BG targets for <6yo, 6-12yo, 13-18yo
6-10, 4-10, 4-7
HbA1C targets for <6yo, 6-12yo, 13-18 yo
<8, < or equal to 7.5, less than or equal to 7
Recommended carbs amount for mild-mod hypoglycemia in >15kg, 15-30kg and >30kg
5g, 10g, 15g
g carb in 1 glu tab, 1 dex tab and 1 juice
glu - 4g, dex - 3g, juice - 40 mL ~ 5g
DKA occurs in what percentage of new dx T1DM
15-67%
Increase risk DKA with
new onset, poor compliance, previous dka, adolescent girl, pump/long acting basal, psych or social issues
pediatric DKA is complicated by cerebral edema in x %
0.7-3
Risk factors for cerebral edema
age <5yo, new onset, high initial urea, low initial pCO2, rapid adminstration hypotonic fluids, IV insulin bolus, early IV insulin infusion (within 1h), failure of serum sodium to rise during treatment, use of bicarbonate
Percent adolescent girls with AN, T1DM versus general population
10% vs 4%
Thyroid screening guidelines
All patients TSH and anti-TPO at dx and q2years, 10-30% with T1DM
Addisons screening guidelines
Recurrent hypoglycemia (unexplained) and decreasing insulin requirements - am cortisol and lytes
Celiac screening guidelines
4-9% in children with T1DM, GI sx, poor growth, poor weight gain, fatigue, anemia, freq hypogylcemia, poor control - TTG and IgA
Nephropathy screening guidelines
yearly starting at 12yo if duration T1DM >5 years, am or random ACR, if abnormal confirm 1 month later if abnormal follow with timed, overnight or 24h urine for albumin excretion. Repeat sampling q3 months over 1 year to demonstrate persistence. Treat only if persistent, could be normal if transient esp in adolescents. Tx is Acei
Retinopathy screening guidelines
yearly starting at 15yo if length T1DM >5years, stretch to q2years if good control and T1DM >10yes/no retinopathy
neuropathy screening guidelines
postpubertal, poor control - screen yearly after duration T1DM >5yrs - screen for numbness, pain, cramps, paresthesia, skin sensation, vibration sense, lighttouch and ankle reflexes tx is glycemic control
DLPD screening guidelines
screen after dx but when metabolic control stable, at 12 and 17 years old, <12 years old screen if BMI >95th%/fhx DLPD or premature CAD - fasting lipids, (cholesterol, LDL, TGs, HDL) tx is statin
HTN screening guidelines
twice yearly, 16% of kids with T1DM
