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ENDOCRINOLOGY > Type 1 Diabetes > Flashcards

Type 1 Diabetes Flashcards

1
Q

Name the members of an interprofessional diabetes team

A
  • Pediatric endocrinologist/pediatrician - dietician - diabetes nurse educator - social worker - mental health professional
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2
Q

Name the following glycemic targets for type 1 diabetes: A1c Preprandial BG 2-hr Postprandial BG

A

A1c = 7.5% Preprandial 4.0-8.0 Postprandial 5.0-10.0 Consider preprandial 6.0-10.0 or higher A1c target if severe hypoglycemia or HUA

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3
Q

List 3 advantages of MDI (Lantus, Levemir) over BID (NPH)

A
  • A1c reduction
  • Improved fasting BG
  • Less nocturnal hypoglycemia
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4
Q

Why was sensor-augmented pump therapy associated with improved glycemic control in adults but not children/adolescents in a large RCT?

A

Lower sensor use in children and adolescents

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5
Q

List CHO treatment for hypoglycemia by age:

  • < 5 years
  • 5-10 years
  • > 10 years
A
  • < 5 years: 5 grams
  • 5-10 years: 10 grams
  • > 10 years: 15 grams
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6
Q

What is the dose for mini-dose glucagon?

A
  • 10 mcg per year of age (= 1 unit per year of age on insulin syringe)
  • First dose: Minimum 20, maximum 150 mcg
  • Double if not effective
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7
Q

What is the dose for glucagon in severe hypoglycemia?

A
  • Age =5: 0.5 mg
  • Age >5: 1 mg
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8
Q

What is the dose for IV dextrose in treating hypoglycemia?

A

0.5-1 g/kg IV over 1-3 minutes

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9
Q

How much does physical activity reduce your HbA1c?

A

0.5%

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10
Q

List 3 potential causative factors for children with A1c >10%

A
  • Depression
  • Eating disorder
  • Lower SES
  • Lower family support
  • Higher family conflict
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11
Q

Why is glycemic control particularly challenging in adolescence?

A
  • Physiologic insulin resistance
  • Depression/other psychologic issues
  • Decreased adherence - growing independence
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12
Q

Prevalence of DKA in newly diagnosed diabetes? Established diabetes?

A
  • Newly diagnosed: 40%
  • Established diabetes: 1-10 per 100 patient years
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13
Q

Risk factors for DKA

A
  • Poor metabolic control or previous episodes of DKA
  • Peripubertal and adolescent girls
  • Children on pump or long-acting basal insulin
  • Ethnic minorities
  • Children with psychiatric disorders
  • Children with difficult family circumstances
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14
Q

How to decrease DKA frequency

A
  • Education
  • Behavioural intervention
  • Family support
  • 24h phone support
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15
Q

What is the frequency of cerebral edema in children with DKA

A

0.5-1%

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16
Q

List 5 risk factors for cerebal edema

A
  • Younger age (<5 years)
  • New onset diabetes
  • Greater degree of acidosis (lower pH and HO3)
  • High initial serum urea
  • Low initial PaCO2 (partial pressure of arterial CO2)
  • Rapid administration of hypotonic fluids
  • IV bolus of insulin
  • Early insulin administration (within the first hour of fluid replacement)
  • Failure of serum sodium to rise during treatment
  • Use of bicarbonate
17
Q

What is the initial infusion rate for IV insulin in DKA management?

A

0.1 units/kg/hr

*Some centres routinely use 0.05 units/kg/hr. This is shown to be safe and effective, but not studied in severe/complicated DKA

18
Q

What is the treatment for cerebral edema?

A

Mannitol or hypertonic saline

19
Q

List 4 psychological problems that children with DM1 are at risk of

A
  • Diabetes distress
  • Depression
  • Anxiety
  • Eating disorders
  • Externalizing disorders
20
Q

What is the prevalence of eating disorders in adolescent females with DM1

A

10% (vs. 4% in age-mated peers)

21
Q

What is the prevalence of autoimmune thyroid disease in patients with DM1?

A

15-30%

22
Q

What is the prevalence of celiac disease in patients with DM1?

A

4-9%

*Asymptomatic in 60-70%

23
Q

What is the method and frequency of screening for the following comorbid conditions in children with DM1:

  • Autoimmune thyroid disease
  • Primary adrenal insufficiency
  • Celiac disease
A
  • AITD: TSH and anti-TPO in all children at diagnosis, then Q2 years if TPO negative, Q6-12 months if TPO positive/symptoms of thyroid disease/goiter
  • AI: 8AM cortisol, Na, K as clinically indicated (ex. unexplained hypoglycemia, decreasing insulin requirements)
  • Celiac: TTG + IgA levels as clinically indicated (ex. recurrent GI sypmtoms, poor growth, fatigue, anemia, unexplained hypoglycemia or poor control)
24
Q

What is the prevalence of hypertension in adolescents with DM1?

A

16%

25
Q

How should nephropathy screening be done in children with DM1? How often?

A
  • Indications/interval: yearly screening beginning at age 12 in those with diabetes duration >5 years
  • Screening method: first morning (preferred) or random urine ACR.
    • If abnormal- confirmation 1 mo later with 1st morning ACR
    • If abnormal- timed, overnight or 24-h split urine collections for albumin excretion rate
26
Q

How should retinopathy screening be done in children with DM1? How often?

A
  • Indications/interval: Yearly screening beginning at age 15 in those with diabetes duration >5 years. May increase to Q2 years in some cases.
  • Screening method:
    • 7-standard field, stereoscopic-colour fundus photography with interpretation by a trained reader OR
    • Direct ophthalmoscopic or indirect slit-lamp fundoscopy through dilated pupil OR
    • Digital fundus photograph
27
Q

When can you consider increasing the interval of retinopathy screening to Q2 years?

A
  • Good diabetes control
  • Duration of diabetes <10 years
  • No retinopathy at initial assessment
28
Q

How should neuropathy screening be done in children with DM1? How often?

A
  • Indications/interval: yearly screening commencing at 15 years of age in children with diabetes duration >5 years and poor metabolic control
  • Screening method: Question and examine for symptoms of
    • Numbness
    • Pain
    • Cramps
    • Paresthesia
    • Skin sensation
    • Vibration sense
    • Light touch
    • Ankle reflexes
29
Q

How should dyslipidemia screening be done in children with DM1? How often?

A
  • Indications/interval: screen at 12 and 17 years of ago
    • Screen in those <12 IF BMI >97th %, family history of dyslipidemia or premature CVD
    • *Delay screening post-diabetes diagnosis until metabolic control has stabilized
  • Screening method: Fasting OR non-fasting TC, HDL, TG, calculated LDL
30
Q

How should hypertension screening be done in children with DM1? How often?

A
  • Indications/interval: screen all children with DM1 at least twice a year
  • Screening method: use appropriate cuff size
31
Q

What percentage of young adults have no medical follow-up during the transition from pediatric to adult diabetes care services?

A

25-65%

32
Q

No follow-up during the transition time increases the risk for _____

A
  • Hospitalization for DKA
  • Loss of follow-up
33
Q

When should transition planning begin in children with DM1? What should it include?

A
  • Early adolescence (ex. age 12)
  • Includes:
    • Education in self-care behaviours
    • Transition readiness assessment
    • Idenitfying transition goals
34
Q

List 4 diabetes antibodies

A
  • Anti-glutamic acid decarboxylate (GAD)
  • Anti-islet cell (ICA)
  • Tyrosine phosphatase related islet antigen 2 (IA2)
  • Zinc transporter (ZnT8)
  • Anti-insulin
35
Q

Type 1 diabetes is primarily TH1/TH2 mediated?

A

TH1

ENDOCRINOLOGY (21 decks)

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