Type 1 Diabetes Flashcards
Name the members of an interprofessional diabetes team
- Pediatric endocrinologist/pediatrician - dietician - diabetes nurse educator - social worker - mental health professional
Name the following glycemic targets for type 1 diabetes: A1c Preprandial BG 2-hr Postprandial BG
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
List 3 advantages of MDI (Lantus, Levemir) over BID (NPH)
- A1c reduction
- Improved fasting BG
- Less nocturnal hypoglycemia
Why was sensor-augmented pump therapy associated with improved glycemic control in adults but not children/adolescents in a large RCT?
Lower sensor use in children and adolescents
List CHO treatment for hypoglycemia by age:
- < 5 years
- 5-10 years
- > 10 years
- < 5 years: 5 grams
- 5-10 years: 10 grams
- > 10 years: 15 grams
What is the dose for mini-dose glucagon?
- 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
What is the dose for glucagon in severe hypoglycemia?
- Age =5: 0.5 mg
- Age >5: 1 mg
What is the dose for IV dextrose in treating hypoglycemia?
0.5-1 g/kg IV over 1-3 minutes
How much does physical activity reduce your HbA1c?
0.5%
List 3 potential causative factors for children with A1c >10%
- Depression
- Eating disorder
- Lower SES
- Lower family support
- Higher family conflict
Why is glycemic control particularly challenging in adolescence?
- Physiologic insulin resistance
- Depression/other psychologic issues
- Decreased adherence - growing independence
Prevalence of DKA in newly diagnosed diabetes? Established diabetes?
- Newly diagnosed: 40%
- Established diabetes: 1-10 per 100 patient years
Risk factors for DKA
- 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
How to decrease DKA frequency
- Education
- Behavioural intervention
- Family support
- 24h phone support
What is the frequency of cerebral edema in children with DKA
0.5-1%
List 5 risk factors for cerebal edema
- 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
What is the initial infusion rate for IV insulin in DKA management?
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
What is the treatment for cerebral edema?
Mannitol or hypertonic saline
List 4 psychological problems that children with DM1 are at risk of
- Diabetes distress
- Depression
- Anxiety
- Eating disorders
- Externalizing disorders
What is the prevalence of eating disorders in adolescent females with DM1
10% (vs. 4% in age-mated peers)
What is the prevalence of autoimmune thyroid disease in patients with DM1?
15-30%
What is the prevalence of celiac disease in patients with DM1?
4-9%
*Asymptomatic in 60-70%
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
- 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)
What is the prevalence of hypertension in adolescents with DM1?
16%
