Type 2 Children Flashcards
Breastfeeding…..
Has been shown to reduce the risk of youth onset of T2D in SOME populations.
At diagnosis children may present with:
DKA
Hyperosmolar coma/HHS
Microvascular complications
Dyslipidemia
List some risk factors for children and T2
Obesity Member of high risk ethnic group (5As and H) T2 in first degree relative. IGT PCOS Exposure to D in utero Acanthosis Nigricans HTN Dyslipidemia NAFLD (non alcoholic fatty liver disease) Atypical antipsychotic use
What is the recommended screening test for children?
FPG. (dx is greater than or equal to 7mmo/L - like adults)
75-gram oral glucose tolerance test may be used as a screening test in very obese children (BMI ≥99th percentile for age and gender) or those with multiple risk factors (dx is greater than or equal to 11.1mmol/l just like adults
A1C is NOT RECOMMENDED as SOLE diagnostic test
It can be difficult to differentiate between whether a child has T1 or T 2. Eg. Both can present with DKA. What screening test maybe useful here?
Testing for islet antibodies. If none then it’s T 2.
What’s the targeted A1C for type two children?
7 (same as adults)
What is the activity level recommended for T 2 children?
SAME as any child. 60 minutes per day of moderate to vigorous activity with sedentary screen time limited to
What is the recommended initiation and interval for screening for the following in children with T2? Dyslipidemia HTN Neuropathy Nephropathy PCOS NAFLD Retinopathy
ALL at diagnosis then YEARLY
Except
HTN. At diagnosis and every clinical visit
Dyslipidemia at diagnosis and every 1year
Nephropathy. At diagnosis and yearly. Neuropathy. At diagnosis and yearly. PCOS. In Pubertal females, at diagnosis and yearly. NAFLD. At diagnosis and yearly Retinopathy. At diagnosis and yearly.
When should insulin be used in T 2 kids?
If A 1C 9%
DKA
Sx of severe hyperglycemia or decompensation.
**may successfully be weaned off insulin if once targets are achieved and lifestyle changes are adopted.
What percent of children diagnosed with type 2 have Dyslipidemia discovered at diagnosis?
44%
When should a statin be started?
Child with:
Familial Dyslipidemia or
Positive family Hx of early CV events AND
LDL >4.1 after 3-6 month trial of dietary intervention
Which children should be screened for T 2 and how often?
Every 2 years when:
Pre-puberty child has 3 risk factors. Pubertal children have 2 risk factors.
1-Obeisity
2-member of 5As and H Ie: High risk ethnic groups
3- family Hx or exposure in utero to D
4- IFG or IGT
5- use of atypical antipsychotics
6-Sx of insulin resistance: PCOS, NAFLD, acanthosis Nigricans, HTN, Dyslipidemia.
If glycemic targets are not reached in 3-6 months what should be done?
Start metformin (preferred) or glimepiride or insulin.
Which ethnic groups are kids at high risk of T2D?
5 As and H!!
African Asian south Asian Arabic Aboriginal Hispanic
How often should aboriginal children be screened and starting at what age?
Start at age 10 or at puberty and screen every 2 years if they have ONE risk factor.
How do you confirm nephropathy In children?
An abnormal first morning urine ACr must be confirmed with either first morning urine or timed overnight collection. Must be PERSISTENT to be diagnosed therefore must retest every 3-4 months over a 12 month period.
A child is considered obese when he is in what percentile of growth chart?
95th
How do you diagnose NAFLD?
ALT > 3x upper limit of normal
Who to screen and how often?
Non-pubertal + ≥3 risk factors
Pubertal + ≥2 risk factors
IFG or IGT
Use of atypical antipsychotic medications
Aboriginal children with 1 risk factor screen at age 10
Screen with FPG every 2 years
what proprotion of t2dm kids at diagnosis have psych issues?
19.4% have neuropsychiatric disorder
at presentation of T2DM
what % of canada’s youth present with DKA?
10%
Aboriginal youth are at an increased or decreased risk of non DM related renal disease?
Aboriginal youth in Canada are at increased risk of renal diseases that are not associated with diabetes
