Type 2 Diabetes

Question 1

What are the criteria for a diagnosis of diabetes?

Answer 1

Fasting blood glucose >7 mmol

2 hr plasma glucose level >11.1 with 75g OGTT

Random plasma glucose >11.1 in patient with classic symptoms of hyperglycemia

Hemoglobin >6.5%

Only need one of these criteria

Question 2

As per the Diabetes Canada guidelines (2018) - who should be screened for T2DM?

Answer 2

**Non-pubertal children with 3 or more risk factors beginning at age 8
**2 or greater risk factors in pubertal children

Risk Factors:
1) Obesity (BMI >95%)
2) Member of high risk ethnic group (African, Arab, Asian, Hispanic, Indigenous, South Asian)
3) 1st degree relative with T2DM and/or exposure to hypoglycemia in utero
4) Signs or symptoms of insulin resistance - acanthosis, HTN, dyslipidemia, NAFLD (ALT >3x ULN or fatty liver on U/S)

Children with PCOS
Children with impaired fasting glucose or OGTT
Use of atypical antipsychotic medication

Question 3

As per the Diabetes Canada guidelines (2018) - how should eligible children be screened for T2DM?

Answer 3

HbA1C
AND
Fasting or random plasma glucose

Question 4

What is the target HbA1C for children with diabetes?

Answer 4

<7.0%

Question 5

What is the most common side effect of metformin? What is the rare side effect to monitor for?

Answer 5

GI upset

Lactic acidosis (typically in those with compromised renal function)

Question 6

What is the indication for insulin therapy in Type 2 DM?

Answer 6

Metabolically unstable:
1) Episode of DKA
2) HbA1C >9.0%
3) Symptoms of severe hyperglycemia

Question 7

What is the dosage for metformin?

Answer 7

500 mg po BID, titrated up to a max of dose 1,000 mg po BID (go up by 500 mg/week)

Question 8

When should children with T2DM be screened for neuropathy?

Answer 8

Yearly screening at onset of DM

Hx re: numbness, pain, cramps, parenthesia

Exam: Sensation, vibration, light touch and ankle reflexes

Question 9

When should children with T2DM be screened for retinopathy?

Answer 9

Yearly screening at onset of DM

Question 10

When should children with T2DM be screened for nephropathy? How do you screen for this?

Answer 10

Yearly screening at onset of DM
First morning (preferred) or random ACR

Question 11

When should children with T2DM be screened for dyslipidemia? How do you screen for this?

Answer 11

Yearly screening on onset of DM

Lipid panel

Question 12

When should children with T2DM be screened for HTN?

Answer 12

At least twice annually
BP measurement

Question 13

When should children with T2DM be screened for NAFLD? How do you screen?

Answer 13

ALT and/or fatty liver on ultrasound

Question 14

When should children with T2DM be screened for PCOS? How do you screen?

Answer 14

Yearly clinical screening commencing at diagnosis of diabetes in pubertal females

Hx: Clinical assessment on history and physical exam for oligo/amenorrhea, acne and/or hirsutism

Question 15

When should children with T2DM be screened for OSA? How do you screen?

Answer 15

History:
Symptoms suggestive of obstructive sleep apnea include: snoring, apneas, morning headaches, fatigue, daytime sleepiness, nocturia and enuresis

Question 16

What two mental health conditions should you screen for annually in children with T2DM (as per the Diabetes Canada guidelines)?

Answer 16

Depression
Binge eating disorder

Question 17

You have a metabolically stable child with T2DM who you initiated on metformin. If glycemic targets are not achieved within ___ months from diagnosis, you should initiate basal insulin.

Answer 17

3-6 months

Question 18

What auto-antibodies can you send if you are trying to differentiate between T1DM and T2DM?

Answer 18

Anti-GAD65
Islet cell antibodies

Question 19

What does MODY stand for? Who meets criteria for MODY?

Answer 19

Monogenic diabetes (also called maturity onset diabetes of the young)

Clinically heterogeneous disorder characterized by diabetes diagnosed at a young age (<25 years) with autosomal dominant transmission and lack of autoantibodies

Question 20

How do you confirm a diagnosis of MODY?

Answer 20

Genetic testing, primarily for mutations in HNF4A, HNF1A, and GCK