Week 5 - Endocrine

Question 1

Type 1 Diabetes

Answer 1

caused by autoimmune destruction of pancreatic beta cells in the islets of Langerhans thought to be triggered by a preceding environmental event in genetically susceptible individuals. This destruction of beta cells results in an absolute deficiency in insulin secretion, reduced biologic effectiveness, or both

Question 2

Diabetes Type 1 S/S

Answer 2

‣ Usually sudden onset of illness
‣ Polydipsia, polyphagia, polyuria
‣ Dehydration
‣ Nocturia, blurred vision
‣ Weight loss or poor weight gain
‣ Muscle wasting
‣ Tachycardia
‣ Fatigue and lethargy
‣ Vaginal yeast, thrush or other infection

Question 3

Diabetes Type 1 S/S ketoacidosis

Answer 3

‣ Abdominal pain, nausea and/or vomiting
‣ Fruity-smelling breath
‣ Weakness (caused by dehydration)
‣ Mental confusion
‣ Slow labored breathing (Kussmaul breathing)
‣ Flushed face and cheeks
‣ Coma

Question 4

Diabetes Type 1 Diagnostics

Answer 4

‣ Urine for glucose and ketones
‣ Metabolic screen for acid-base status to exclude DKA
‣ Hemoglobin A1c (HbA1c)
‣ Blood glucose
‣ Screen for the presence of pancreatic autoantibodies: This should be considered to confirm the diagnosis of type 1 diabetes, particularly in those cases where there may be uncertainty regarding type

Question 5

Diagnostic criteria for diabetes

Answer 5

‣ HbA1c ≥ 6.5%
‣ Fasting plasma glucose 126 mg/dL (7 mmol/L) or greater
‣ Random plasma glucose 200 mg/dL or greater plus presence of classic symptoms (polyuria, polydipsia, polyphagia)
‣ Postprandial (2 hours after eating) plasma glucose 200 mg/dL (11.1 mmol/L) or greater

Question 6

Diabetes Type 1 Treatments

Answer 6

‣ determining the insulin regimen and dose best suited to the individual child
‣ target range for blood glucose levels
‣ best methods to manage the child’s diet
‣ Start on insulin
‣ Screen for hypothyroidism (thyroid peroxidase/thyroglobulin testing) – annual screening
‣ Screen for celiac disease
‣ Exercise
‣ Nutrition
‣ f/u ever 3-4 months

Question 7

Insulin dosages

Answer 7

‣ Partial remission (any age) <0.5units/kg/day
‣ Prepubertal 0.7-1.0 units/kg/day
‣ Pubertal 1.0-2.0 units/kg/day

Question 8

Goal for insulin treatment

Answer 8

‣ HbA1c less than 7.5% and/or a fasting blood glucose level between 90 and 130mg/dL

Question 9

Recommended screenings for youth with diabetes

Answer 9

‣ HbA1c
‣ Thyroid disease
‣ Celiac disease
‣ Dyslipidemia
‣ Hypertention
‣ Retinopathy
‣ Neuropathy
‣ Nephropathy
‣ Psychosocial

Question 10

Type 2 Diabetes

Answer 10

increased tissue resistance to insulin, resulting in hyperinsulinemia and hyperglycemia. Although pancreatic beta cells initially produce insulin, hyperglycemia creates an increased insulin demand; with increasing demand for insulin over time, the pancreas loses its ability to effectively secrete insulin

Question 11

Diabetes Type 2 Screening guidelines

Answer 11

‣ Screen if BMI over 85th percentile + two of the following
‣ Family history of DM2 in 1st or second degree relative
‣ Native American, African American, latino, Asian, pacific islander)
‣ Signs of insulin resistance (PCOS, HTN, Hyperlipidemia, acanthosis nigricans)
‣ Maternal history of diabetes or gestational diabetes

Question 12

History findings for someone with suspected type 2 diabetes

Answer 12

‣ Polydipsia, polyphagia, polyuria
‣ Nocturia or bedwetting
‣ Blurred vision
‣ Obesity, especially central
‣ Report of a hyperpigmented, velvetlike rash in skin folds
‣ Frequent or slow-healing infections
‣ Fatigue, symptoms of sleep apnea
‣ History of premature adrenarche
‣ Family history of type 2 diabetes

Question 13

Diabetes Type 2 Physical Exam

Answer 13

‣ Dehydration
‣ Overweight (BMI greater than 85th percentile for age and gender) or obesity
‣ Weight loss (less common)
‣ Acanthosis nigricans noted in the axilla, base of the neck, groin, knuckles, and other skin folds
‣ Vaginal yeast, thrush, other infection
‣ Polycystic ovary syndrome symptoms (e.g., acne, hirsutism)
‣ Hypertension

Question 14

Diabetes Type 2 Diagnostics

Answer 14

‣ Urine for glucose and albumin (can be performed in the office)
‣ Children can have ketoacidosis if they have gone undiagnosed for a long time
‣ Fasting blood sample for blood glucose, HbA1c, lipid panel, TSH and free T4, and insulin level

Question 15

Diabetes Type 2 Treatments

Answer 15

‣ Daily self-monitoring
‣ HBA1C Q3 months (6 months with glycemic control)
‣ Follow up q3 months lifestyle, nutrition,
‣ Screening for HTN, HLD,
‣ Diet changes – healthy plate
‣ Exercise changes – 60 minutes per day

Question 16

Obesity

Answer 16

BMI greater than or equal to the 95th percentile for age and gender

Question 17

Assessment for obese children – screen for…

Answer 17

‣ DM and pre-DM
‣ Dyslipidemia with fasting lipid panel
‣ Nonalcoholic steatohepatitis w/ ALT
‣ OSA
‣ PCOS
‣ Free total testosterone level
‣ Pre HTN or HTN
‣ Psych issues – low-self esteem, behavior problems, depression

Question 18

Management of obesity in children

Answer 18

‣ Refer to endocrinology for DM2, PCOS
‣ Aim to maintain weight not lose (children grow into weight)
‣ For complications – weight loss of 1 pound per month is appropriate

Question 19

Congenital hypothyroidism

Answer 19

Results from an abnormality in development of the thyroid gland during fetal life (dysgenesis or agenesis) or a problem with the ability of the thyroid to make thyroid hormone

OR

may result from an abnormality at the level of the pituitary or hypothalamus

Question 20

Untreated congenital hypothyroidism can lead to…

Answer 20

‣ Irreversible brain damage ‣ ‣ variable degrees of growth failure
‣ deafness
‣ neurologic abnormalities.

Earlier detection of CH through improvements in newborn screening combined with more aggressive thyroid hormone replacement regimens (10 to 15 μg/kg/day) at diagnosis have led to improved developmental outcomes for newborns with CH.