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Pediatric Diabetes
Pediatric diabetes
| Question | Answer |
|---|---|
| Target glucose goals for toddlers and preschooler under age 6 | Before meals 100-180 Bedtime/qhs 110-200 A1C 7.5-8.5 Rationale: hypoglycemia not safe for kids |
| Target goals for School age 6-12 | Before meals 90-180 Bedtime/qhs 100-180 A1C <8 Rationale: risks of hypoglycemia and low risk of complications prior to puberty |
| Adolescents and young adults 13-19 | Before meals 90-130 Bedtime/Qhs 90-150 A1C <7.5 Rationale: risk of hypoglycemia, developmtental and psycholgical issues |
| Clinical presentation of Type 1 | DKa first or modest hyperglyemia with infection.Acidosis. _insulin secretion. Low C-peptide level. Prone to other autoimmune disorders. usually sick, polyuria, polydipsia, polyphagia. Wt loss, change in appetite. Post URI, gastro.New enuresisis, fatigue |
| Clinical presentation of Type 2 | asymptomatic, obese, sedentary lifestyle, increased BP, elevated lipids. Glycosuria without ketonuria. Absent or mild p, p, p. A. nigricans, PCOS,!lipds, HTN fatigue |
| How would you make changes to insulin? | In increments of 10-20% at a time |
| What is the sick day management | Hydrate, give insulin ASAP to stop the production and formation of ketones. |
| What are the primary differences between Type 1 and Type 2 | Don't see ketone production in Type 2. Type 2 you get high, high glucose. Type 1 glucose level is not as high. |
| What is the definition of Type 1 diabetes | Beta cell destruction that usually leads to absolute insulin deficiecy. Start with relative insulin deficiency then progresses to absolute. Immune mediated. Genetic Markers are present. Autoimmune antibodies are present in 90% of patients.Low c-peptide |
| How long does it take for progression to DKA when ketones are found in the urine | 12 hours. Once ketones start spilling into the urine they need to treat to prevenr breakdown of fatty acids that leads to acidosis.DKA rare in type 2 b/c enough insulin is usualy produced to prevent the breakdown of fatty acids |
| What are characteristics of Type 2 Diabetes | Ranges from predominatnly insulin resistance with relateive insluin deficincy to predominantly an insulin seretory defect with insulin resistance. Strong genetic predisposition. Autoimmune destruction of beta cells does not occur. DKA seldom Insdious onst |
| For classification of diabetes if autoantibodies are present the most likely form is | Type 1 |
| What is the criteria for diagnosis of DM in children and youth | Symptoms (polyuria, polyd, polyp, wt loss) + random BS >200 OR FPG >126 OR 2H pp >200 during OGTT |
| how do you identify children with diabetes | Clinical presentation varies. S/s insulin resistance (a.nigricans). DM complications. High risk (FmHx, BMI, ethnicity, HTN, Lipds, PCOS) |
| What is the testing criteria for children | Overweight or at risk for overweight. FMHx (1st` or 2nd` relative) ethnic, s/s: a.nigricans, HTN, !lipids, PCOS |
| When do you start testing and how often | Start at age 10, q 2 years |
| What are the basic elements of the team approach | insulin administration, nutirtion mgmt, physical activity, SMBG, avoidance of hypoglycemia. |
| What are the five assessment criteria | FEMIS: food eaten, exercise, medication (oral or injection), illness (sick day management), stress |
| What is the best tool to fight ketoacidosis | insulin |
| What can cause Hypoglyemia | Too much insulin.Missing a meal or snack. Exercising too mc |
| What are signs of hypoglycemia | Irritabiilty shaky confused loss of consciousness or sz. Raise BS to >90 then add protein to maintain level. |
| What can causer hyperglycemia | Forgetting to take meds on time, eating too much, getting too little exercise, illness |
| What are some characteristics of insulin therapy | Change over time. Change 1/2 u at a time. Watch for patterns. Keep target goal in mind. |
| What is the honeymoon phase | After dx pancreas gives one last burst of insulin production. Give small amount of insulin to preserve pancreas function |
| What is the usual starting dose of insulnse | Adults: 0.5 -1.5u/kg/day. Puberty (growth spurts) can go up to 2u/kg/day |
| When does retinopathy usually appear | after puberty. 1st exam should be at age 10. It takes about 3-5 years to show up. |
| What are the treatment goals for chilren and adolescents | _ risk of acute & chronic complications, avoid DKA. Avoid P p p fatigue wt loss, blurred vision, recurrent vaginitis, balantis, Near nrml lifestyle. Promote well being.Restore metabolic function |
| What are the nonpharmacological measurements of treatment | MNT (see dietitian), Exercise goals (SMBG before, during and after ex). *Don't ex if they have moderate to large ketones. Ex could make it worse. |
| What is the basic principle of food management and insulin administration | 1 unit of insulin for 10-20 g carbs (depends on sensitivity or insulin resistance) how much insulin your body uses per gram of carbs |
| How do you treat new onset DM with large ketonuria | pH < 7.30, Dehydration. Give insulin IV and fluid therapy. Insulin brings down the ketones |
| How do you treat new onset DM with moderate to large ketonuria | pH 7.35-7.45, adequately hydrated. Give insulin (doesnt have to be IV) SubQ ok |
| How do you treat new onset DM with mild ketonuria | SubQ insulin give 1or 2 supplemental units aside from usual dose |
| What are characteristics of "thinking" scales | How much insulin/carbs, (1u/10-20 g). What time of day reactions occur, what insulin is causing the reactions. Watch for trends. What activity is going on. |
| What is the treatment for hypoglycemia | Juice, soda initially, then add protein to stabilize glucose. Glucagon SQ or IM 0.3 mg < 5yr old or 0.5 mg >5 yr old |
| What are some elements of sick day management | Illness is a stress on the body -works against insulin Hydration. SMBG q 2h. U ketone q4h p vomiting or DKA. Blood Ketones q 2-4 h if BS >300. Don't stop insulin. Give 1-2 u suppl. |
| What is the management of DM at dx | Estalish goals of care and required Rx. Lipids (with FmHx) begin diabetes self management education, nutrition consult, endocrine consult, physocial assessment |
| What is the management of DM at the quarterly visit | A1c, growth, height wt, BMI, BP, BS diary, assess teaching, pscyocial assessment |
| annual visit management of Diabetes | check for comoplications: urine, eye nutrition therapy, kidneys, neuropathy, examine feet |
| What is the treatment of DKA | Fluid replacement. Inhibition of lipolysis and return to glucose utilization. Replacement of body salts. Correction of acidosis. Fluids too rapidly can cause cerebral edema. |
| What is Somogyi effect | rebound hyperglycemia d/t low blood sugar. Results in high fasting BS |
| What is the Dawn effect | Increased counter regulatry hormones. Result High fasting BS |
| How can you tell the difference between Somogyi and Dawn | do a 3am BS. If the 3am BS is low then the !FBS+ Somogyi. If the 3am BS is nrml to ! then the !FBS is due to Dawn. |
| What adjustments would you make if Dawn were confirmed | increase night time insulin dose |
| What do you do if Somogyi were confirmed | Reduce night time insulin dose |
| What oral agent has been approved for kids | Metformin |
Created by:
lknightly
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