Card Set Information
Pediatric Diabetes PHPR523 Test4
What are the differences between kids and adults in diabetes?
insulin sensitivity related to sexual maturity
physical growth demands more glucose
ability to provide self-care
unique neurologic vulnerability to hypoglycemia
care plans must include family dynamics and developmental stages
recommendations are based more on expert opinion d/t lack of studies
more prevalence of Type I
Type II comorbidities
: NASH, PCOS, hirsutism, acne, amenorrhea
What are the differences in complications of Type I and Type II diabetes?
more microalbuminemia (nephropathy)
How are the testing goals for Type I different from those for Type II diabetes?
Type I goals are not as strict as Type II goals in younger kids (<6)
Goals get stricter as age increases
What are the different methods of insulin therapy in kids with Type I diabetes?
Continuous Subcutaneous Insulin pump (CSII - still basically basal bolus)
How is split-mixed insulin therapy instituted in pediatric Type I diabetes?
Short-acting + NPH
1 unit/kg divided into 2-3 injections/d (starts lower and works up to this)
2/3 of daily dose in AM, 1/3 in PM
: 2/3 NPH, 1/3 short acting
: 50:50 NPH and short acting
NOT recommended post honeymoon
Not used often in peds
How is basal bolus insulin therapy instituted in pediatric Type I diabetes?
Rapid-acting + long-acting
At least 4 injections/d
Pre-meal rapid-acting dose based upon
anticipated carb intake
anticipated level of physical activity
to dose erratic toddlers postprandial (pre-meal still better)
better glucose control
less nocturnal hypoglycemia
How is Continuous Subcutaneous Insulin pump therapy instituted in pediatric Type I diabetes?
Another form of basal bolus
Requires carb counting
Must test 4-6 times/d and bolus
Used more in preadolescents and adolescents (but no best age to start)
Adult support and supervision still essential
Use is rapidly increasing
How is insulin typically dosed in pediatric Type I diabetes?
0.5-1 unit/kg/d or less during honeymoon
Typically end at 1 unit/kg/d
Up to 1.4 units/kg/d during puberty (increased insulin resistance, growth hormone, sex hormones)
Insulin Sensitivity Factor (ISF) for adjusting uncontrolled FBG
1800/TDD of insulin = approx effect of 1 unit of rapid-acting insulin
How are sick days managed in pediatric Type I diabetes?
: prevent DKA
Most common mistake is to hold all insulin
Perform frequent urine ketone checks - add insulin if present (15-30% of TDD for moderate, 25-30% if large)
May need to decrease insulin if child not eating or low sugars
Why is hypoglycemia so detrimental in children?
When should urine ketone checks be performed in children?
when FBG > 250
When should drug therapy be started for dyslipidemia in kids?
when LDL is > 160mg/dL
Statins approved over 10yo
Why are toddlers and preschoolers with Type I diabetes not controlled as tightly as older kids?
high risk and vulnerability to hypolycemia
Why are 6-12yo with Type I diabetes not as tightly controlled as older kids?
risks of hypoglycemia
relatively low risk of complications prior to puberty
Why are adolescents and young adults with Type I diabetes not as tightly controlled as adults?
still some risk of hypoglycemia
developmental and psychological issues
How is Type II diabetes a growing epidemic in children?
rate of increase is unknown
obesity is definitely causal
When should kids be screened for Type II diabetes?
Beginning at age 10 or puberty, whichever is less
When BMI is in 85th percentile or higher and 2 of the following are present
family hx in 1st or 2nd degree relative
signs of insulin resistance
What are the signs of insulin resistance in children?
Acanthosis nigricans (areas of dark skin)
PCOS (Polycystic Ovary Syndrome)
When should children be screened for chronic complications in Type I diabetes?
: at each visit
: at each visit
: monofilament at each visit
: 10yo and 5yrs post-diagnosis, but urine albuminemia annually
: at diagnosis for > 2yo after glucose controlled if family hx present, otherwise after 12yo and q 5yrs
: 10yo and > 3-5yrs of DM duration; annually thereafter
When and how should HTN be treated in kids with I diabetes?
BP = 85 percentile or higher
What is the role of pharmacotherapy in pediatric Type II diabetes?
not the main answer
How is mild hyperglycemia treated in pediatric Type II diabetes (FBG < 150; 2h OGTT < 300)?
Excercise and diet x 3-6mo, then
if FBG > 100 and A1c > 6% -
x 3-6mo, then
if still insuccessful, add another agent
How is severe hyperglycemia treated in pediatric Type II diabetes (FBG > 150; 2h OGTT > 300)?
BG under 350 and no DKA
if unsuccessful, add
Sulfonylurea, TZD, Glitinide, or alpha-glucosidase inhibitor
BG over 350 OR DKA
until stable, then
add Sulfonylurea, TZD, Glitinide, or alpha-glucosidase inhibitor