For an African-Canadian child with a body mass index (BMI) greater than the 85th percentile for age and gender, and whose mother has type 2 diabetes mellitus, screening for type 2 diabetes should begin at what age?
Correct Answer B:
The Canadian Diabetes Association recommends that children and adolescents at increased risk should be screened for type 2 diabetes at age 10, or at puberty if it occurs before age 10. Children are considered at increased risk if their BMI is > 85th percentile for age and sex, their weight for height is >85th percentile, or their weight is > 120% of ideal for height, AND they have two or more of the following:
Screening should be performed every 2 years.
A 34-year-old gravida 3 para 1 woman with Class D diabetes mellitus is 36 weeks pregnant. You appropriately refer her for a level II ultrasound.
All of the following abnormalities may be seen, except:
Correct Answer D:
Although the spectrum of congenital anomalies seen in infants of diabetic mothers (IDM) is broad, abdominal wall defects are not typically seen. Diabetic embryopathy is the most common teratogenic disorder and occurs secondary to persistent hyperglycemia in maternal insulin dependent diabetes mellitus (IDDM). Congenital anomalies are seen in 10% of exposed infants, compared to 2-5% of the general population.
A. Sacral agenesis with lumbar vertebral anomalies, poor growth of the caudal region, distal spinal cord disruption, and other anomalies are common in IDM.
B. IDM infants are often large for gestational age, with increased body size and visceromegaly.
C. Congenital heart disease is very common among IDM infants and includes transient hypertrophic subaortic stenosis, transposition of the great vessels, ASD, VSD, and aortic coarctation.
E. Other midline defects, including CNS anomalies such as anencephaly, myelomeningocele, hydrocephalus, and microcephaly, are also common in IDM.
A 10-year-old child presents with a 1-month history of polydipsia, polyuria, and a 15 lb weight loss.
All of the following will be seen upon further evaluation, except:
Correct Answer C:
This is a classic presentation of insulin dependent diabetes mellitus. Management includes fluid resuscitation, administration of insulin, dietary adjustment, and patient and family education. Metabolic acidosis is seen in diabetes due to elevated ketones, not alkalosis.
A. Dehydration occurs due to osmotic dehydration and increased urination.
B. Kussmaul respirations describe hyperpnea secondary to metabolic acidosis.
D. Hyperglycemia occurs secondary to insulin resistance and pancreatic insufficiency.
E. Glucosuria occurs when the serum glucose is elevated above a threshold level, stimulating glucose losses in the urine.
Which one of the following injection sites for insulin administration is best for preventing hypoglycemia in a 14-year-old male with diabetes mellitus who wishes to participate in track and field running events?
The use of a non-exercised injection site for insulin administration, such as the abdomen (choice B), may reduce the risk of exercise-induced hypoglycemia.
If the leg is used as an injection site, exercise may accelerate insulin absorption, resulting in increased levels of plasma insulin. However, leg exercise has no effect on insulin disappearance from the arm and may actually reduce the rate of insulin disappearance from abdominal injection sites. Compared with leg injection, arm or abdominal injection reduces the hypoglycemic effect of exercise by approximately 60% and 90%, respectively.
An overweight 11-year-old male with acanthosis nigricans is found to have a fasting plasma glucose level of 9.8 mmol/L on two occasions. Over the next 6 months, despite reasonable adherence to a diet and exercise regimen, he has pre-prandial and bedtime finger-stick blood glucose levels that average 10 mmol/L. His hemoglobin A1C is 9.0%.
Which one of the following oral agents would be most appropriate at this time?
Correct Answer A:
Metformin and insulin are the only agents approved for treatment of type 2 diabetes mellitus in children.
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