BC ADM Pediatric Diabetes 2 — Questions and Answers
Question 1: A 10-year-old with type 1 diabetes has an A1C of 9.8%. The most likely contributing factor is:
- Excessive carbohydrate intake at breakfast
- Dawn phenomenon causing fasting hyperglycemia
- Suboptimal adherence to insulin regimen (Correct answer)
- Insulin resistance due to puberty onset
Correct answer: Suboptimal adherence to insulin regimen
Suboptimal adherence to the insulin regimen is the most common reason for elevated A1C in school-age children with T1D.
Question 2: Which insulin-to-carbohydrate ratio adjustment is most appropriate for a pubertal adolescent with type 1 diabetes experiencing consistent postprandial hyperglycemia?
- Increase the ratio (more carbs per unit)
- Decrease the ratio (fewer carbs per unit) (Correct answer)
- Switch from rapid-acting to regular insulin
- Add a second injection of basal insulin
Correct answer: Decrease the ratio (fewer carbs per unit)
Decreasing the ICR (fewer grams of carbohydrate covered per unit of insulin) delivers more insulin per meal, correcting postprandial hyperglycemia.
Question 3: A 7-year-old with newly diagnosed type 1 diabetes is being discharged. Which target blood glucose range is most appropriate for this age group per ADA guidelines?
- 70–130 mg/dL
- 80–180 mg/dL (Correct answer)
- 90–150 mg/dL
- 100–200 mg/dL
Correct answer: 80–180 mg/dL
ADA recommends a pre-meal glucose target of 80–180 mg/dL for children under 13 years to balance control with hypoglycemia risk.
Question 4: During a school field trip, a child with type 1 diabetes using an insulin pump becomes hypoglycemic. The teacher reports the child is conscious but confused. The FIRST action should be:
- Call 911 immediately
- Administer glucagon intramuscularly
- Give 15 grams of fast-acting carbohydrate orally (Correct answer)
- Suspend the insulin pump and wait 15 minutes
Correct answer: Give 15 grams of fast-acting carbohydrate orally
A conscious child who can swallow should receive 15 g of fast-acting carbohydrate as the first-line treatment for mild-to-moderate hypoglycemia.
Question 5: A 14-year-old female with type 1 diabetes reports intentionally skipping insulin doses to lose weight. This behavior is best described as:
- Diabulimia (Correct answer)
- Anorexia nervosa with comorbid diabetes
- Insulin omission syndrome
- Binge-purge disorder
Correct answer: Diabulimia
Diabulimia refers to the deliberate restriction of insulin by individuals with type 1 diabetes to induce glycosuria and promote weight loss.
Question 6: Which clinical finding most strongly suggests Maturity-Onset Diabetes of the Young (MODY) rather than type 1 diabetes in a child?
- Positive GAD65 antibodies
- Ketoacidosis at presentation
- Strong family history across three generations with autosomal dominant pattern (Correct answer)
- Need for insulin within 6 months of diagnosis
Correct answer: Strong family history across three generations with autosomal dominant pattern
MODY follows an autosomal dominant inheritance pattern, making a multigenerational family history of diabetes a key distinguishing feature from T1D.
Question 7: A 9-year-old with type 1 diabetes has recurring nocturnal hypoglycemia. Which basal insulin adjustment is most appropriate?
- Increase evening NPH dose by 20%
- Reduce bedtime basal insulin dose (Correct answer)
- Switch to a longer-acting basal analog given in the morning
- Add a bedtime snack without changing insulin
Correct answer: Reduce bedtime basal insulin dose
Reducing the bedtime basal insulin dose is the primary intervention to prevent nocturnal hypoglycemia in pediatric patients.
BC ADM Pediatric Diabetes 2
A 10-year-old with type 1 diabetes has an A1C of 9.8%.
The most likely contributing factor is: