BC ADM Pediatric Diabetes 3 — Questions and Answers
Question 1: A 16-year-old with type 1 diabetes has an A1C of 7.2% but reports frequent hypoglycemia. The BEST next step is to:
- Maintain the current regimen as A1C is at goal
- Liberalize glycemic targets to reduce hypoglycemia frequency
- Evaluate timing and causes of hypoglycemic episodes (Correct answer)
- Decrease all insulin doses by 10%
Correct answer: Evaluate timing and causes of hypoglycemic episodes
Evaluating the pattern and causes of hypoglycemia allows targeted adjustments rather than broad insulin reductions that may worsen overall control.
Question 2: Which complication screening should begin 5 years after diagnosis in a child with type 1 diabetes who is 10 years old or older?
- Cardiovascular stress testing
- Microalbuminuria and diabetic nephropathy screening (Correct answer)
- Peripheral arterial disease assessment
- Autonomic neuropathy screening
Correct answer: Microalbuminuria and diabetic nephropathy screening
Annual microalbuminuria screening should begin 5 years post-diagnosis or at age 10, whichever comes first, to detect early diabetic nephropathy.
Question 3: A child with type 1 diabetes on a closed-loop insulin delivery system (artificial pancreas) has persistent hyperglycemia during exercise. The MOST likely cause is:
- The system delivers too much insulin anticipating post-exercise hypoglycemia
- Activity mode was not activated, so the system did not reduce basal delivery (Correct answer)
- Glucagon counter-regulation is impaired in closed-loop users
- The CGM sensor is inaccurate during exercise
Correct answer: Activity mode was not activated, so the system did not reduce basal delivery
Most closed-loop systems have an 'activity' or 'exercise mode' that preemptively reduces insulin; failure to activate it results in relative insulin excess initially but can also reflect exercise-induced hyperglycemia from anaerobic activity.
Question 4: Which finding on urinalysis is MOST suggestive of type 2 diabetes rather than type 1 diabetes in an obese adolescent presenting with polyuria?
- Glucosuria with ketonuria
- Glucosuria without ketonuria (Correct answer)
- Microalbuminuria
- Elevated urine specific gravity
Correct answer: Glucosuria without ketonuria
Glucosuria without significant ketonuria favors type 2 diabetes, as insulin resistance (not deficiency) predominates and ketosis is less common at presentation.
Question 5: A 13-year-old with type 1 diabetes starts competitive swimming. Which strategy BEST addresses the risk of exercise-induced hypoglycemia?
- Increase basal insulin by 20% on swim days
- Reduce rapid-acting insulin by 25–50% before swimming and have rapid carbohydrates available (Correct answer)
- Avoid competitive sports to minimize hypoglycemia risk
- Switch to inhaled insulin on exercise days
Correct answer: Reduce rapid-acting insulin by 25–50% before swimming and have rapid carbohydrates available
Reducing the pre-exercise rapid-acting insulin dose by 25–50% and having carbohydrate sources available is the standard strategy for aerobic exercise in T1D.
Question 6: Which statement about celiac disease in children with type 1 diabetes is MOST accurate?
- Celiac disease occurs in 0.1% of children with T1D, similar to the general population
- Symptomatic celiac disease always precedes diabetes diagnosis
- Children with T1D should be screened for celiac disease with tissue transglutaminase IgA antibodies (Correct answer)
- A gluten-free diet is optional if the child is asymptomatic
Correct answer: Children with T1D should be screened for celiac disease with tissue transglutaminase IgA antibodies
Celiac disease occurs in 4–9% of children with T1D, and ADA recommends screening with tTG-IgA antibodies at diagnosis and periodically thereafter.
Question 7: A 5-year-old with type 1 diabetes cannot reliably communicate hypoglycemia symptoms. Which CGM feature is MOST important for this child's safety?
- High glucose alarm set at 250 mg/dL
- Low glucose predictive alarm alerting parents/caregivers (Correct answer)
- Share feature transmitting data to a parent's smartphone
- Calibration reminders to ensure accuracy
Correct answer: Low glucose predictive alarm alerting parents/caregivers
A predictive low glucose alarm warns caregivers before hypoglycemia occurs, which is critical in young children who cannot self-report symptoms reliably.
BC ADM Pediatric Diabetes 3
A 16-year-old with type 1 diabetes has an A1C of 7.2% but reports frequent hypoglycemia.
The BEST next step is to: