BC ADM Pediatric Diabetes 4 — Questions and Answers
Question 1: In a child with type 1 diabetes, which HbA1c target is recommended by the ADA for all pediatric age groups to balance glycemic control with quality of life?
- Less than 6.5%
- Less than 7.0% (Correct answer)
- Less than 7.5%
- Less than 8.0%
Correct answer: Less than 7.0%
The ADA recommends an A1C target of less than 7.0% for most children with T1D, recognizing that lower targets may increase hypoglycemia risk.
Question 2: A 12-year-old with type 2 diabetes has an A1C of 8.9% on maximum-dose metformin. The MOST appropriate next pharmacologic step is:
- Add a sulfonylurea
- Initiate basal insulin therapy (Correct answer)
- Add a GLP-1 receptor agonist
- Switch to insulin pump therapy
Correct answer: Initiate basal insulin therapy
Basal insulin is the recommended second-line agent for children with type 2 diabetes inadequately controlled on metformin, per ADA pediatric guidelines.
Question 3: Which electrolyte abnormality is MOST commonly associated with diabetic ketoacidosis in children and requires careful monitoring during treatment?
- Hyponatremia
- Hypocalcemia
- Hypokalemia (Correct answer)
- Hypermagnesemia
Correct answer: Hypokalemia
Potassium shifts from intracellular to extracellular space during DKA, but total body potassium is depleted; insulin therapy drives potassium back into cells, causing hypokalemia.
Question 4: A 15-year-old athlete with type 1 diabetes asks about using a CGM during contact sports. The BEST advice is:
- CGM is contraindicated during contact sports due to injury risk
- Use an armband or protective cover over the sensor site to reduce dislodgement (Correct answer)
- Switch to fingerstick testing on game days for accuracy
- CGM readings are too inaccurate during physical activity to be useful
Correct answer: Use an armband or protective cover over the sensor site to reduce dislodgement
Protective covers and strategic sensor placement on the arm or abdomen can reduce sensor dislodgement during contact sports while maintaining continuous glucose monitoring.
Question 5: Which finding in a 3-year-old newly diagnosed with diabetes should prompt immediate testing for monogenic diabetes (neonatal diabetes)?
- Diagnosis before 6 months of age (Correct answer)
- Positive islet cell antibodies
- A1C greater than 10% at presentation
- Presence of ketoacidosis
Correct answer: Diagnosis before 6 months of age
Diabetes diagnosed before 6 months of age is almost always due to a monogenic cause (neonatal diabetes) rather than autoimmune type 1 diabetes.
Question 6: During sick-day management in a child with type 1 diabetes, urine ketone testing shows large ketones with blood glucose of 220 mg/dL. The MOST appropriate action is:
- Withhold insulin until ketones clear
- Administer a correction dose of rapid-acting insulin and increase fluid intake (Correct answer)
- Proceed to the emergency room immediately without any intervention
- Give only basal insulin and monitor glucose every 4 hours
Correct answer: Administer a correction dose of rapid-acting insulin and increase fluid intake
Correction doses of rapid-acting insulin combined with aggressive hydration are the cornerstone of home sick-day management to prevent progression to DKA.
Question 7: Which lipid abnormality is MOST commonly seen in adolescents with poorly controlled type 1 diabetes?
- Elevated LDL cholesterol
- Elevated HDL cholesterol
- Elevated triglycerides (Correct answer)
- Reduced total cholesterol
Correct answer: Elevated triglycerides
Hypertriglyceridemia is the most common dyslipidemia in poorly controlled T1D, driven by increased VLDL production due to insulin deficiency.
BC ADM Pediatric Diabetes 4
In a child with type 1 diabetes, which HbA1c target is recommended by the ADA for all pediatric age groups to balance glycemic control with quality of life?