BC ADM Pediatric Diabetes 5 — Questions and Answers
Question 1: A school nurse asks how to identify hypoglycemia in a 6-year-old with type 1 diabetes who cannot self-report. Which symptom pattern is MOST reliable in young children?
- Classic symptoms of sweating, tremor, and palpitations
- Behavioral changes such as irritability, crying, and pallor (Correct answer)
- Headache and blurred vision
- Nausea and vomiting
Correct answer: Behavioral changes such as irritability, crying, and pallor
Young children often present with behavioral and neuroglycopenic symptoms (irritability, pallor, crying) rather than adrenergic symptoms typical in older children and adults.
Question 2: A 17-year-old with type 1 diabetes is transitioning to adult care. Which approach is MOST effective in supporting this transition?
- Abrupt transfer to adult endocrinology upon 18th birthday
- Transition planning starting at age 14 with structured preparation and overlap visits (Correct answer)
- Maintaining pediatric care until age 21 regardless of maturity
- Providing a summary letter to the adult provider with no patient preparation
Correct answer: Transition planning starting at age 14 with structured preparation and overlap visits
Structured transition programs beginning in early adolescence improve self-management skills, reduce A1C deterioration, and increase retention in adult diabetes care.
Question 3: Which feature BEST distinguishes type 1 diabetes from type 2 diabetes in an obese adolescent?
- Body mass index above the 95th percentile
- Presence of acanthosis nigricans
- Positive pancreatic autoantibodies (GAD, IA-2, ZnT8) (Correct answer)
- Elevated fasting insulin level
Correct answer: Positive pancreatic autoantibodies (GAD, IA-2, ZnT8)
Positive pancreatic autoantibodies confirm autoimmune destruction of beta cells and distinguish type 1 from type 2 diabetes, even in obese adolescents.
Question 4: A 10-year-old on an insulin pump has recurrent unexplained hyperglycemia. After reviewing logs, you suspect site failure. Which action should be prioritized FIRST?
- Increase the basal rate by 30%
- Change the infusion set and site immediately (Correct answer)
- Add a correction bolus and observe for 2 hours before site change
- Switch to multiple daily injections temporarily
Correct answer: Change the infusion set and site immediately
When site failure is suspected, the infusion set and site should be changed immediately as the primary intervention before additional insulin corrections.
Question 5: Thyroid disease screening in children with type 1 diabetes should include which test at diagnosis and periodically thereafter?
- Total T4 only
- Free T4 and TSH
- Thyroid peroxidase antibodies and TSH (Correct answer)
- Thyroid ultrasound
Correct answer: Thyroid peroxidase antibodies and TSH
ADA recommends screening with TSH and thyroid peroxidase antibodies at diagnosis, as autoimmune thyroid disease shares genetic susceptibility with T1D.
Question 6: Which insulin regimen is generally PREFERRED for a newly diagnosed toddler (age 2) with type 1 diabetes?
- Twice-daily premixed insulin 70/30
- Basal-bolus regimen with diluted insulin or insulin pump therapy (Correct answer)
- Once-daily long-acting insulin alone
- Regular insulin before each meal with NPH at bedtime
Correct answer: Basal-bolus regimen with diluted insulin or insulin pump therapy
Insulin pump therapy or diluted basal-bolus regimens are preferred in toddlers to allow precise, small dose adjustments and flexibility with unpredictable eating patterns.
Question 7: A 14-year-old with type 1 diabetes reports that their CGM frequently reads 40 mg/dL lower than their blood glucose meter. The MOST likely explanation is:
- The patient is hyperglycemic and the CGM underestimates at high glucose levels
- The CGM sensor is placed in an area with poor interstitial fluid flow causing a lag (Correct answer)
- Blood glucose meters are always less accurate than CGM
- Altitude changes are affecting CGM calibration
Correct answer: The CGM sensor is placed in an area with poor interstitial fluid flow causing a lag
CGM measures interstitial glucose, which can lag behind blood glucose by 5–15 minutes, and sensor placement in areas with poor perfusion can amplify this discrepancy.
BC ADM Pediatric Diabetes 5
A school nurse asks how to identify hypoglycemia in a 6-year-old with type 1 diabetes who cannot self-report.
Which symptom pattern is MOST reliable in young children?