diabetes: The SEARCH for diabetes in youth study. Pediatric Diabetes , 21 (7), 1093-1101. https://doi.org/10.1111/pedi.13091 • Settles, J., Hinnen, D., Spaepen, E., Bajpai, S., Turakhiya, A., Ghodke, S., & Child, C. J. (2022). Nasal glucagon is easier to use and more preferred and needs less effort to administer than injectable glucagon: User perceptions of glucagon administration during severe hypoglycemia simulation. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists , 28 (5), 486-493. https://doi.org/10.1016/j.eprac.2022.02.012 • Tascini, G., Berioli, M. G., Cerquiglini, L., Santi, E., Mancini, G., Rogari, F., Toni, G., & Esposito, S. (2018). Carbohydrate counting in children and adolescents with type 1 diabetes. Nutrients , 10 (1), 109. https://doi.org/10.3390/nu10010109 • Toni, G., Berioli, M. G., Cerquiglini, L., Ceccarini, G., Grohmann, U., Principi, N., & Esposito, S. (2017). Eating disorders and disordered eating symptoms in adolescents with type 1 diabetes. Nutrients , 9 (8), 906. https://doi.org/10.3390/nu9080906 • Verbeeten, K. C., Perez Trejo, M. E., Tang, K., Chan, J., Courtney, J. M., Bradley, B. J., McAssey, K., Clarson, C., Kirsch, S., Curtis, J. R., Mahmud, F. H., Richardson, C., Cooper, T., Lawson, M. L., & CGM TIME Trial Study Group and the JDRF Canadian Clinical Trials Group. (2021). Fear of hypoglycemia in children with type 1 diabetes and their parents: Effect of pump therapy and continuous glucose monitoring with option of low glucose suspend in the CGM TIME trial. Pediatric Diabetes , 22 (2), 288-293. https://doi.org/10.1111/pedi.13150 •
• McDonnell, L., Gilkes, A., Ashworth, M., Rowland, V., Harries, T. H., Armstrong, D., & White, P. (2021). Association between antibiotics and gut microbiome dysbiosis in children: Systematic review and meta-analysis. Gut Microbes , 13 (1), 1-18. https://doi.org/10.1080/19 490976.2020.1870402 • Nevo-Shenker, M., & Shalitin, S. (2021). The impact of hypo- and hyperglycemia on cognition and brain development in young children with type 1 diabetes. Hormone Research in Paediatrics , 94 (3-4), 115-123. https://doi.org/10.1159/000517352 • Ogle, G. D., James, S., Dabelea, D., Pihoker, C., Svennson, J., Maniam, J., Klatman, E. L., & Patterson, C. C. (2022). Global estimates of incidence of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Atlas, 10th edition. Diabetes Research and Clinical Practice , 183 , 109083. https://doi.org/10.1016/j. diabres.2021.109083 • Peng, F., Li, X., Xiao, F., Zhao, R., & Sun, Z. (2022). Circadian clock, diurnal glucose metabolic rhythm, and dawn phenomenon. Trends in Neurosciences , 45 (6), 471-482. https://doi.org/10.1016/j.tins.2022.03.010 • Rawshani, A., Sattar, N., Franzén, S., Rawshani, A., Hattersley, A. T., Svensson, A. M., Eliasson, B., & Gudbjörnsdottir, S. (2018). Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: A nationwide, register-based cohort study. Lancet (London, England) , 392 (10146), 477-486. https://doi.org/10.1016/ S0140-6736(18)31506-X • Salah, N. Y., Hashim, M. A., & Abdeen, M. (2022). Disordered eating behaviour in adolescents with type 1 diabetes on continuous subcutaneous insulin infusion; relation to body image, depression and glycemic control. Journal of Eating Disorders , 10 (1), 46. https://doi.org/10.1186/s40337-022-00571-4 • Sauder, K. A., Stafford, J. M., The, N. S., Mayer-Davis, E. J., Thomas, J., Lawrence, J. M., Kim, G., Siegel, K. R., Jensen, E. T., Shah, A. S., D’Agostino, R. B., Jr, Dabelea, D., & SEARCH for Diabetes in Youth Study Group. (2020). Dietary strategies to manage diabetes and glycemic control in youth and young adults with youth-onset type 1 and type 2 Rationale: Although a fasting plasma glucose level requires 8 or more hours without food, a random plasma glucose ≥200 mg/ dL with classic hyperglycemic symptoms is an American Diabetes Association criterion for diagnosis. Since Rob is experiencing polyuria, polydipsia, and recent weight loss, a random plasma glucose level of 240 mg/dL would be above the threshold for diagnosis. 2. The correct answer is B. Rationale: Young children may not be able to recognize and verbalize symptoms of hypoglycemia. This may put them at higher risk of developing severe hypoglycemia, especially with strict goals for glycemic control. These patients may need a higher hemoglobin A1c target to minimize this risk. 3. The correct answer is B. Rationale: Insulin requirements are estimated based on body weight calculations. The total daily dose usually ranges from 0.4 to 1 unit/kg/day, and about half of that calculated value is given as a basal dose. Typically, initial calculations will start at the lower end of the range and are titrated to effect. In this case, 8 units as a basal dose implies 16 units as a total daily dose, which is ~0.5 units/kg/day.
Zhong, T., Tang, R., Gong, S., Li, J., Li, X., & Zhou, Z. (2020). The remission phase in type 1 diabetes: Changing epidemiology, definitions, and emerging immuno-metabolic mechanisms. Diabetes/Metabolism Research and Reviews , 36 (2), e3207. https://doi. org/10.1002/dmrr.3207 • Zhou, K., & Isaacs, D. (2022). Closed-loop artificial pancreas therapy for type 1 diabetes. Current Cardiology Reports , 24 (9), 1159-1167. https://doi.org/10.1007/s11886- 022-01733-1 Pharmacological Management: Type 1 Diabetes in Children, 2nd Edition Self-Assessment Answers and Rationales 1. The correct answer is C.
4. The correct answer is D. Rationale: Rob is prescribed rapid-acting insulin, which means the “rule of 1800” can be used to calculate his insulin sensitivity factor, and the “rule of 500” can be used to calculate his insulin- to-carbohydrate ratio: ● 1800/16 ~ 110 ● 500/16 ~ 30 5. The correct answer is C. ● Rationale: Total carbohydrate count = 75.5 grams ○ 1 yogurt = 33 grams ○ 1 slice of whole grain bread = 34 grams/2 = 17 grams ○ 1.5 tablespoons of hazelnut spread = 22 grams * 1.5/2 = 16.5 grams ○ 1/3 banana = 27 grams/3 = 9 grams ● ICR calculation: 75.5 grams/(1 unit:30 grams) ~ 2.5 units ● Calculate difference between preprandial and goal: 155 mg/ dL – 100 mg/dL = 55 mg/dL ● ISF calculation: 55 mg/dL/(1 unit:110 mg/dL) ~ 0.5 unit ● Total insulin required: 2.5 units + 0.5 unit = 3 units
Course Code: ANCCUS03DC
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Book Code: AUS3024
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