PHARMACOLOGICAL MANAGEMENT: TYPE 2 DIABETES IN CHILDREN, 2ND EDITION Self-Assessment Answers and Rationales 1. The correct answer is B.
6. The correct answer is B. Rationale: Insulin should be injected subcutaneously. Intramuscu - lar injection may result in unpredictable absorption of insulin with subsequent fluctuations in blood glucose levels. The minimum length needle should be selected to avoid accidental injection into muscle. 7. The correct answer is A. Rationale: Once-daily insulin injection is typically required for basal dosing of insulin. The desired effect can be achieved with a long-acting insulin, which does not have a significant peak and lasts for a duration of approximately 24 hours. Long-acting insu- lins are insulin glargine, insulin degludec, and insulin detemir. 8. The correct answer is B. Rationale: Gastrointestinal symptoms are one of the most com- mon adverse effects associated with liraglutide and other gluca- gon-like peptide-1 receptor agonists. Although there are many other adverse effects and potential risks, most are rare in other - wise healthy adolescents without a family history of medullary thyroid carcinoma. Gastrointestinal symptoms are most common soon after initiation and are dose-related. Patients may need to be maintained on a lower dose with slow titration if symptoms are intolerable. 9. The correct answer is D. Rationale: Depression and anxiety are common among adoles- cents with type 2 diabetes. Screening is essential at each office visit, and intervention may help alleviate symptoms and indirectly improve glycemic control. Although evidence is limited in the pe- diatric population, the focus of existing studies is based on ad - dressing the underlying psychosocial concern. Modifying type 2 diabetes therapy to an insulin-only regimen does not demonstrate a benefit in depression and may increase the burden of management. Insulin-based regimens require mul- tiple painful injections, increase the need for supplies and train - ing, and put patients at risk for hypoglycemia. Although some patients may require insulin for glycemic control, other agents are preferred for individuals who are able to achieve a goal hemoglo- bin A1C without insulin.
Rationale: In type 2 diabetes mellitus, pancreatic ß-cell dysfunc - tion is not an autoimmune- mediated process. The dysfunction is multifactorial and related to insulin resistance. Islet autoantibod- ies are an indicator of type 1 diabetes, regardless of other patient characteristics traditionally associated with type 2 diabetes. This is an important differentiator between the two diagnoses. 2. The correct answer is D. Rationale: Hemoglobin A1C = 6.5% is a criterion for diabetes diagnosis. Since there are conditions that may impact the findings of this result, and Billy is not currently presenting with classic hy - perglycemic symptoms, the diagnosis should be confirmed with a second test. Ideally, fasting blood glucose should be measured, or an oral glucose tolerance test should be performed to confirm elevated hemoglobin A1C findings 3. The correct answer is A. Rationale: Microvascular complications include nephropathy, ret - inopathy, and neuropathy. All of these complications should be screened for upon or soon after diagnosis and annually thereafter if findings are normal. Other conditions associated with diabetes should also be screened for regularly, as indicated in Table 1. 4. The correct answer is C. Rationale: The American Diabetes Association recommends at least 150 minutes of moderate-intensity physical activity to pre- vent progression from prediabetes to diabetes. Recommenda- tions should be tailored to the patient’s level of fitness so that the goals are realistic and achievable. In general, physical activ - ity should serve to reduce sedentary time and promote healthy weight loss. 5. The correct answer is D. Rationale: Metformin causes gastrointestinal symptoms in many patients, which may limit their tolerance of the medication. A strategy to mitigate this adverse effect is to start at a low dose and titrate weekly, as tolerated, to a higher dose. Symptoms usu - ally resolve after consistent use over time, and patients should be encouraged to continue the medication if at first they experience diarrhea, nausea, or abdominal pain.
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