Answer 1 is incorrect. 13.97% chose this answer. “TC’s Hemoglobin A1c is above target. Elevated glucose values could be contributing to fatigue and difficulty with weight gain.” 1. Answer 1 is incorrect, as it is not the best answer. Although the ADA Standards of Care state an A1C of <7% is appropriate for many children and adolescents, we must provide additional assessment for TC’s case. Keep reading below. 

Answer 2 is correct. 49.71% of you chose this answer. “Ensure IgA tissue transglutaminase (tTG) antibodies, with documentation of normal total serum IgA levels have been checked.” 2. Answer 2 is correct. Screening for celiac disease is recommended in individuals with type 1 diabetes soon after diagnosis or when symptoms occur, such as those reported by TC. It is recommended that IgA tissue transglutaminase (tTG) antibodies be checked, with documentation of normal total serum IgA levels, or IgG tTG and deamidated gliadin antibodies if IgA is deficient. 

Answer 3 is incorrect. About 16.53% of respondents chose this. “Recommend a gluten-free diet since individuals with type 1 diabetes can be at higher risk of celiac disease.” 3.  Although a gluten-free diet is recommended if TC is diagnosed with celiac disease, it is essential to complete appropriate screening before implementation of a gluten-free diet. 

Finally, Answer 4 is incorrect. 19.79% chose this answer. “Consider referral for a gastric emptying study given complaint of frequent nausea and diarrhea.” 4. Although we can see an increased risk of gastroparesis in diabetes, determined by a gastric emptying study, gastroparesis typically develops as a long-term complication of diabetes. Initial recommendations would be to rule out other causes and ensure recommended screening and treatment. 

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!