A 13yearold Native American female has a BMI at the 90th percentile for age.
The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvetlike rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will

Question

A 13­year­old Native American female has a BMI at the 90th percentile for age.
The primary care pediatric nurse practitioner notes the presence of a hyperpigmented velvet­like rash in skin folds. The child denies polydipsia, polyphagia, and polyuria. The nurse practitioner will

Quizplus · Accepted Answer

The presence of a hyperpigmented velvet-like rash in skin folds, known as acanthosis nigricans, is commonly seen in individuals with insulin resistance and is a marker for the development of type 2 diabetes. The child denying symptoms of polydipsia, polyphagia, and polyuria is not sufficient to rule out the possibility of developing type 2 diabetes. A fasting blood sample for a metabolic screen for type 2 diabetes is the best next step to evaluate for glucose intolerance. Counseling the child to lose weight may still be a necessary intervention, but it is not the best next step. Diagnosing type 2 diabetes based on a single random glucose of 180 mg/dL is inappropriate and requires further evaluation. Referring the child to a pediatric endocrinologist is premature without initiating a metabolic screen first.

A 13­year­old Native American Female Has a BMI at the 90th

A 13yearold Native American Female Has a BMI at the 90th