11.1a Diabetes Mellitus Flashcards
1
Q
Metabolic Changes Associated with Pregnancy
A
- Glucose levels in fetus are directly proportional to maternal levels
- Glucose crosses the placenta but insulin does not
- Women who have insulin dependent diabetes are more prone to hypoglycemia during the 1st trimster
2
Q
Diabetogenic Effect
A
Occurs during the 2nd and 3rd trimester
- Decreased tolerance to glucose
- Increased insulin resistance
- Decreased hepatic glycogen stores
- Increased hepatic production of glucose
- Rising levels of human chorionic somatomammotropin, estrogen, prolactin, cortisol, insulinase which all increases insulin resistance
- INSULIN RESISTANCE IS A GLUCOSE SPARING MECHANIC TO ENSURE ABUNDANT GLUCOSE IS AVAILABLE FOR THE BABY
3
Q
Maternal Insulin Requirements
A
- Insulin requirements gradually increases 18-24 weeks until 36 weeks of gestation
- Once placenta is expulsed there is a large decrease in cortisol and insulinase which reduces insulin sensitivity back to pre-pregnancy states
- NONBREAST FEEDING MOTHERS RETURN TO NORMAL IN 7-10 DAYS
- BREASTFEEDING MOTHERS - LACTATION USES GLUCOSE WHICH LOWERS INSULIN REQUIREMENTS
4
Q
Maternal Insulin Requirements
A
1st trimester - Insulin requirements reduced due to increased insulin sensitivity and production as well as decreased food intake
2nd trimester - Insulin levels increase due to placental hormones (cortisol and insulinase)
3rd trimester - Insulin needs can double to quadruple until 36 weeks
Day of Birth - Dramatic decrease in insulin needs
Breastfeeding mothers - Insulin requirements stay low
Non-breastfeeding mothers - Returns to normal in 7-10 days
5
Q
DM
A
- Best to control diabetes before contraception and throughout gestational period
6
Q
Pregestational Diabetes
A
- Existed before pregnancy
7
Q
Gestational Diabetes
A
- Carbohydrate intolerance that occurs during pregnancy
8
Q
White’s System of Diabetes Classification
A
- Estimates risk associated with gestational diabetes
- Especially on damage to eyes and kidneys
