Diabetes

Question 1

what are some of the complications of diabetes

Answer 1

increased risk of congenital abnormality, stillbirth, macrosomia, hypertensive disorders and an increased rate of C-section.

Question 2

Why is pregnancy a challenge for those that have diabetes

Answer 2

the physiological changes to carbohydrate metabolism in pregnancy make it a challenge for those with diabetes to maintain good glycemic control which is known to improve outcomes

Question 3

midwives do not care for people with diabetes why do we need to watch out for people with at risk lifestyles

Answer 3

pg acts as a ‘stress test’ for diabetes and women who have an underlying susceptibility to diabetes and may develop gestational diabetes

Question 4

Gestational diabetes

Answer 4

carbohydrate intolerance of varying degrees of severity with the onset or first recognition during pregnancy and which resolves after pregnancy. it has the same risk factors as those for type 2 diabetes and many women who develop gestational diabetes go on to develop type 2 diabetes in the months and years following pregnancy

Question 5

what is one of the reasons for major changes to carbohydrate and fat metabolism in pg

Answer 5

the need to provide adequate nutrients to support fetal growth and development brings about major changes

Question 6

why does the fetus need your fat and carbohydrate metabolism to change

Answer 6

the fetus needs nutrients for the tremendous growth and development that takes place in utero as well as requiring adequate stores of energy and substrates for the transition to extrauterine life.

Question 7

what is the metabolic tug of war when it comes to nutrient needs

Answer 7

the fetal demand/ need for growth and development and stores for extra uterine life is balanced against the maternal need for energy and nutrients for the physiological demands of pregnancy, labor and lactation

Question 8

Utilization of glucose in the liver

Answer 8

• glucose arrives at liver via portal circulation from intestine
• glucose used by liver or stored as glycogen within the liver
• glucose leaves in hepatic veins꞉ to body cells for energy, to maintain blood glucose level, to muscle to be stored as glycogen, excess glucose is stored as fat

Question 9

What is a key hormone for carbohydrate metabolism

Answer 9

insulin

Question 10

what is diabetes caused by

Answer 10

an absence or limitation of insulin

Question 11

what is metabolism

Answer 11

general term for the chemical reaction in the body that enable it to function

Question 12

what is glucose derived from

Answer 12

the breakdown of carbohydrates. it is absorbed into the blood capillaries of the villi of the small intestine and transported via the portal circulation to the liver

Question 13

what are some of the ways glucose is used in the body

Answer 13

• glucose is broken down to form ATP [energy transfer molecule] and used for the metabolic activity of the liver and other body cells.
• some glucose remains in the circulating blood to maintain blood glucose levels
• some excess glucose is converted to glycogen and stored in the liver and skeletal muscle
• further excess glucose is converted to fat deposits

Question 14

why is insulin necessary

Answer 14

its necessary for glucose to be utilized by cells

Question 15

what happens when blood glucose levels fall

Answer 15

glucose can be generated from glycogen in the liver and muscle under the influence of the hormones. glucose can also be generated from non-carbohydrate sources such as aa and fat

Question 16

what is insulin

Answer 16

a small protein hormone secreted from within the pancreas. when blood glucose levels rise, more insulin is secreted. it acts as a key to unlock the cell to allow glucose to enter the cell and be utilized.

Question 17

what regulates the maintenance of stable blood sugar levels

Answer 17

insulin and glucagon [which act in opposition to each othet]

Question 18

what is glucagon

Answer 18

triggered by a fall in blood sugar levels. it activates enzymes in the liver which catalyzes the breakdown of glycogen to glucose and raises blood sugar

Question 19

what else is insulin involved in the regulation of. and how is it connected to ketones

Answer 19

involved in the regulation of amino acids and fat. with reduced insulin or loss of its action, there is an increase in blood sugar and amino acids. also increased breakdown of fats will occur = ketones

Question 20

the normal changes in carbohydrate and lipid metabolism in pg is to ensure what

Answer 20

constant supply of nutrients [predominantly glucose] to the growing uterus

Question 21

how is the carbohydrate metabolism in normal pg in early pg

Answer 21

there is a metabolic drive to laying down maternal fat stores as a preparatory phase for the later demands of pg.

• less insulin is required.
• maternal glucose levels are a little lower than those who are not pg

Question 22

why does blood glucose levels in the mother during early pg

Answer 22

• embryo and young fetus are utilizing available glucose directly from the mothers bloodstream [demand increases as pg progresses]
• cells [adipose tissue] develop an increased sensitivity to insulin= an enhanced uptake of nutrients and resulting in enhanced fat storage

Question 23

why does nausea in early pg play a role in blood glucose levels

Answer 23

because of nausea decreased amounts of food intake, tend to eat frequent carbohydrate-based snacks. this all could be a response to the lower fasting maternal blood glucose levels. also bc of the lower blood glucose, activity decreases and significant tiredness is noted by women= conserving energy.

Question 24

how does glucose change in late pregnancy

Answer 24

from 20 weeks to term, insulin resistance increases progressively as does insulin secretion.

Question 25

what does insulin resistance mean

Answer 25

that a normal response by the cells to a given amount of insulin is reduced = higher levels of insulin are needed. Blood glucose levels do not drop as rapidly as usual after a meal. In the analogy of insulin being the key in insulin resistance the lock is stiff and needs more insulin to prize it open.

Question 26

why does insulin resistance occur in late pg

Answer 26

mostly unknown but appears to be mediated by increasing levels of placental steroid hormones and cortisol. glucose is kept in the plasma longer and can be carried via the placenta to ensure a consistent supply to the fetus.

Question 27

what does the body do in late pg to meet the demand for more insulin

Answer 27

the pancreatic beta cells increase in size and number enabling increased insulin production. by third trimester, insulin production has increased up to 3x that of before pg.

Question 28

how does changes in hormonal levels during pg effect fat metabolism

Answer 28

to conserve glucose for the fetus, fat is used for maternal needs more readily as an alternative to glucose. fats are the body’s most concentrated source of energy and are broken down into free fatty acids and glycerol.

Question 29

in essence why does GDM occur

Answer 29

pg represents a metabolic challenge with increased insulin resistance by the tissues, creating a demand for more insulin. for most women, insulin requirements are readily met. if the insulin requirements are not met, hyperglycemia develops and diabetes become overt as GDM. GDM pgs feature exaggerated insulin resistance as well as impaired insulin production

Question 30

What does HbA1c test for

Answer 30

Glucose in the blood becomes bound irreversibly to the hemoglobin of RBCs over an approximately 10 week period, forming glycosylated hemoglobin [HbA1c]. the more glucose avaoilable in the blood, the more HbA1x will be present.

Question 31

why does testing for Hb1c a good idea for first trimester labs

Answer 31

measurement of HbA1c therefore gives an indication os the levels to which the RBCs have been exposed to over the last two months.

Question 32

why is it important to diagnose GDM

Answer 32

Diagnosing enables interventions that aim to optimize blood sugar levels and prevent a range of complications for mother and baby

Question 33

what are some of the complications for mom if they have pre-existing diabetes

Answer 33

adjustment to insulin requirements, hypoglycemia, ketoacidosis, hypertension and increased risk of pre-e, diabetic retinopathy, diabetic nephropathy, polyhydramnios, shoulder dystocia, C-section, infection and impaired wound healing

Question 34

what are some complications for fetus/newborn if mother has pre-existing diabetes

Answer 34

congenital malformation, macrosomia, SGA, increased rate of stillbirth, preterm delivery, increased perinatal mortality, neonatal hypoglycemia, polycythemia [extra blood cells], jaundice, respiratory distress syndrome

Question 35

macrosomia and GDM

Answer 35

caused by the delivery of excessive glucose and other nutrients to the fetus. maternal hyperglycemia simulates the fetus to produce insulin [for fetus is like a growth hormone] and other growth factors that promote fat deposition [especially around the upper trunk], larger shoulders and the enlargement of organs