Diabetes Flashcards
Gdm definition
Carb intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy -
What % of women affected by gdm
5% of pregnancy women
What is type 1
Absolute lack of insulin
Auto immune condition where the insulin producing beta cells in the pancreas are damaged by the immune system
8% have type 1
What is type 2
Relative lack of insulin/ lack of resistance
90% living with diabetes have type 2
What is maturity onset diabetes of the young
Autosomal dominant genetic condition
2% of people with diabetes have MODY
Characteristics of gdm
Develops in pregnancy
Many be symptomless
Characteristics of type 1
Abrupt onset of
Occur at any age
Young, no obesity, no family history, hyperglycaemia
BG= >11mmols
Glycosuria and keonuria
Symptoms of type 1
Weight loss
Poly dips is
Polyuria
Nausea
Vomiting
Weakness
Confusion
Characteristics of type 2
Inability t o produce sufficient insulin due to partial destruction of beta cells
Reduced insulin sensitivity an increased insulin resistance
Influencing factors - genetics, ethnicity,prev gdm
Characteristics of MODY
Diagnosed aged under 25 and have 1+ parents with diabetes
Diagnosing diabetes in pregnancy
Pregnanc women with pre existing diabetes have- take full history of type of diabetes, medication and method of control
Preganancy women without pre existing diabetes - may be screened for gdm during pregnancy if at a higher chance of developing it
Pregnant women without pre existing a higher chance of developing diabetes are usually offered screening for diabetes via a GTT
In what circumstances is GTT offered
BMI above 30
Previous macrosomic baby abover 4.5kg
Prev gdm
Family history of diabetes
Ethnicity with high prevalence
In ongoing AC - glycosuria above 2+ or above on one occasion
Glycosuria of 1+ or above on 2 occasions
Other risk factors for gdm
PCOS
Cystic fibrosis
Accelerated fetal growth
How to do GTT
Fast from midnight of day before
Obtain fasting blood test
Costume drink contains 75g of glucose
Rest for 2 hours
Obtain second blood test Costume
Check and document results and inform woman
When GTT
Prev GDM or Glycosuria at booking or bmi over 45 - test as soon as possible and at 26-28 weeks
Other risks factors - at 24-28 weeks
Normal ranges of gtt
Fasting test is less than 5.6mmol/l
2hour test is less than 7.8mmol/l
Hba1c less than 6% or less than 42mmol/l
Intervention and monitoring gdm
Information sharing and health promotion regarding gdm and blood glucose associated with bette preganancy outcomes suc as reducing risk of fetal macrosomia, trauma during birth, IOL or c section, Nekntal hyperglycaemia and perinatal death
Info about exercise - walking for 30mins after meal
Info about foods with low gycaemia index- whole meal and fibrous foods
Referral to dietician
Monitoring gdm targe ranges
Aim for capillary blood glucose below
- fasting - 5.3
- 1hour after meal - 7.8
If exercise and die not effective at mainting normal blood lactose - metformin considered
All treatments stopped postnatally
Antenatal care for woman with gdm
Refer to consultant led mdt care with diabetes team
Offer USS to assess fetal growth and liquor volume from 28-36/40
Ensure contact with the women every 1-2 weeks to review blood glucose
Polyhydraminous
Increased amniotic fluid - more than 8cm deepest pool depth
Associated perinatal mortality and morbidity
Causes - fetal polyiria due to increased blood glucose levels , dilution of ish glucose conc in amniotic fluid
Planning for birth with GDM
Offer IOL no later than 40+6
Consider elective birth before 40+6 for women with GDM who have maternal or fetal complications
If IOL contraindicated offer LSCS
If IOL decline offer increased fetal monitoring
Maternal risk of diabetes
Retinopathy - damage to retina
Nephronopathy - damage to nephron in kidney
Ketoacidosis - harmful build up of blood ketones
Fetal/neonatal risks
Miscarriage
Stillbirth
Congenital anomalies
Mmacrosomia
Birth injury
Shoulder dystocia
Abnormal placental development
Hypoxia
Neonatal hypoglycaemia
Development of obesity and diabetes later in life
Pre conception care
Info sharing - try to have good blood glucose before conception and through pregnancy will reduce miscarriage etc
Optimise health - use contraception until achieved god glucose control, pre conception retinopathy and nerphropathy screening
5mg folic supplement
Weight optimisation to achieve bmi 18.5 - 27m2
Offer blood tests up to monthly when planning pregnancy
Aim for less than 48mmol before stopping contraception
Antenatal care with diabetes
Offer retinal and renal assessment
Refer to consultant les with mdt
Measure hbA1c as part of risk assessment
Advise daly aspirin 75-150mg orally from 12/40 until birth
Ensure contact with woman every 1-2 weeks to review blood glucose
Offer USS to assess fetal growth and Iquitos volume from 28- 36/40
Ketonancidosis
Ketones - by product oof using fat for energy rather than carbs
Normal level - less than 1.5
Borderline - 1.5 - 3 further investigations and fluids repaired
High - more than 3
Maternal mortality <1%
Fetal mortalitup to 35%
Often occurs 2nd and 3rd trimester more common in type 1 than 2 and gdm
Emergency treatment required in hdu - fluids insulin titration, monitoring
Antenatal care pre existing diabetes
IOL between 37-38+6/40
Reduces stillbirth
Contradindications - unstable lie, breech , prev c sections
Labour care for diabetes
In a obstretric unit with advanced neonatal care unit
Monitor capillary plasma glucose every hour during labour and birth for women with diabetes and maintain it between 4mmol/l and 7mmol/l
Use it dextrose and insulin infusion during labour and birth for women with diabetes whose capillary plasma glucose is not maintained between 4 and 7mmol/l
If then woman has general anaesthetic montor BG every 30mins from induction o general anaesthesia
Consider ctg monitor in labour
