Diabetes Flashcards

1
Q

Gdm definition

A

Carb intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy -

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2
Q

What % of women affected by gdm

A

5% of pregnancy women

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3
Q

What is type 1

A

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

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4
Q

What is type 2

A

Relative lack of insulin/ lack of resistance
90% living with diabetes have type 2

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5
Q

What is maturity onset diabetes of the young

A

Autosomal dominant genetic condition
2% of people with diabetes have MODY

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6
Q

Characteristics of gdm

A

Develops in pregnancy
Many be symptomless

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7
Q

Characteristics of type 1

A

Abrupt onset of
Occur at any age
Young, no obesity, no family history, hyperglycaemia
BG= >11mmols
Glycosuria and keonuria

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8
Q

Symptoms of type 1

A

Weight loss
Poly dips is
Polyuria
Nausea
Vomiting
Weakness
Confusion

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9
Q

Characteristics of type 2

A

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

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10
Q

Characteristics of MODY

A

Diagnosed aged under 25 and have 1+ parents with diabetes

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11
Q

Diagnosing diabetes in pregnancy

A

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

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12
Q

In what circumstances is GTT offered

A

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

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13
Q

Other risk factors for gdm

A

PCOS
Cystic fibrosis
Accelerated fetal growth

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14
Q

How to do GTT

A

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

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15
Q

When GTT

A

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

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16
Q

Normal ranges of gtt

A

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

17
Q

Intervention and monitoring gdm

A

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

18
Q

Monitoring gdm targe ranges

A

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

19
Q

Antenatal care for woman with gdm

A

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

20
Q

Polyhydraminous

A

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

21
Q

Planning for birth with GDM

A

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

22
Q

Maternal risk of diabetes

A

Retinopathy - damage to retina
Nephronopathy - damage to nephron in kidney
Ketoacidosis - harmful build up of blood ketones

23
Q

Fetal/neonatal risks

A

Miscarriage
Stillbirth
Congenital anomalies
Mmacrosomia
Birth injury
Shoulder dystocia
Abnormal placental development
Hypoxia
Neonatal hypoglycaemia
Development of obesity and diabetes later in life

24
Q

Pre conception care

A

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

25
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
26
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
27
Antenatal care pre existing diabetes
IOL between 37-38+6/40 Reduces stillbirth Contradindications - unstable lie, breech , prev c sections
28
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