diabetes

Question 1

classification of diabetes

Answer 1

pre-gestational (type 1&2)

gestational

Question 2

antepartum goals of trt for diabetes

Answer 2

glucose levels 70-120mg/dl

well controlled glucose=good fetal survival

Question 3

effects of uncontrolled diabetes

Answer 3

maternal - preterm l&d, pre/eclampsia, infection, polyhydramnios, shoulder dystocia
fetal - abort/stillborn, fetal growth
neonatal - delayed lung maturity (rsd), hypoglycemia

Question 4

PRE GESTATIONAL diabetes risks

Answer 4

Congenital anomalies

Question 5

pre-gestational diabetes

Answer 5

dx prior to preg.
preconceptual counseling very important
glucose is a teratogen?
insulin control
bld sugar levels changing in preg.

Question 6

changing insulin needs during preg

Answer 6

1st tri = insulin need reduced -
23nd tri = insulin need increased - cortisol acts as insulin antagonist, decreasing effects of insulin
3rd tri = gradual increase to 36 weeks
day of delivery = insulin need drops dramatically
breastfeeding mom = lwr insulin need, return to pre-preg in 7-10 days after delivery
weaning = insulin needs same as pre-pregnancy

Question 7

diabetes in pregnancy (GDM)

Answer 7

dx 24-28 weeks - occurs during 2nd half of preg.

Question 8

GDM screening

Answer 8

24-28 wks
1hr 50g glucose challenge test (gtt)
=140 positive

Question 9

GDM dx

Answer 9

3 hr glucose tolerance test (ogtt) - 100gm oral glucose-fast 1, 2 & 3 hr
dx made if: fasting glucose=abnormal, 2 or more glucose levels are high

Question 10

trt of gestational diabetes

Answer 10

diet - if fasting 95 or unable to maintain norm BS

Question 11

GDM usually resolves after preg T or F

Answer 11

true

Question 12

6 important activities for Diabetes

Answer 12

diet
blood glucose monitoring (4-6 x’s/day; fasting & 2hrs after each meal)
urine testing - ketones, proteins, glucose
insulin
exercise
antepartum fetal awareness (movement, non-stress test, amnio, ultrasound)
diabetes log - below 93?

Question 13

intrapartum mgmt of diabetes

Answer 13

timing of delivery
insulin requirements decreased during delivery
insulin in labor (reg iv piggyback/dextrose in ringers lactate)
maternal glucose monitored hourly
discontinue glucose after 3rd stage

Question 14

postpartum mgmt of diabetes

Answer 14

insulin req. dramatically decreased
monitor BS x4/daily
breastfeeding moms