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medical complexities and research methods > Diabetes > Flashcards

Diabetes Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the oral glucose test

A

Blood test before eating breakfast followed by glucose drink and another blood sample two hours later

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2
Q

When are women screened for GDM?

A

16-18/40 if previous hx of GDM (retest at 28/40 if normal)

24-28/40 for those at risk

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3
Q

What is the GDM diagnosis

A

Fasting glucose level of 5.6 or above

2 hour plasma glucose level of 7.8 or above

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4
Q

Characteristics of GDM (x4)

A

Carbohydrate intolerance of variable severity with onset of first recognition during present pregnancy.
Usually no symptoms
Develops in 2nd/3rd trimester
Related to changes in carbohydrate metabolism and increased insulin resistance

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5
Q

Ways GDM can be diagnosed (x4)

A

Routine screening
Large for dates baby
Polyhedral nips
Glycosuria

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6
Q

How is GDM managed? (X7)

A

Modification of normal diet
Home monitoring of blood glucose levels
Insulin if dietary compliance poor/hyperglycaemia persists
Avoid starting hypoglycaemic drugs (risk of teratonics)
Full hospital care
Regular growth scans
Consider timing and mode of delivery

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7
Q

GDM management intrapartum x3

A

May not need insulin during labour
Sliding scale insulin
Stop sliding scale when placenta delivered
Insulin requirements return rapidly to pre pregnancy levels

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8
Q

GDM management postpartum x3

A

Oral gtt at 6 weeks p/n
Counselling about diabetes risk in the future
If on insulin stop sliding scale when placenta is delivered and stop dextrose within 1-2 hours

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9
Q

Classification of type 1 diabetes (x4)

A

No insulin production
Auto immune beta cell destruction causing antibodies to islet cells to be detectable
Age

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10
Q

What type of diabetes is ketoacidosis related to?

A

Type 1

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11
Q

What is ketoacidosis?

A

Blood sugar over 11, ph7.3

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12
Q

Symptoms of ketoacidosis x7

A 
Thirst
Polyuria 
Fatigue 
Dramatic weight loss 
Cramps
Abdominal pain 
Blurred vision
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13
Q

Severe symptoms of ketoacidosis x6

A 
Nausea 
Vomiting 
Abdominal pain 
Shortness of breath 
Drowsiness 
DeAth
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14
Q

Who is screening for GDM recommended to? (X5)

A

Previous GDM, family hx, previous large for dates baby, high BMI, ethnicity

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15
Q

Presenation of type 2 diabetes (x6)

A 
Insulin resistance 
Obesity 
Increased risk by inactivity and high fat diet
Strong genetic factor 
>35 
Often slow onset
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16
Q

Aim of pre existing diabetes pre conception care

A

To reduce risks of congenital abnormalities and improve obstetric outcomes

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17
Q

Pre existing pre conception care includes (x6)

A 
Education
Good control of blood glucose levels 
Avoid unplanned pregnancies 
Lower hba1c levels 
Frolic acid 5mg/day until 12/40
Assess extent of retinopathy, nephropathy and hypertension
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18
Q

Diabetes target blood glucose level during pregnancy

A

3.5-5.9 (fasting)

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19
Q

Key medical antenatal points (x3)

A

Monitor hba1c
Frequent monitoring of blood glucose levels
Increased insulin requirements as pregnancy advances may mean a need for continuous insulin infusion

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20
Q

Care if women presents with ketoacidosis? X2

A

Urgent hospital admission

Treatment with iv fluids and insulin

21
Q

How is type 2 usually controlled in pregnancy?

A

Usually need for them to be on insulin even if their diabetes is usually well controlled

22
Q

What hypoglycaemic drug can be taken during pregnancy?

A

Meteor in

23
Q

Why do hypoglycaemic agents have to be discontinued during pregnancy?

A

They cross the placenta

24
Q

Who should be involved in antenatal care for those with diabetes?

A 
Multidisciplinary team 
Nutritionist 
Obstetrician 
Midwife 
Diabetic dr/nurse
25
Q

What is the insulin schedule during pregnancy?

A

4x daily
3 pre meal doses - rapid acting (with meals)/ fast acting (before meals)
1 night time intermediate acting dose

26
Q

Why do you continue insulin if patient is ill?

A

When Ill infections mean you need a higher insulin dose

27
Q

What should happen if a patient is on steroids or beta sympathy mimetic drugs

A

Increase insulin as likely to cause hyperglycaemia

28
Q

Other things that should be monitored through pregnancy (x2)

A

Retinal - eye text in early pregnancy and every 6 months

Renal function

29
Q

Scans that should be carried out? X6

A 
Early scan (dating/viability) 
Nuchal translucency at 11-13+6 with risk assessment 
Foetal cardiology scan 18-20 
Detailed anomaly scN 
Doppler blood flow studies 
Regular growth scans
30
Q

When should an anaesthetic assessment take place?

A

3rd trimester

31
Q

Target glucose level in the intrapartum period?

A

4-7mmol/l

32
Q

What is hypoglycaemia?

A

When blood glucose falls below 4

33
Q

Causes of hypoglycaemia (x8)

A 
Intensive insulin therapy
Imbalance of food activity and insulin 
Exercise 
Alcohol and drugs 
Low carbohydrate diets 
Vomiting 
Breast feeding 
Infection site problems
34
Q

Describe the patients state in a mild hypo

A

Conscious and able to swallow

35
Q

Mild hypo treatment x5

A

15-20g quick acting carbohydrate
Recheck 10 mins later if still less than 4 repeats cycle
When blood glucose >4 give complex carbohydrate
If blood glucose remains 45 mins contact doctor urgently
Consider 1mg of glucagon im or iv 10% glucose infusion at 100ml/hr

36
Q

Describe patients state in a moderate hypo

A

Patient in uncooperative but is able to swallow

37
Q

Moderate hypo treatment

A

1.5-2 tubes of glucogel/dextrogel squeezed into mouth between teeth and gums or 2 teaspoons of honey/jam
May need to give glucagon 1mg IM (May not be effective if prolonged hypo)

38
Q

Describe he patients state during a severe hypo

A

Requires assistance to recover

Low level of consciousness/unable to swallow

39
Q

Treatment of severe hypo x3

A

Glucagon 1 mg IM
75-80ml of 20% glucose (over 10-15 mins)
150-160ml of 10% glucose (over 10-15 mins)

40
Q

Conditions for discharge of the newborn x3

A

Must be at least 24 hours old, feeding well and maintaining blood glucose levels

41
Q

How can we prevent hyperglycaemia in newborns? X3

A

Early and regular feeds
Keep warm
Skin to skin

42
Q

How often should blood glucose levels be checked on the newborn

A

Routine every 2-4hrs after birth then 4hrly for first 24 hours

43
Q

What blood glucose level are we aiming for in newborns

A

> 2.5

44
Q

What blood glucose level in newborns would result in admission to special care unit?

A
45
Q

Signs of hypoglycaemia in newborns

A 
Jittery 
Hypothermia 
Poor muscle tone 
Poor feeding 
Reduced responsiveness
46
Q

Actions if neonate has hypoglycaemia (x5)

A 
Well clothed and kept warm 
Frequent regular feeds 
Skin to skin 
Breast feeding 
Stable room temperature
47
Q

What is fetal macrosomia?

A

Birthweight >4.5 or >90th centile

48
Q

Effect of diabetes on pregnancy (x5)

A 
Increased risk of miscarriage 
Increased risk of pet 
Increased risk of infection 
Increased risk of c/s rate 
Increased poor outcome related to quality of blood glucose control and presence of existing complications

medical complexities and research methods (5 decks)

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