Diabetes Flashcards
What is it?
Diabetes is a disorder in which the blood sugar level is persistently raised above the normal range
Why does it happen?
The abnormality is caused by an absolute or relative lack of insulin, secreted from the pancreatic B-cells
Diabetes is the most common pre-existing medical disorder complicating pregnancy in the UK
What is type 1 diabetes?
Beta cell destruction / total insulin deficiency
What is type 2 diabetes?
insulin resistance + insulin deficiency
What is gestational diabetes?
Any degree of glucose intolerance with onset or first recognition during pregnancy. ( Usually around 28 weeks)
What are the maternal risk factors with pre- existing and gestational diabetes?
Hypoglycaemia unawareness Ketoacidosis Deterioration in retinopathy Deterioration in nephropathy Pre-eclampsia Miscarriage Increased caesarean rate Polyhydramnious Shoulder dystocia (to a lesser degree with GDM)
What are the fetal risk factors with pre- existing and gestational diabetes?
Congenital abnormalities Macrosomia Late stillbirth Increased neonatal and perinatal mortality Neonatal hypoglycaemia Jaundice Premature birth (to a lesser degree with GDM- except congenital abnormalities)
Gestational diabetes is more common if there’s a family history of…?
FH Type 2 diabetes
What causes insulin resistance with gestational diabetes?
Placenta
What are the risk factors for gestational diabetes?
High BMI Maternal age (over 35) PCOS Previous large baby Previous GDM Previous unexplained perinatal death Ethnicity- South Asian,Black Caribbean, Middle Eastern
What are you more likely to develop later on in life if you have GDM?
Type 2 diabetes
When to screen if previous gestational diabetic?
GTT at booking
Repeat at 24-28 weeks if normal
What risk factors (arising during pregnancy) should women be offered screening for?
Macrosomia or polyhydramnious (fetal abdominal circumference or estimated fetal weight > 90th centile)
Glycosuria 2+ or more on dipstick testing on one occasion or 1+ on two occasions
A GTT after 36 weeks has a high false positive rate. After 35+6 refer to the Diabetic ANC for blood sugar monitoring
What should a fasting blood sugar be?
5.6 mmol/l or below
What should a woman’s blood sugar be 2hrs post 75g glucose?
7.8 mmol/l or below
What is a potential type 2 diabetic pre-pregnancy/possibly type 1 blood sugar?
11.1 mmol/l or above
What is the HbA1c test?
HbA1c means glycosylated haemoglobin- glucose in the blood binds to Hb
Shows the average blood glucose level over the past 2-3 months
Target below 48
How often should a GDM mother have scans?
Every 4 weeks from 28-36 weeks gestation for fetal growth and amniotic fluid volume
What is it important to monitor in a diabetic woman?
BP/Urinalysis for protein to detect hypertensive disorders
Retinopathy- opthalmology review at around 11 and 36 weeks (type 1 and 2)
Nephropathy- ACR/PCR/24 hr urine (type 1 and 2)
What is diabetic retinopathy?
Chronically high blood sugar from diabetes damage to the tiny blood vessels in the retina. The retina detects light and converts it to signals sent through the optic nerve to the brain. DR can cause blood vessels in the retina to leak fluid or hemorrhage distorting vision. In its most advanced stage, new abnormal blood vessels proliferate on the surface of the retina- scarring and cell loss in the retina
What is diabetic nephropathy?
The kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn’t able to do its job as well- can lead to complete kidney failure
How is diabetic nephropathy diagnosed?
Albumin (protein) in urine
What is metformin used for?
reduces insulin resistance
increases peripheral utilisation of glucose
used in PCOS
What should you aim to keep the blood sugar at during labour?
Between 4-7 mmol/l
How much dextrose should there be in an insulin sliding scale during labour?
5% or 10%
What is the management of a GDM woman at delivery?
Stop the sliding scale
What is the management of a type 1 + 2 diabetic woman at delivery?
Halve rate and continue with sliding scale until back on sc insulin with meals
What is the management of a GDM woman post natally?
STOP insulin/metformin
2-3 post meal blood glucose readings
Advice re: diet, exercise, weight loss
Fasting glucose with GP 6-13 weeks after delivery
What is the management of a type 2 diabetic woman post natally?
Insulin/metformin at pre-pregnancy dose
What is the management of a type 1 diabetic woman post natally?
Pre-pregnancy dose, decrease by 20% if breast feeding
How do you treat a hypo (blood glucose below 4) if the patient is conscious?
x5 dextrose sweets or 200ml lucozade
Once blood glucose above 4 give a starchy carbohydrate e.g : 1-2 digestive biscuits
How do you treat a hypo (blood glucose below 4) if the patient is unconscious?
No IV access – glucagon 1mg s/c or IM
If IV access – 100mls 20% dextrose or 200mls of 10% dextrose
Do NOT omit the next insulin dose
Management of a woman with really high blood sugar
Admit Sliding scale insulin Fluid rehydration Monitor ketones Monitor glucose Monitor baby
Who are insulin pumps for and how do they work?
Type 1 diabetes
Basal insulin- background levels delivered for whole 24 hours at set rates
Bolus insulin - added when eating
More flexible, fasting not a problem, eat at variable times
What is diabetic ketoacidosis?
Ketones are acids produced from body burning its own fat which occurs when body can’t get enough glucose from blood into cells to use as energy.
Can lead to KETOSIS- feel sick, lack of energy, dangerous for women with low BMI as loose too much weight, can be caused by vomiting, diarrhoea, not eating, general sickness, poisonous chemicals
Diabetic ketoacidosis: (ketosis caused by diabetes) life threatening thirst, abdo pain, nausea, vomiting, excessive urine, smell of pear drops on breath, unconsciousness, fainting
Why might some women be reluctant to take insulin?
It’s a growth hormone so can increase weight
What dose of folic acid with type 1/2 diabetes be taking?
Enhanced- 5mg
According to the NICE (2015) guidelines what pre-conception care /advise should be given to diabetic women planning for pregnancy?
Informed that establishing good glycaemic control before conception to reduce the risk of complications
The importance of avoiding unplanned pregnancy.
Offered pre-conception care and advice before discontinuing contraception
