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Week 1: Diabetes and CTG > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is it?

A

Diabetes is a disorder in which the blood sugar level is persistently raised above the normal range

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2
Q

Why does it happen?

A

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

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3
Q

What is type 1 diabetes?

A

Beta cell destruction / total insulin deficiency

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4
Q

What is type 2 diabetes?

A

insulin resistance + insulin deficiency

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5
Q

What is gestational diabetes?

A

Any degree of glucose intolerance with onset or first recognition during pregnancy. ( Usually around 28 weeks)

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6
Q

What are the maternal risk factors with pre- existing and gestational diabetes?

A 
Hypoglycaemia unawareness
Ketoacidosis
Deterioration in retinopathy
Deterioration in nephropathy
Pre-eclampsia
Miscarriage 
Increased caesarean rate
Polyhydramnious
Shoulder dystocia
(to a lesser degree with GDM)
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7
Q

What are the fetal risk factors with pre- existing and gestational diabetes?

A 
Congenital abnormalities
Macrosomia
Late stillbirth
Increased neonatal and perinatal mortality
Neonatal hypoglycaemia
Jaundice
Premature birth 
(to a lesser degree with GDM- except congenital abnormalities)
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8
Q

Gestational diabetes is more common if there’s a family history of…?

A

FH Type 2 diabetes

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9
Q

What causes insulin resistance with gestational diabetes?

A

Placenta

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10
Q

What are the risk factors for gestational diabetes?

A 
High BMI
Maternal age (over 35)
PCOS
Previous large baby
Previous GDM
Previous unexplained perinatal death
Ethnicity- South Asian,Black Caribbean, Middle Eastern
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11
Q

What are you more likely to develop later on in life if you have GDM?

A

Type 2 diabetes

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12
Q

When to screen if previous gestational diabetic?

A

GTT at booking

Repeat at 24-28 weeks if normal

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13
Q

What risk factors (arising during pregnancy) should women be offered screening for?

A

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

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14
Q

What should a fasting blood sugar be?

A

5.6 mmol/l or below

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15
Q

What should a woman’s blood sugar be 2hrs post 75g glucose?

A

7.8 mmol/l or below

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16
Q

What is a potential type 2 diabetic pre-pregnancy/possibly type 1 blood sugar?

A

11.1 mmol/l or above

17
Q

What is the HbA1c test?

A

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

18
Q

How often should a GDM mother have scans?

A

Every 4 weeks from 28-36 weeks gestation for fetal growth and amniotic fluid volume

19
Q

What is it important to monitor in a diabetic woman?

A

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)

20
Q

What is diabetic retinopathy?

A

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

21
Q

What is diabetic nephropathy?

A

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

22
Q

How is diabetic nephropathy diagnosed?

A

Albumin (protein) in urine

23
Q

What is metformin used for?

A

reduces insulin resistance
increases peripheral utilisation of glucose
used in PCOS

24
Q

What should you aim to keep the blood sugar at during labour?

A

Between 4-7 mmol/l

25
Q

How much dextrose should there be in an insulin sliding scale during labour?

A

5% or 10%

26
Q

What is the management of a GDM woman at delivery?

A

Stop the sliding scale

27
Q

What is the management of a type 1 + 2 diabetic woman at delivery?

A

Halve rate and continue with sliding scale until back on sc insulin with meals

28
Q

What is the management of a GDM woman post natally?

A

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

29
Q

What is the management of a type 2 diabetic woman post natally?

A

Insulin/metformin at pre-pregnancy dose

30
Q

What is the management of a type 1 diabetic woman post natally?

A

Pre-pregnancy dose, decrease by 20% if breast feeding

31
Q

How do you treat a hypo (blood glucose below 4) if the patient is conscious?

A

x5 dextrose sweets or 200ml lucozade

Once blood glucose above 4 give a starchy carbohydrate e.g : 1-2 digestive biscuits

32
Q

How do you treat a hypo (blood glucose below 4) if the patient is unconscious?

A

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

33
Q

Management of a woman with really high blood sugar

A 
Admit
Sliding scale insulin
Fluid rehydration
Monitor ketones
Monitor glucose
Monitor baby
34
Q

Who are insulin pumps for and how do they work?

A

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

35
Q

What is diabetic ketoacidosis?

A

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

36
Q

Why might some women be reluctant to take insulin?

A

It’s a growth hormone so can increase weight

37
Q

What dose of folic acid with type 1/2 diabetes be taking?

A

Enhanced- 5mg

38
Q

According to the NICE (2015) guidelines what pre-conception care /advise should be given to diabetic women planning for pregnancy?

A

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

Week 1: Diabetes and CTG (2 decks)

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