diabetes

Question 1

risk factors for diabetes in pregnancy?

Answer 1

1 in 100
past medical history of gestational diabetes
obesity
family history

Question 2

effect diabetes has on pregnancy

Answer 2

maternal: retinopathy, ischemic heart disease, nephropathy,
urogentinital complications- UTI, recurrent candida infections
medical E: HTN, pre-clampsia
CS and vaginal deliveries

Question 3

effects of diabetes on fetus

Answer 3

hyperglycemia, hyperinsuliniema, growth promoter macrosomia, oragnomegaly, erythro- polycythemia, polyhydranminos, miscarriage,
congenital abnormalities- neural tube defects, microcephalic, cardiac, renal problems. preterm
polyhydramnios,

Question 4

diabetes effects on the infant

Answer 4

hypoglycemia, hypocalcemia, hypomagnesaemia, hypothermia, cardiomegaly
birth trauma: shoulder dystocia.

Question 5

pre conception screening targets

Answer 5

strict
HBA1c= normal below 6
fasting between- 3.5=5.0
post prandial- less than 7

Question 6

lifestyle advice people with diabetes

Answer 6

exercise
diet
BMI
taking folic acid 5 mg

Question 7

What do you need to train the diabetic mom in?

Answer 7

if sick urine dipstick= blood and ketones hospital

glucagon administration if hypo.

Question 8

what are the considerations during pregnancy?

Answer 8

tight control 
skin prick 7 times per day 
glucagon if hypo 
insulin increase in 2nd trimester and decrease in third 
diet and exercise= insulin needs.

Question 9

what are you going to be monitoring the patient for during pregnancy?

Answer 9

Think of the weird body picture- 1 eye retinopathy screen with optho 
smile- nausea vomiting, DKA 
thyroid- hypo or hyper thryriodism 
heart - be every visit 
pre-eclapmia screen

Question 10

fetal considerations during pregnancy.

Answer 10

booking visit 7=10 weeks
20 week anomaly scan
3rd trim scan for growth
if preterm need steroids and hospital admission.

Question 11

labour if diabetic

Answer 11

sliding scale
when to deliver depends on compliance if good can delivery naturally at 39=40 weeks
risk factor shoulder dystopia and macrosomia
complications- 38 weeks deliver
hourly measurement
post natal feed within the hour.

Question 12

when CS indicated

Answer 12

big baby weighs over 4.5 kg

Question 13

contraception

Answer 13

progestogen only

Question 14

in gestational diabetes what is first line and what is second line?

Answer 14

diet
insulin- pre-meal greater 6
1 hour greater than 7.5
AC greater than 95 centile

Question 15

follow up

Answer 15

OGGT 6 weeks postpartum

risk - 50 % over next 25 years

Question 16

what entails the OGTT test?

Answer 16

fasting 8 hours water only
75g glucose in water
plasma glucose fasting and 2 hours