Diabetes Flashcards

1
Q

Incidence of any type of diabetes in pregnancy

A

7% of all pregnancies, (86% of those cases are GDM)

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2
Q

GDM is associated with what risks?

A
  • Developing preeclampsia
  • Having a c/s
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3
Q

What percentage of GDM patient will develop T2DM within 22-28 years after pregnancy?

A

70%!!!!!

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4
Q

Fetal risks when mom has GDM?

A
  • Macrosomia
  • Neonatal hypoglycemia
  • Hyperbilirubinemia
  • Shoulder dystocia
  • Birth trauma
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5
Q

When is GDM screening?

A

24-28 weeks

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6
Q

What is the screening test for GDM?

A

1 hour glucose GCT (50 g)

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7
Q

1 hour 50 g GCT cut off

A

130-140 mg/dL

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8
Q

Carpenter and Coustan cutoff for 3 hour GTT

A

Fasting 95
1 hour 180
2 hour 155
1 hour 140

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9
Q

Is a woman still at increased risk of adverse perinatal outcomes if she only has 1 abnormal value on 3 hr GTT?

A

Yes!

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10
Q

How often should GDM patients check their blood sugar?

A

AM Fasting and 1-2 hours post prandial

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11
Q

Goals for blood glucose of GDM patient’s?

A

Fasting < 95
1 hour post prandial < 140
2 hour post prandial < 120

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12
Q

Treatment for GDM

A
  1. Lifestyle- diet and exercise
  2. Insulin
  3. Metform
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13
Q

Typical starting dose for insulin for GDM?

A

0.7-1 unit/kg daily - divided among multiple injections using long and short acting insulin

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14
Q

Does insulin cross the placenta?

A

Nope!

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15
Q

Short acting insulins

A

Lispro
Aspart

Onset- 1-15 minutes
Peak action at 1-2 hours

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16
Q

Long acting insulins

A

NPH
Glargine (lantus)
Determir

Onset 1-3 hours

17
Q

MOA of metoformin

A

Biguanide

Inhibits hepatic gluconeogenesis and glucose absorption and stimulated glucose uptake in peripheral tissues

18
Q

Does metformin cross the placenta?

A

Yes! Levels can be as high as maternal concentrations

19
Q

If on metformin for PCOS when should you discontinue metformin?

A

After frist trimester??

Limited evidence to suggest a decrease risk of adverse pregnancy outcomes (including first trimester loss)

20
Q

Counseling for Metformin in treating GDM?

A
  1. Lack of superiority when compared with insulin
  2. It crosses placenta!
  3. Absence of long-term data in exposed offspring
21
Q

Dosage for Metformin for GDM?

A

500 mg nightly for 1 week, then increase to twice daily

Max dose: 2500-3000 mg/day

**Check Creatinine!

22
Q

Fetal surveillance for GDM either poorly controlled or on medications?

A

Antenatal testing starting at 32 weeks

no consensus regarding antenatal testing in GDMA1

23
Q

What fluid abnormality can be seen in babies w/ GDM moms?

A

Polyhydramnios

Results from fetal hyperglycemia.

Can incorporate serial measures of amniotic fluid

24
Q

Delivery of GDM patients

A

Good control, no other complications = term

Good control + medical therapy = 39 weeks

Poor control = 37 weeks

25
In GDM patients, c/s is recommended for what EFW?
4,500 g | 5,000 g for non-GDM
26
Postpartum screening for GDM
12 weeks postpartum Fasting glucose and 75 g 2 hour GTT
27
Early labor glucose checks for GDM?
AC, QHS (before meals and at night) or Q4 hours
28
Active labor glucose checks for GDM?
q1-2 hours insulin drip + D5 if high blood glucose
29
Screening for pre-gestational diabetes.. Who needs it?
Early 1 hour GCT Obesity BMI >/= 30 Prior macrosomia/SD/Stillbirth/GDM PCOS Fm Hx of diabetes Hyperlipidemia Physical inactivity Hx of CVD
30
Pre gestational Diabetes RISKS
Miscarriage IUFD IUGR, macrosomia PTD Congenital anomalies
31
What type of congenital anomalies are associated with pre gestational diabetes?
Caudal regression (sacral agenesis) Cardiac anomalies (ASD, VSD, Transposition) Neural Tube Defects (spina bifida, anencephaly)
32
Are there increased risks of fetal congenital anomalies for GDM?
Nope!! (Risks of macrosmia, SD, hyperbilirunemia, etc but NOT congenital heart defects, etc)
33
Patient screens positive for pre gestational diabetes? Next steps?
1. Referral to diabetes ed 2. Start checking BG 3. Start ASA 81 mg for Pre E PPx 4. Detailed anatomy scan + fetal ECHO 5. Antenatal Surveillance