Diabetes Flashcards
What is Diabetes?
High blood sugar levels
What is insulin?
Hormone made in the beta cells of the pancreas that allows glucose to enter cells
How are glucose levels regulated in someone without Diabetes?
The pancreas detects when glucose enters the blood and releases the correct amount of insulin to allow glucose to enter cells
What is Type I Diabetes?
Pancreas doesn’t make insulin or the beta cells of the pancreas are destroyed
What is Type II Diabetes?
Insulin is not effective or the pancreas doesn’t produce enough insulin to counteract the levels of glucose
What is Gestational Diabetes?
Placenta-induced insulin resistance with onset or first recognition during pregnancy
What are the common symptoms of Diabetes?
- Increased urine output
- Thirst
- Lethargy
- Weight loss/gain
- Affects heart, eyes and kidneys
How does Diabetes affect the heart?
High BP and insulin resistance increase the risk of coronary heart disease
How does Diabetes affect the eyes?
Increased risk of retinopathy, cataracts and glaucoma
How does Diabetes affect the kidneys?
Increased risk of nephropathy
What are the neonatal risks associated with Diabetes in pregnancy?
- Stillbirth
- Neonatal death
- Congenital abnormality
- Prematurity
- Macrosomia
- Jaundice
- Hypoglycaemia
What are the maternal risks associated with Diabetes in pregnancy?
- Ketoacidosis
- PET
- Miscarriage
- Polyhydramnios
- Shoulder dystocia
Why is there an increased risk of macrosomia?
Lack of insulin results in excess glucose which is passed to the baby
What is a normal glucose level?
Before breakfast = <5.2
1 hour after each meal = <7.8
What is the glycaemic index?
How fast or slow food is digested
How can the glycaemic index be reduced?
- Reduce sugar intake (e.g. artificial sweetener in tea, no chocolate or sweets)
- Avoid saturated fats (e.g. cream, butter)
Give a good breakfast meal for a Diabetic mother
- Bran flakes
- Muesli
- Weetabix
- Eggs, bacon, beans
Give a good lunch meal for a Diabetic mother
- Wholegrain bread
- Olive-based spread
- Fish/chicken salad
- Fruit and yoghurt
Give a good evening meal for a Diabetic mother
- Spaghetti bolegnese
- Roast dinner
Give a good snack for a Diabetic mother
- Carrots and houmous
- Fruit
- Nuts
What are the risk factors for GDM?
- BMI >30
- Previous baby >4.5kg
- Previous GDM
- FH of Diabetes
- PCOS
When does a Glucose Tolerance Test take place?
At booking and with 27/40 bloods (or if arises in pregnancy, just at 27/40 bloods)
How does the GTT work?
- Fast for 12 hours
- Blood test on arrival
- Drink glucose solution
- Wait 2 hours
- Repeat blood test
What values indicate GDM?
Fasting = >5.6
After glucose = >7.8
What additional testing can be done?
- HbA1c is glucose bound to Hb that has become glycosylated
- Testing these levels show the average glucose level over the past 2-3 months
- Results should be <48
How is Diabetes in pregnancy managed?
- Diabetic clinic
- Blood sugar monitoring
- USS every 4 weeks from 28/40
- Dietary advice
- Medication if required
- Increased folic acid dose (5mg)
How often should blood sugar be monitored?
- Before breakfast
- 1 hour after every meal
What medication may be used if diet control is not efficient?
- Metformin
- Insulin
What is the postnatal management for GDM?
- Stop medication
- 2-3 post-meal blood glucose readings
- Advice re. diet and exercise
- GTT with GP at 6 weeks
What is the postnatal management for Type I Diabetes?
- Return to pre-pregnancy dose
- Decrease dose by 20% if BF
- Need SC Insulin and something to eat before sliding scale taken down
What is the postnatal management for Type II Diabetes?
Return to pre-pregnancy dose
How should a hypo be treated if the patient is conscious?
- If blood glucose <4, give 5x dextrose sweets or 200ml Lucozade
- Once blood glucose >4 give starchy carbohydrate (e.g. digestive biscuits)
How should a hypo be treated if the patient is unconscious?
- No IV access = Glucagon 1mg SC or IM
- IV access = Dextrose 100ml 20% or 200ml 10%
- Do NOT omit the next insulin dose
How does Metformin work?
- Decreases amount of sugar produced
- Increases insulin sensitivity of cells
What should Diabetic mothers be advised to do regarding feeding?
Colostrum harvesting
What may be seen on USS that is an indicator for an SGTT?
- Large foetal abdomen
- Polyhydramnios
What foods should be avoided?
- Fruit juice
- Exotic fruits
- Cereal
- White rice/ pasta
How can urinalysis be used to indicate an SGTT?
2x glucosuria in a row
