Diabetes Flashcards
Which one of these crosses the placenta: glucose or insulin?
Glucose crosses the placenta.
Insulin does not.
If mom is hyperglycemic, what will baby be categorized as too?
Baby will be hyperglycemic
Your diabetic patient who is in her first trimester asks which is she at more risk of: hypoglycemia or hyperglycemia?
Why?
Hypoglycemia
This is due to
- n/v around 6-12 weeks of PG
- Elevated Estrogen and Progesterone which means INSULIN gets used up more by cells
- Increased storage of glycogen in liver
- Decrease glucneogenesis
What trimesters do diabetogenic effects occur in?
2nd & 3rd
What diabetogenic effects happens to hormones in 2nd and 3rd trimester?
PG hormones are being released more due to placenta being developed now
What diabetogenic effect happens to glucose in 2nd and 3rd trimester?
Decrease tolerance of glucose
What diabetogenic effect happens to insulin in 2nd and 3rd trimester? Why is this happening?
An increase in insulin resistance (insulin isn’t transporting the glucose anymore)
The insulin resistance is due to the placental hormones of PG which is also increasing.
Which hormones is it that are being increased due to the placenta being diabetogenic in the 2nd and 3rd trimester?
What is the net effect of these hormones?
HCS (human chorionic sommatropin) Estrogen Progesterone Prolactin Cortisol Insulinase - which ruins insulin activity
They elevate glucose in the blood stream
What would you expect the blood glucose levels or net effect be due to placenta hormones?
What does this mean for mom?
Elevation of glucose in the blood stream
And so her insulin need is going to rise in order to take care of the more glucose
What happens if mom’s blood glucose goes down in the 2nd and 3rd trimester?
If BG goes down, there is an issue in the PG.
The BG in these trimesters should never go down.
(they can only go down in1st)
In normal diabetes - when the body goes long periods of not being able to use their glucose/carbs?
What does this lead to?
The human body will turn to fats and proteins
Ketoacidosis > metabolic acidosis
- ketones and fatty acids accumualte
What happens to a diabetics weight if they are in ketoacidosis?
Now will this same thing happen to PG mom too if she is diabetic?
They have weight loss
YES
When Melzher says “Hyperglycemia acts as an osmotic diuretic” what does this mean
So if mom is hyperglycemic and you check her hydration status, what will you find?
(Why did you see the more peeing/polyuria though?)
She means the hyperglycemia causes increased urine output. And that leads to intracellular and extracellular dehyration of the cell
Her skin might be dry and also mucous membranes
(The osmotic diuresis goes on leads to more blood volume which you have to pee out)
Why does polyphagia occur in diabetes?
Extreme hunger occurs bc the cells are starving
Why does polydipsia occur?
Extreme thirst occurs bc the cells are dehydrated from the polyuria actually
Why did you see the more polyuria?
When you check mom’s pee, you see a glucose reading of 3+. Is this ok?
What do you know may come after this?
Osmotic diuresis causes increased blood volume and you must pee it out
If it is above 1+ that means mom is spilling glucose. And this is abnormal
She can start spilling ketones and go into acetonuria too if she is already beginning to breakdown fat and proteins
You notice mom is having the polyuria, polyphagia, and polydipsia symptoms. When you go to check her BS what are you expecting and why?
Hyperglycemia bc it is the high BS that causes the osmotic effects to take place and cause the 3 P’s
Patient asks what the difference is between Gestational Diabetes and regular diabetes. What do you tell her?
Gestational Diabetes means they discovered you were a diabetic during your PG. But this doesn’t mean you have no chance of being diabetic before hand.
Your patient might have gestational diabetes. What tests do you anticipate?
Blood glucose level.
May do fasting test first at 1 hr and then 2 hr, 3 hr.
Patient diagnosed with Type 1 diabetes doesn’t understand the patho of this. Can you explain?
Beta cells in the pancreas are being destroyed & so the organ isn’t making insulin anymore for you to use.
And you need that insulin to carry and use your glucose
Who is more prone to ketoacidosis.
Type 1 or Type 2 diabetics?
Type 1 diabetics
In knowing that your patient was diagnosed with Type 2 diabetes, how do you explain it to them?
Type 2 develops gradually over time.
It is more of an insulin resistance issue
What are other reasons or types of diabetes out there?
From genes, injury, illness, or drugs
Patient with cardiac issues isn’t controlling her diabetes as she should.
What do you educate her on about the possible vascular issues that can happen if she doesn’t get in control?
Atherosclerosis
Retinopathy
Nephronpathy
Neuropathy
What are the two main reasons a mom may have Gestational diabetes
1) she already had it and just didn’t know it
2) Her hormones of PG /placenta caused it which antagonizes insulin
What is the first suggestion when trying to manage/tx Gestational diabetes?
Lifestyle changes such as change diet and work out
Wha is the second option for management/tx
of Gestational diabetes?
Oral agents like Metformin & Glyburide
These are easier to use too.
What is the third option for management/tx of gestational diabetes when the other two options didn’t work
Mom will go on insulin if the diet/exercise/metformin didn’t work .
Goal BS for pregnancy:
Fasting
95 fasting BG
Goal BS for pregnancy:
1 hr after eating
140 @1 hr
Goal BS for pregnancy :
2 hr after eating
120 @2 hr
Pros of using oral agents to control diabetes?
What do healthcare professional need to make sure of?
They’re easier to use
Make sure the patient went and got the prescription. Just bc you told them to go doesn’t mean they did
A mom says to you that since she has gestational diabetes she’ll have it again next pregnancy. What is your response?
Tell her it is likely if she isn’t willing to make lifestyle choices to better prepare for PG
So point is she doesn’t have to be gestational diabetic again.
T/F
Gestation diabetes never goes away
Very false.
Most of the time it goes away with birth.
If it doesn’t, then you have type 2 onset