Diabetes and endocrinology

Question 1

what is gestational diabetes

Answer 1

state of insulin resistance induced by the metabolic strain of pregnancy

Question 2

risk factors for gestational diabetes

Answer 2

• Previous gestational diabetes
• Previous macrosomic baby (≥ 4.5kg)
• BMI > 30
• Ethnic origin (black Caribbean, Middle Eastern and South Asian)
  Family history of diabetes (first-degree relative)

Question 3

what is the screening test of choice for gestational diabetes

Answer 3

oral glucose tolerance test - OGTT

Question 4

when is gestational diabetes usually daignosed

Answer 4

24-28 weeks of gestation

Question 5

when should women with gestational diabetes deliver

Answer 5

no later than 40+6 weeks of gestation

Question 6

does GDM usually disappear

Answer 6

yes as soon as the placenta is delivered

Question 7

how is gestational diabetes treated

Answer 7

with a low GI diet- glycaemic index plus metformin and insulin if required

Question 8

comlications of gestational diabetes

Answer 8

congenital malformations
large baby size
obstetric complications
incrased rates of miscarriage and stillbirth
polyhydramnios
macrosomia
intrauterine death
intrauterine growth retardation

Question 9

What does HPL do apart from stimulate breast development?

Answer 9

promote insulin resistance

Question 10

what is HPL

Answer 10

hormone produced during pregnancy by placenta

Question 11

role fo HPL

Answer 11

HPL increases maternal insulin resistance to ensure that more glucose is available in the bloodstream for the growing fetus.
It modifies maternal carbohydrate and fat metabolism to prioritize fetal nutrition.

Question 12

HPL and gestational diabetes

Answer 12

If the pancreas cannot compensate for the increased insulin resistance caused by HPL and other pregnancy hormones, blood glucose levels rise, leading to gestational diabetes.

Question 13

where is HCG produvced

Answer 13

placenta

Question 14

what is HCG

Answer 14

HCG is the hormone detected in urine and blood pregnancy tests. It is secreted after implantation and can confirm pregnancy as early as 8–10 days after ovulation.
asseses viability of early oregnancy

Question 15

when does foetal organogenesis occur

Answer 15

at 5 weeks/ possibly earlier

Question 16

complications in neonates of gestational diabetes

Answer 16

Respiratory Distress - immature lungs
Hypoglycaemia - fits
Hypocalcaemia - fits

Question 17

skeletal abnormalities

Answer 17

caudal regression syndrome

Question 18

does the foetus produce its own insulin

Answer 18

yes in the 3rd trimester

Question 19

management for all diabetes

Answer 19

Diabetic Diet
Aim for good blood sugar control pre-meal <4- 5.5 mmol/l 2h post meal <6-6.5 mmol/l
Use Continuous glucose monitoring
Monitor HbA1c
Monitor BP
Maintain good blood glucose during labour IV insulin and IV dextrose

Question 20

management for type 1 an 2

Answer 20

Pre-pregnancy Counseling
Folic Acid 5mg (not 400ug as in nonDM pregnancy)
Consider change from tablets to insulin
Regular eye checks (10/(20)/30wks gestation)
Avoid ACEI and probably avoid Statin - for BP use Labetalol, Nifedipine, methyldopa
Start Aspirin 150mg at 12 weeks (High Risk Pregnancy)

Question 21

test for GDM

Answer 21

6 week post natal fasting glucose, HbA1c or GTT - to ensure resolution of DM - If not they have T2DM

Question 22

what is the preferred treatment of blood pressure management in pregnancy

Answer 22

Methyldopa because of its established safety net for the mother and baby

Question 23

what is HCG secreted by

Answer 23

Implanted fertilised ovum cells