Diabetes and endocrinology Flashcards
what is gestational diabetes
state of insulin resistance induced by the metabolic strain of pregnancy
risk factors for gestational diabetes
- 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)
what is the screening test of choice for gestational diabetes
oral glucose tolerance test - OGTT
when is gestational diabetes usually daignosed
24-28 weeks of gestation
when should women with gestational diabetes deliver
no later than 40+6 weeks of gestation
does GDM usually disappear
yes as soon as the placenta is delivered
how is gestational diabetes treated
with a low GI diet- glycaemic index plus metformin and insulin if required
comlications of gestational diabetes
congenital malformations
large baby size
obstetric complications
incrased rates of miscarriage and stillbirth
polyhydramnios
macrosomia
intrauterine death
intrauterine growth retardation
What does HPL do apart from stimulate breast development?
promote insulin resistance
what is HPL
hormone produced during pregnancy by placenta
role fo HPL
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.
HPL and gestational diabetes
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.
where is HCG produvced
placenta
what is HCG
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
when does foetal organogenesis occur
at 5 weeks/ possibly earlier
complications in neonates of gestational diabetes
Respiratory Distress - immature lungs
Hypoglycaemia - fits
Hypocalcaemia - fits
skeletal abnormalities
caudal regression syndrome
does the foetus produce its own insulin
yes in the 3rd trimester
management for all diabetes
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
management for type 1 an 2
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)
test for GDM
6 week post natal fasting glucose, HbA1c or GTT - to ensure resolution of DM - If not they have T2DM
what is the preferred treatment of blood pressure management in pregnancy
Methyldopa because of its established safety net for the mother and baby
what is HCG secreted by
Implanted fertilised ovum cells
