diabetes and preg Flashcards
what is pregestational diabetes
type 1 or type 2 diabetes before preg
what is gestational diabetes
diabetes diagnosed in pregnancy
what can high glucose levels lead to in the first trimester?
increased rate of fetal malformation
what can high glucose levels lead to in the second and third trimester?
increased rate of macrosomia and metabolic complications
what happens with the insulin resistance in the body during a normal pregnancy ?
increase of maternal adiposity and cortisol production from placenta leads to insulin resistance.
it is an adaptation in the 2nd trimester that leads to the use of more fat than CHO for energy and spares the CHO for the fetus.
when is glycemic control needed?
throughout the whole pregnancy and BEFORE TOO!
the risk of anomalies increases alot when A1C is not on target.
what are some preconception counselling tips for pregestational diabetes?
- -make sure birth control is reliable.
- -metformin in PCOS may improve fertility and possible preg.
- -metformin safe for ovulation induction in PCOS
- -healthy weight-no obesity is crucial for adverse pregnancy outcomes
what is the preg management for pre-existing diabetes?
type 1?
type 2?
1: basal-bolus insulin therapy or CSII
2: switch to insulin
what are the SMBG pre and post prandially for pre-exisiting diabetes ?
what is A1C target?
fasting and pre prandial BG: less than 5.3
1hPP: less than 7.8
2hPP : less than 6.7
A1C: less than or equal to 6.5 or lower than 6.1 if possible
give advice for type 1 management with pre existing diabetes and what to do to reduce risk?
ASA to reduce risk of preeclampsia.
CGM should be considered because ti decrease LGA and nicu stay and neonatal hypoglycemia.
what is gestational diabetes?
type diagnosed during second or third semester and it appears with insulin resistance.
after birth, diabetes goes away.
at 6 weeks and 6 months PP you do an oral glucose tolerance test
name risk factors for GDM
previous dx of GDM hx of prediabetes older than 35 yo obesity fam hx of t2dm PCOS corticosteroid use macrosomal infant
what can happen if there is persistent hyperglycemia during preg in the mother
for the mother: increases the risk of C sectoin, preeclampsia and development of metabolic syndrome and T2DM
what can happen if there is persistent hyperglycemia during preg in the fetus
fetal macrosomia and increased risk of infant shoulder dystocia during birth.
neonatal metabolic instabilities like hypoglycemia and hyperbilirubinemia or stillbirth
when is the universal screening for GDM done?
24-28 weeks of gestational age
screen earlier if risk factors for GDM and then rescreen at 24 weeks if - the first time
what is the process for early screening for women at high risk for T2DM ?
screen with A2C in first trimester
if A1C is greater than 6.5 or FBG is more than 7 we treat like t2nm
and then confirm diagnosis after birth
according to the 2018 GDM approaches:
explain the preferred approach
NO FASTING
50 g glucose challenge with PG 1 hour later
if the result is between 7.8 and 11 then there is a 75 g OGTT measure, FBG 1hPG and 2hPG and then if the value is above the standards then GDM
if after the glucose challenge you have higher than 11, its GDM
if after the glucose challenge you have less than 7.8 then you reassess at 24 weeks if needed
according to the 2018 GDM approaches:
explain the alternative approach
FASTING 75 g OGTT, measure FBG, 1hPG, 2hPG if FBG is greater than 5.1 if 1h is greater than 10 if 2h is greater than 8.5 t if any of these are met, then there is GDM
what are the blood glucose targets that you want for FBG, 1H AND 2H
how long do you have to get these targets in control?
FBG: less than 5.3
1H: less than 7.8
2h: less than 6.7
if you cant achieve within 1-2 weeks: start meds
what are the blood glucose levels if on insulin if fasting and HS insulin, and 1h post meal with meal time insulin
how much insulin do youstart with?
FG is on HS insulin: 4.2-4.7
1h post meal with insulin at meal: 5.5-7.2
give 4 unites of long lasting in the evening and adjust accordingly.
how do you manage GDM ? what is the first line and second line of meds
first line is insulin so can use aspart, lispro, glulisine
second is metformin and can be used as alternative
–its safe, evidence of les maternal weight gain and less big babies, less baby hypo
when can you use glyburide in GDM?
may be used for those who refuse insulin and not well controlled on metformin
how soon should a nutrition intervention occur from diagnosis of GDM
within 48 hours and then 3 other visits during pregnancy.
how should the weight gain during pregnancy occur?
it should be progressive and not all at once.
most weight gained in the UW or normal BMI category.
what is the recommended weekly rate of weight gain in the 2 and 3 trimester for 1 baby in UW, NW, OW, OB
UW: 0.5 kg
NW: 0.4
OW: 0.3
OB:0.2
how much kcal are women storing during pregnancy in BMI groups?
UW: 360 kcal as fat tissue
NW: 240 kcal/day
ow: 165 KCAL
ob: do not store but instead mobilize 260 kcal from adipose tissue
what is the energy EER gain needed per trimester?
1: 0
2: 340
3: 454
according to the rule of thumb: what is the energy requirement?
UW: 35-40 kcal
NW: 30-34
OW: 25-29
OB: less than 24
what is the nutrition intervention for GDM
1) eating small frequent meals to spread the CHO loads.
2) include protein at every meal and snack to stabilize the BG
3) and minimum of 175 g of cho per day
what would you recommend when wanting to have desserts with GDM?
limit the intake but if having, take in small quantitie and eat where protein and fibre can also be found in the meal and that can help the rising BG
what type of glycemic index foods will we recommend?
we would recommend the low glycemic index food choices.
even low ones can raise BG levels above the targets that we want for GMD
what meal of the day would you NOT recommend fruit, cereal and milk products?
bedtime snack or breakfast
what is a bedtime snack proposition to help with GDM
no cereal, fruit or dairy before bed as it can raise morning BG alot
- should be eaten as late as possible so no more than 8 hours between bed time snack and breakfast
what is the relation between GDM and PA ?
it is inversely proportional
- risk reduction by half if PA prior to and early on in pregnancy.
what are some benefits fo PA with GDM
improves glycemic control
helps with weight control
improves the insulin sensitivity
when should PA be done for GDM?
1 hour after meals
10 min after a meal helps BG more so than 30 min of PA any other time of the day
what are the glycemic targets during labour and delivery ? why?
between 4 and 7
to avoid neonatal hypoglycemia
what is the recommendation for GDM postpartum?
breastfeed immediately after to avoid neonatal hypoglycemia.
and for at least 3-4 months to prevent obesity and diabetes in the offsrpting and to rreduce T2DM and HTn in mother
what type of test is done postparturm for GDM?
27 g oral glucose tolerance test.
between 6 weeks and 6 months after.
what are the results of the OGTT postpartum?
if normal, then healthy behaviour intervention
if impaired: healthy behaviour with metformin maybe
if t2dm: healthy behaviour and metformin and maybe insulin
