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Appreciating Complex Midwifery Care > Diabetes in pregnancy > Flashcards

Diabetes in pregnancy Flashcards

1
Q

What is Diabetes?

A

Diabetes is a disorder in which the blood sugar level is persistently raised above the normal range?

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2
Q

What is the abnormality caused by?

A

The abnormality is caused by an absolute or relative lack of insulin, secreted from the pancreatic B-cells

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3
Q

What are Beta-cells?

A

Beta cells are unique cells in the pancreas that produce, store and release the hormone insulin.

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4
Q

What is the classification for type 1 diabetes?

A

beta cell destruction / total insulin deficiency

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5
Q

What is the classification for type 2 diabetes?

A

insulin resistance + insulin deficiency

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6
Q

What is the classification for Gestational diabetes?

A

any degree of glucose intolerance with onset or first recognition during pregnancy. ( Usually around 28 weeks )

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7
Q

Name three things that the NICE guidelines 2015 recommends for women diabetes?

A

inform mothers that establishing a good glycaemic control before conception to reduce the risk of complications.

Avoiding unplanned pregnancy, is essential in order for professionals to be prepared to provide better diabetes education.

Should be offered pre-conception care and advice

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8
Q

Name four maternal complications of pre-existing diabetes?

A 
Hypoglycaemia unawareness
Ketoacidosis
Deterioration in retinopathy
Deterioration in nephropathy
Pre eclampsia
Miscarriage 
Increased caesarean rate
Polyhydramnious
Shoulder dystocia
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9
Q

Name four fetal complications of pre-existing diabetes?

A 
Congenital abnormalities
Macrosomia
Late stillbirth
Increased neonatal and perinatal mortality
Neonatal hypoglycaemia
Jaundice
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10
Q

Name four types should be screened for gestational diabetes?

A

BMI > 30kg/m2
Previous baby>4.5kg
Previous gestational diabetes
PCOS (Polycystic ovarian syndrome)

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11
Q

Why is identifying Diabetes during pregnancy?

A

babies are 5 times as likely to be stillborn
3 times as likely to die in the first month of life
Twice as likely to have a major congenital abnormality
5 times as likely to deliver before 37 weeks
Twice as likely to be macrosomic

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12
Q

What are the complications for women with Gestational Diabetes?

A

As well as the complications that are usually accompanied by diabetes, gestional diabetes can lead to congential abnormalities .
50% of women risk developing type 2 diabetes within 5-10 years.

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13
Q

At what gestation will you screen for GTT and what steps would you take?

A

24-28weeks gestation.

give 75g Rapilose

Fast& 2hr blood test

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14
Q

If a woman had previous GTT what steps would you take?

A

GTT at booking

Repeat at 24-28 weeks if normal

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15
Q

What risk factors should be offered screening at the time the risk factor presents?

A

Macrosomia or polyhydramnious (fetal abdominal circumference or estimated fetal weight > 90th centile)

Glycosuria 2+ or more on dipstick testing on one occasion or 1+ on two occasions.

A GTT after 36 weeks has a high false positive rate. After 35+6 refer to the Diabetic ANC for blood sugar monitoring

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16
Q

What is considered as normal result in GTT screening?

A

7.7mmol/l or below

17
Q

What is considered as gestational diabetes result in GTT screening?

A

5.6 or above fasting or 7.8 mmol/l or above two hours post 75gram glucose load

18
Q

What is considered as potential type 2 diabetic pre-pregnancy, possibly type 1 result in GTT screening?

A

> 11.1 mmol/l

19
Q

what are the glycaemic managements of all diabetes in pregnancy

A

Pre meal <5.3
1 hour post meal <7.8
HbA1C target should be below 48

20
Q

What is HbA1c?

A

HbA1c means glycosylated haemoglobin

21
Q

What is the HbA1c test?

A

A test that Shows the average blood glucose level over the past 2-3 months

22
Q

How does glucose become HbA1c?

A

Glucose in the blood binds to the haemoglobin and becomes glycosylated, which is known as HbA1c

23
Q

Name 3 other health professionals that will work with the midwife when discussing diabetes and GDM.

A 
Obstetrician
Diabetologist
Diabetes Nurse
Diabetes Midwife
Dietician
24
Q

Name 3 other ways management in regards to diabetes and GDM.

A

Blood sugar monitoring /HbA1C

USS for fetal growth and amniotic fluid volume
Every 4 weeks from 28-36 weeks gestation.

Dietary advice
Insulin if raised blood sugars

25
Q

What is Metformin?

A

A medication given to diabetic and GDM patients,it reduces insulin resistance
increases peripheral utilisation of glucose
used in polycystic ovarian syndrome

26
Q

What type of management for GDM would you do during labour?

A

Aim to keep the blood glucose between 4-7mmol/l

Sliding scale insulin
Run with 5% or 10% dextrose.

During Delivery
GDM – stop sliding scale
Type 1 or 2 , halve rate and continue with sliding scale until back on sc insulin with meals.

27
Q

What type of management for GDM would you do during Postnatal Care?

A

STOP insulin/metformin

2-3 post meal blood glucose readings

Advice re: diet, exercise, weight loss

Fasting glucose with GP 6-13 weeks after

28
Q

What type of management for type 2 diabetes would you do during Postnatal Care?

A

Go back to Insulin/metformin at pre-pregnancy

29
Q

What type of management for type 1 diabetes would you do during Postnatal Care?

A

Pre-pregnancy dose, decrease by 20% if breast feeding.

30
Q

How to treat a hypo if patient conscious?

A

Blood glucose below 4 – x5 dextrose sweets or 200 mls lucozade

Once blood glucose above 4 give a starchy carbohydrate e.g : 1-2 digestive biscuits

31
Q

How to treat a hypo if patient unconscious?

A

If no IV access – glucogon 1mg s/c or IM

If IV access – 100mls 20% dextrose or 200mls of 10% dextrose

Do NOT omit the next insulin dose.

32
Q

What ongoing management would give the mothers

A 
New diagnosis diabetes
Educate- dietician
Educate- diabetologist
Do blood glucose tests
Give insulin
Treat hypos
33
Q

What is basal insulin?

A

Background levels delivered for whole 24 hours at set rates

34
Q

What is bolus insulin?

A

Insulin Added when eating

Appreciating Complex Midwifery Care (13 decks)

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