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Appreciating Complex Midwifery Care > Diabetes in Pregnancy > Flashcards

Diabetes in Pregnancy Flashcards

1
Q

What is Diabetes?

A

High glucose levels

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2
Q

What is insulin and what does it do?

A
  • A hormone made by the beta cells in the pancreas

- Detects when glucose enters blood and allows it to enter cells

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3
Q

What is Type 1 Diabetes?

A

Pancreas doesn’t make insulin or the beta cells are destroyed

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4
Q

What is Type 2 Diabetes?

A

Insulin is not effective or the pancreas doesn’t produce enough for the amount of glucose in the blood

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5
Q

Give 6 symptoms of Diabetes

A
  1. Increased urine output
  2. Lethargy
  3. Weight loss
  4. Increased risk of infections
  5. Thirsty
  6. Main body parts it affects: heart, eyes, feet, kidneys
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6
Q

Give 3 microvascular complications of Diabetes

A
  1. Damage to eye blood vessels, causing retinopathy, cataracts and glaucoma
  2. Overworks the kidneys, resulting in nephropathy
  3. Damages the NS, resulting in pain/numbness
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7
Q

Give 3 macrovascular complications of Diabetes

A
  1. Risk of stroke
  2. Risk of coronary heart disease
  3. Reduced blood flow in legs
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8
Q

What percentage of pregnant women have GDM, Type 1 and Type 2?

A

Gestational = 87.5%
Type 1 = 7.5%
Type 2 = 5%

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9
Q

What does Diabetes increase the risk of causing in babies?

A
  • 5 x as likely to be stillborn
  • 5 x as likely to be premature
  • 3 x as likely to die in the first month of life
  • 2 x as likely to have a major congenital abnormality
  • 2 x as likely to be macrosomic
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10
Q

Give 4 complications in pregnancy relating to the mother

A
  1. Pre-eclampsia
  2. Miscarriage
  3. Increased CS rate
  4. Ketoacidosis
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11
Q

Give 6 complications in pregnancy relating to the baby

A
  1. Stillbirth (5 x risk)
  2. Premature (5 x risk)
  3. Congenital abnormality (2 x risk)
  4. Macrosomia (2 x risk)
  5. Neonatal hypoglycaemia
  6. Jaundice
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12
Q

Give 5 risk factors for GDM

A
  1. High BMI (>35)
  2. Previous large baby
  3. Maternal age
  4. PCOS
  5. Previous GDM
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13
Q

What causes GDM?

A

Hormones produced in pregnancy (mainly hCG) block the action of insulin

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14
Q

What are the 3 main types of treatment?

A
  1. Controlled diet and exercise
  2. Metformin tablets
  3. Insulin injections
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15
Q

What are the normal blood glucose levels?

A

Before breakfast = <5.2mmol/l

1 hour after each meal = <7.8mmol/l

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16
Q

What are the 5 food groups on the eatwell plate?

A
  1. Fruit and vegetables
  2. Protein
  3. Dairy
  4. Fats
  5. Carbohydrates
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17
Q

What are the benefits of fruit and vegetables?

A
  • Maintain bowel movements

- Provide vitamins and minerals

18
Q

Give examples of protein sources

A
  • Meat
  • Fish
  • Eggs
  • Nuts
  • Soya
19
Q

What is the glycaemic index of food?

A

How fast or slow a food is digested

20
Q

Give 3 factors that affect glycaemic index

A
  1. Amount of fat, protein and acid in food
  2. Type of fibre food contains
  3. Amount of processing the food has undergone
21
Q

Give 2 examples of carbohydrates that break down quickly and explain why they are bad

A

Cause a peak in glucose levels

  • Sugar added to food and drinks
  • White/wholemeal bread
22
Q

Give an example of a carbohydrate that breaks down slowly

A

Wholegrain/granary bread

23
Q

Give 5 ways of reducing glycaemic index

A
  • Drinks with no added sugar
  • Cut out chocolate, sweets etc
  • Use artificial sweetener rather than sugar in tea and coffee
  • Avoid saturated fats (cream, butter, lard)
  • Use unsaturated fats (olive/vegetable oil)
24
Q

Give a good breakfast meal

A

Swap sugar puffs/ricicles for bran flakes, muesli, Weetabix, eggs, bacon or beans

25
Give a good lunch meal
Wholegrain bread sandwich with olive-based spread, fish/chicken and salad, fruit and yoghurt
26
Give a good dinner meal
Small portion of spaghetti bolegnese or roast dinner
27
Give some good snacks for a Diabetic woman
Carrots with houmous, fruit, nuts
28
Who should be screened for GDM? Give 7
1. BMI >30kg/m2 2. Previous baby >4kg 3. Previous GDM 4. 1st/2nd degree relative with Diabetes 5. Family origin with high prevalence of Diabetes 6. Previous unexplained perinatal death 7. Polyhydramnios
29
What is a GTT and when should it be performed?
- Glucose Tolerance Test | - 24-28 weeks
30
Which risk factors could present at any time in pregnancy that indicate a GTT?
- Macrosomia/ polyhydramnios (>90th centile) | - Glycosuria 1 x 2+ or more or 2 x 1+
31
How is Diabetes diagnosed?
Normal = 7.7mmol/l or below GDM = >5.6 (fasting) or >7.8 (after glucose load) Type 1/2 = >11.1
32
How does a GTT work?
- Fast overnight - Blood sugars taken on arrival to clinic - Give rapilose solution to drink (75g glucose) - Wait 2 hours and then take blood sugars again
33
What is HbA1c testing?
- Glucose in the blood binds to Hb and becomes glycosylated, known as HbA1c - Testing this shows the average blood glucose level over the past 2-3 months - Target = below 48
34
What is the general management for a woman with GDM?
- Joint ANC/ diabetic clinic - Blood sugar monitoring - USS every 4 weeks - Dietary advice - Insulin if raised blood sugars - Increased folic acid dose (5mg)
35
What does metformin do?
- Reduces insulin resistance | - Increased utilisation of glucose
36
What is the general management in labour?
- Aim to keep blood glucose between 4-7mmol/l - VRIII (variable rate IV insulin infusion) - At delivery: GDM - stop sliding scale Type 1/2 - halve rate and continue sliding scale until back on SC insulin with meals
37
Describe the postnatal management for GDM
- Stop medication - 2-3 post meal blood glucose readings - Advice re. diet, exercise and weight loss - Fasting glucose with GP 6-12 weeks
38
Describe the postnatal management for Type 1 and 2
- Reduce to pre-pregnancy dose | - Need SC insulin and something to eat before sliding scale is taken down (type 1)
39
How should a conscious patient be treated for a hypo?
- Blood glucose below 4 = x5 dextrose sweets or 200ml Lucozade - One blood glucose above 4 = give a starchy carbohydrate (e.g. biscuits)
40
How should an unconscious patient be treated for a hypo?
- If no IV access = glucagon 1mg SC or IM - If IV access = 100ml 20% dextrose or 200ml 10% dextrose - Do NOT omit the next insulin dose
41
What are some reasons that patients could not manage their own insulin pumps?
- unconscious - too ill - major surgery - diabetic ketoacidosis - in labour if 2 BMs >7 or ketonuria

Appreciating Complex Midwifery Care (14 decks)

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