Diabetes in Pregnancy Flashcards
What is Diabetes?
High glucose levels
What is insulin and what does it do?
- A hormone made by the beta cells in the pancreas
- Detects when glucose enters blood and allows it to enter cells
What is Type 1 Diabetes?
Pancreas doesn’t make insulin or the beta cells are destroyed
What is Type 2 Diabetes?
Insulin is not effective or the pancreas doesn’t produce enough for the amount of glucose in the blood
Give 6 symptoms of Diabetes
- Increased urine output
- Lethargy
- Weight loss
- Increased risk of infections
- Thirsty
- Main body parts it affects: heart, eyes, feet, kidneys
Give 3 microvascular complications of Diabetes
- Damage to eye blood vessels, causing retinopathy, cataracts and glaucoma
- Overworks the kidneys, resulting in nephropathy
- Damages the NS, resulting in pain/numbness
Give 3 macrovascular complications of Diabetes
- Risk of stroke
- Risk of coronary heart disease
- Reduced blood flow in legs
What percentage of pregnant women have GDM, Type 1 and Type 2?
Gestational = 87.5%
Type 1 = 7.5%
Type 2 = 5%
What does Diabetes increase the risk of causing in babies?
- 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
Give 4 complications in pregnancy relating to the mother
- Pre-eclampsia
- Miscarriage
- Increased CS rate
- Ketoacidosis
Give 6 complications in pregnancy relating to the baby
- Stillbirth (5 x risk)
- Premature (5 x risk)
- Congenital abnormality (2 x risk)
- Macrosomia (2 x risk)
- Neonatal hypoglycaemia
- Jaundice
Give 5 risk factors for GDM
- High BMI (>35)
- Previous large baby
- Maternal age
- PCOS
- Previous GDM
What causes GDM?
Hormones produced in pregnancy (mainly hCG) block the action of insulin
What are the 3 main types of treatment?
- Controlled diet and exercise
- Metformin tablets
- Insulin injections
What are the normal blood glucose levels?
Before breakfast = <5.2mmol/l
1 hour after each meal = <7.8mmol/l
What are the 5 food groups on the eatwell plate?
- Fruit and vegetables
- Protein
- Dairy
- Fats
- Carbohydrates
What are the benefits of fruit and vegetables?
- Maintain bowel movements
- Provide vitamins and minerals
Give examples of protein sources
- Meat
- Fish
- Eggs
- Nuts
- Soya
What is the glycaemic index of food?
How fast or slow a food is digested
Give 3 factors that affect glycaemic index
- Amount of fat, protein and acid in food
- Type of fibre food contains
- Amount of processing the food has undergone
Give 2 examples of carbohydrates that break down quickly and explain why they are bad
Cause a peak in glucose levels
- Sugar added to food and drinks
- White/wholemeal bread
Give an example of a carbohydrate that breaks down slowly
Wholegrain/granary bread
Give 5 ways of reducing glycaemic index
- 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)
Give a good breakfast meal
Swap sugar puffs/ricicles for bran flakes, muesli, Weetabix, eggs, bacon or beans
Give a good lunch meal
Wholegrain bread sandwich with olive-based spread, fish/chicken and salad, fruit and yoghurt
Give a good dinner meal
Small portion of spaghetti bolegnese or roast dinner
Give some good snacks for a Diabetic woman
Carrots with houmous, fruit, nuts
Who should be screened for GDM? Give 7
- BMI >30kg/m2
- Previous baby >4kg
- Previous GDM
- 1st/2nd degree relative with Diabetes
- Family origin with high prevalence of Diabetes
- Previous unexplained perinatal death
- Polyhydramnios
What is a GTT and when should it be performed?
- Glucose Tolerance Test
- 24-28 weeks
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+
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
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
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
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)
What does metformin do?
- Reduces insulin resistance
- Increased utilisation of glucose
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
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
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)
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)
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
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
