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05 Endo > Diabetes in Pregnancy > Flashcards

Diabetes in Pregnancy Flashcards

1
Q

(UNITE) Insulin levels from conception to 12 weeks

A

low insulin levels
increased estrogen, progesterone
increased pancreatic b cell hyperplasia
increased insulin resistance

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2
Q

(UNITE) insulin requirements 20 weeks to delivery

A

increase (3x normal)

fetoplacental hormones
decreased maternal insulin sensitivity

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3
Q

(UNITE) t/f universal screening using laboratory tests is recommended

A

f, it’s not recommended as it would identify very few individuals who are at risk

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4
Q

(UNITE) laboratory testing should be considered in ___

A

all adults >40 yo

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5
Q

(UNITE) if initial tests are negative for diabetes, repeat testing should be done every ____

A

year

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6
Q

(UNITE) t/f screening for t1dm among children is not recommended

A

t, disease is of low prevalence

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7
Q

(UNITE) age when screening for pre-diabetes/t2dm is recommended for children

A

10 yo or puberty

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8
Q

(UNITE) risk factors for child dm

A 
overweight/obese
family history
signs of insulin resistance
maternal history of dm
gdm during child's gestation
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9
Q

(UNITE) criteria for diagnosing dm

A

fbs >126 mg/dl (7.0 mmol/l) after overnight fast of at least 8-14 hrs
2 hr plasma glucose >200 mg/dl (11.1 mmol/l) in ogtt
rbs >200 mg/dl w/ symptoms of hyperglycemia or hyperglycemic crisis

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10
Q

(UNITE) ogtt is first test for:

A

previous fbs with impaired fasting glucose (100-125 mg/dl)
previous diagnosis of cvd or high risk for cvd
diagnosis for metabolic syndrome

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11
Q

(UNITE) not recommended for diagnosis of diabetes

A

urine glucose

plasma insulin

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12
Q

(UNITE) criteria for pre-diabetes

A

impaired fasting glucose: fbs 5.6 mmol/l (100 mg/dl) to 6.9 mmol/l (125 mg/dl)
impaired glucose tolerance: rbs 7.7-11.0 mmol/l (140-199 mg/dl) or 2 hr bs 7.7-11.0 mmol/dl

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13
Q

(UNITE) normal blood sugar

A

fbs <5.6 mmol/l (100 mg/dl)
rbs < 7.7 mmol/ (140 mg/dl)
2 hr bs <7.7 mmol/dl (140 mg/dl)

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14
Q

(UNITE) t/f all women should be screened for gdm

A

true, at first prenatal visit

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15
Q

(UNITE) routine testing for gdm is recommended at (time) ____ for women with no risk factors

A

24-28 weeks aog

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16
Q

(UNITE) testing for gdm should be carried out in women at risk ____ (time)

A

even beyond 24-28 weeks aog

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17
Q

(UNITE) ogtt should be done ___ (time) after delivery in gdm women who do not have diabetes immediately postpartum

A

6-12 weeks after delivery

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18
Q

(UNITE) t/f rbs and fbs is recommended for long term follow up and reclassification of previous gdm

A

f, not recommended. but if they have fbs/rbs at consult, threshold will be the same as non-pregnant

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19
Q

(UNITE) t/f women with previous gdm should also undergo screening for cv risk factors and components of metabolic syndrome

A

true

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20
Q

(ADA) starting at ___ and continuing in all women with diabetes and reproductive potential, preconception counselling should be incorporated into routine diabetes care

A

puberty

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21
Q

(ADA) glucose level recommended to reduce risk of congenital anomalies, preeclampsia, macrosomia, and other complications

A

A1c < 6.5%

22
Q

(ADA) glycemic targets for gdm and preexisting diabetes

A

fbs < 95 mg/dl (5.3 mmol/l)
1 hr ppg <140 mg/dl (7.8 mmol/l)
2 hr ppg <120 mg/dl (6.7 mmol/l)

23
Q

(ADA) a1c target for pregnancy

A

ideally <6% but ok <7% to prevent hypogly

24
Q

(ADA) preferred medication for treating hypergly in gdm, t1dm in preg, and t2dm in preg

A

insulin

metformin and glyburide cross the placenta to the fetus, not recommended

25
Q

(ADA) t/f lifestyle behavior change can suffice for treatment of many women

A

true

26
Q

(ADA) prescribed at the end of first trimester to lower the risk of preeclampsia in t1dm/t2dm pregnant

A

60-150 mg/day aspirin

27
Q

(ADA) bp targets in pregnant

A

no lower than 120/80

28
Q

(ADA) medications that should be stopped at conception

A

acei, arbs, statins

29
Q

(ES) recommendation for who to give preconception counseling

A

all women with diabetes who are considering pregnancy

30
Q

(ES) recommended treatment for insulin-treated women with diabetes

A

multiple daily doses of insulin
OR
continuous sc insulin infusion

31
Q

(ES) recommended type on insulin for insulin-treated women with diabetes seeking to concieve

A

rapid acting insulin analog therapy (aspart or lispro) > regular insulin

32
Q

(ES) supplement to reduce risk of neural tube defects

A

folic acid

33
Q

(ES) t/f if the degree of retinopathy warrants therapy, can proceed to conceive

A

false, defer conception until retinopathy has been treated

34
Q

(ES) women with established retinopathy see their eye specialist every ___

A

trimester then within 3 months of delivering, then as needed

35
Q

(ES) recommended bp before conception

A

<130/80

36
Q

(ES) cv medications that should be discontinued before trying to conceive/withdrawn upon confirmation of pregnancy

A

acei or arbs

37
Q

(ES) not recommended dyslipidemia medications for women trying to conceive

A

fibrates and niacin

38
Q

(ES) diagnostic criteria for overt dm at first prenatal visit for women not known to already have diabetes

A

fbs >/= 126 mg/dl (>/= 7.0 mmol/l)
rbs >/= 200 mg/dl (>/= 11.1 mmol/l)
hba1c >/= 6.5%

39
Q

(ES) diagnostic criteria for gdm at first prenatal visit for those women not known to already have diabetes

A

fbs 92-125 mg/dl (5.1-6.9 mmol/l)

40
Q

(ES) in the case of overt diabetes but not gestational diabetes ____ must be performed to confirm diagnosis in the absence of symptoms + abnormal on another day

A

second test (fbs, rbs, hba1c, or ogtt)

41
Q

(ES) test to identify gdm at 24-28 weeks aog

A

2 hour ogtt

42
Q

(ES) diagnostic criteria for gdm using ogtt at 24-28 weeks aog

A

fbs 92-125 mg/dl

1h: >/=180 mg/dl (>/= 10.0 mmol/l)
2h: 153-199 mg/dl (8.5-11.0 mmol/l)

43
Q

(ES) recommended initial treatment for gdm

A

medical nutrition therapy

daily moderate exercise for 30 mins or more

44
Q

(ES) when to start pharma therapy in gdm?

A

if lifestyle therapy is insufficient

45
Q

(ES) ___ should be done 24-72 hours after delivery to rule out hyperglycemia

A

fbs or fasting self monitored blood glucose

46
Q

(ES) t/f 2 hr ogtt should be undertaken 6-12 weeks after delivery in women with gdm to rule out prediabetes/diabetes

A

true

47
Q

(ES) target preprandial blood glucose

A

= 95 mg/dl (5.3 mmol/l)

48
Q

(ES) recommended or allowed insulin during pregnancy

A

detemir, glargine, lispro, aspart

49
Q

(ES) suitable alternative to insulin therapy

A

glyburide

last resort: metformin

50
Q

(ES) target blood glucose levels during labor and delivery

A

72-126 mg/dl (4.0-7.0 mmol/l)

05 Endo (16 decks)

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