Diabetes in Pregnancy Flashcards
(UNITE) Insulin levels from conception to 12 weeks
low insulin levels
increased estrogen, progesterone
increased pancreatic b cell hyperplasia
increased insulin resistance
(UNITE) insulin requirements 20 weeks to delivery
increase (3x normal)
fetoplacental hormones
decreased maternal insulin sensitivity
(UNITE) t/f universal screening using laboratory tests is recommended
f, it’s not recommended as it would identify very few individuals who are at risk
(UNITE) laboratory testing should be considered in ___
all adults >40 yo
(UNITE) if initial tests are negative for diabetes, repeat testing should be done every ____
year
(UNITE) t/f screening for t1dm among children is not recommended
t, disease is of low prevalence
(UNITE) age when screening for pre-diabetes/t2dm is recommended for children
10 yo or puberty
(UNITE) risk factors for child dm
overweight/obese family history signs of insulin resistance maternal history of dm gdm during child's gestation
(UNITE) criteria for diagnosing dm
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
(UNITE) ogtt is first test for:
previous fbs with impaired fasting glucose (100-125 mg/dl)
previous diagnosis of cvd or high risk for cvd
diagnosis for metabolic syndrome
(UNITE) not recommended for diagnosis of diabetes
urine glucose
plasma insulin
(UNITE) criteria for pre-diabetes
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
(UNITE) normal blood sugar
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)
(UNITE) t/f all women should be screened for gdm
true, at first prenatal visit
(UNITE) routine testing for gdm is recommended at (time) ____ for women with no risk factors
24-28 weeks aog
(UNITE) testing for gdm should be carried out in women at risk ____ (time)
even beyond 24-28 weeks aog
(UNITE) ogtt should be done ___ (time) after delivery in gdm women who do not have diabetes immediately postpartum
6-12 weeks after delivery
(UNITE) t/f rbs and fbs is recommended for long term follow up and reclassification of previous gdm
f, not recommended. but if they have fbs/rbs at consult, threshold will be the same as non-pregnant
(UNITE) t/f women with previous gdm should also undergo screening for cv risk factors and components of metabolic syndrome
true
(ADA) starting at ___ and continuing in all women with diabetes and reproductive potential, preconception counselling should be incorporated into routine diabetes care
puberty
(ADA) glucose level recommended to reduce risk of congenital anomalies, preeclampsia, macrosomia, and other complications
A1c < 6.5%
(ADA) glycemic targets for gdm and preexisting diabetes
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)
(ADA) a1c target for pregnancy
ideally <6% but ok <7% to prevent hypogly
(ADA) preferred medication for treating hypergly in gdm, t1dm in preg, and t2dm in preg
insulin
metformin and glyburide cross the placenta to the fetus, not recommended
(ADA) t/f lifestyle behavior change can suffice for treatment of many women
true
(ADA) prescribed at the end of first trimester to lower the risk of preeclampsia in t1dm/t2dm pregnant
60-150 mg/day aspirin
(ADA) bp targets in pregnant
no lower than 120/80
(ADA) medications that should be stopped at conception
acei, arbs, statins
(ES) recommendation for who to give preconception counseling
all women with diabetes who are considering pregnancy
(ES) recommended treatment for insulin-treated women with diabetes
multiple daily doses of insulin
OR
continuous sc insulin infusion
(ES) recommended type on insulin for insulin-treated women with diabetes seeking to concieve
rapid acting insulin analog therapy (aspart or lispro) > regular insulin
(ES) supplement to reduce risk of neural tube defects
folic acid
(ES) t/f if the degree of retinopathy warrants therapy, can proceed to conceive
false, defer conception until retinopathy has been treated
(ES) women with established retinopathy see their eye specialist every ___
trimester then within 3 months of delivering, then as needed
(ES) recommended bp before conception
<130/80
(ES) cv medications that should be discontinued before trying to conceive/withdrawn upon confirmation of pregnancy
acei or arbs
(ES) not recommended dyslipidemia medications for women trying to conceive
fibrates and niacin
(ES) diagnostic criteria for overt dm at first prenatal visit for women not known to already have diabetes
fbs >/= 126 mg/dl (>/= 7.0 mmol/l)
rbs >/= 200 mg/dl (>/= 11.1 mmol/l)
hba1c >/= 6.5%
(ES) diagnostic criteria for gdm at first prenatal visit for those women not known to already have diabetes
fbs 92-125 mg/dl (5.1-6.9 mmol/l)
(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
second test (fbs, rbs, hba1c, or ogtt)
(ES) test to identify gdm at 24-28 weeks aog
2 hour ogtt
(ES) diagnostic criteria for gdm using ogtt at 24-28 weeks aog
fbs 92-125 mg/dl
1h: >/=180 mg/dl (>/= 10.0 mmol/l)
2h: 153-199 mg/dl (8.5-11.0 mmol/l)
(ES) recommended initial treatment for gdm
medical nutrition therapy
daily moderate exercise for 30 mins or more
(ES) when to start pharma therapy in gdm?
if lifestyle therapy is insufficient
(ES) ___ should be done 24-72 hours after delivery to rule out hyperglycemia
fbs or fasting self monitored blood glucose
(ES) t/f 2 hr ogtt should be undertaken 6-12 weeks after delivery in women with gdm to rule out prediabetes/diabetes
true
(ES) target preprandial blood glucose
= 95 mg/dl (5.3 mmol/l)
(ES) recommended or allowed insulin during pregnancy
detemir, glargine, lispro, aspart
(ES) suitable alternative to insulin therapy
glyburide
last resort: metformin
(ES) target blood glucose levels during labor and delivery
72-126 mg/dl (4.0-7.0 mmol/l)
