Diabetes Mellitus

Question 1

Percentage of diabetic cases in pregnancy

Answer 1

2-5%

Question 2

Percentage of diabetes by types in pregnancy

Answer 2

GDM 87.5%
Type1 7.5%
Type2 5%

Question 3

Diabetes in pregnancy is associated with risks to the woman and to the fetus which are

Answer 3

Pregnancy:
- Miscarriage
- still birth
- preterm labor
Mother:
birth injury,
prenatal mortality,
preeclampsia
diabetic retinopathy
IOL
CS
Fetus:
congenital malformations (cardiac or sacral agenesis)
macrosomia

Question 4

The preferable contraceptive method of a women with DM

Answer 4

Iucd

Question 5

Dietary supplements of women with DM planning for pregnancy

Answer 5

• Women with BMI>27: lose weight
• Folic acid 5mg/day until 12 weeks

Question 6

Target ranges for blood glucose in the preconception Period.

Answer 6

*HbA1c level below 48mmol/mol (6.5%)
Strongly against pregnancy if HBA1c level is above 86 mmol/mol

Question 7

Safest diabetes mellitus drug during pregnancy

Answer 7

• Metformin is used instead of Insulin
• The short acting insulin analogues (aspart, lispro)
• Isophane Insulin is 1st choice long acting insulin analogues (insufficient evidence)

Question 8

What diabetic complications medications are CI during pregnancy

Answer 8

ACEI, ARB AND STATINS

Question 9

Retinal assessment in the preconceptional period in diabetic patient

Answer 9

At the first appointment, then annually

Question 10

When to refer to nephrologist in diabetic patient

Answer 10

• S creatinine is abnormal (120 µmol/L or more) or
• Urinary albumin:creatinine ratio is greater than 30 mg/mmol or
• Estimated GFR is less than 45 mL/minute/ 1.73 m²

Question 11

Risk factors for GDM

Answer 11

1- BMI>30kg/m2
2- previous macrosomic baby >4.5 kg
3- Previous GDM
4- Family History for DM
5- FAMILY origin with high prevelance

Question 12

Screening if any of the 5 risk factors for gestational diabetes

Answer 12

2-hour post prandial 75g OGTT
At 24 to 28 weeks

Question 13

Screening for GDM exclusion if there is glycosuria

Answer 13

2+ or more at 1 occasion
Or
1+ or more at 2 occasions

Question 14

Screening for GDM in case of previous GDM

Answer 14

• early self monitoring of blood glucose
  Or
• 75g 2-hour OGTT at booking, if normal then repeat at 24-28 w

Question 15

Diagnosis of GDM

Answer 15

Fasting: >5.6 mmol/L
Or
2hours: >7.8 mmol/L

Question 16

Intervention if fasting plasma glucose level below 7mmol/L

Answer 16

1. Trial to diet and exercise
   (If it doesn’t reach target level in 1-2 w)
2. Metformin
   (If contraindicated or unacceptable)
3. Insulin

Question 17

Intervention if fasting plasma glucose level above 7mmol/L

Answer 17

Immediate ttt w/ insulin

Question 18

Management of DM during pregnancy

Answer 18

1. Diet and exercise or
2. Oral therapy
3. Rapid acting insulin analogues (aspart- lispro) better than human insulin during pregnancy

Question 19

If woman w/ type 1 become unwell:

Answer 19

Exclude DKA

IF DKA confirmed:
1. Level 2 critical care
2. Daily fasting and 1 hour

Question 20

Maintain GDM patient capillary plasma glucose

Answer 20

Fasting: <5.3 mmol/L
1 hour post prandial: <7.8 mmol/L Or
2 hour post prandial: <6.4 mmol/L

If on Insulin or glibenclamide: >4 mmol/L

Question 21

Retinal assessment during pregnancy

Answer 21

If w/ prexisting DM-> Retinal assessment at booking:
1. If normal: repeat at 28 w
2. If retinopathy: 16-20 w

Question 22

Mode of birth in case of Diabetic retinopathy

Answer 22

It isn’t a contraindication to vaginal birth

Question 23

In DM pregnant woman, when to perform congenital malformations screening

Answer 23

18-20 weeks

Examination of the 4 chambers and outflow tracts

Question 24

Monitring Fetal Growth and wellbeing in DM

Answer 24

• U/S scan for fetal structural abnormalities
• Fetal Heart~4 chambers , outflow tracts & 3 vessels (20 W)
• USG- FG & AF volume - every 4 weeks for 28 to 36 weeks
• If Risk of FGR - Umbilical a. doppler & fetal weelbeing b/f 38 W

Question 25

Tocolysis in DM

Answer 25

Diabetes isn’t a CI of antenatal stroids or tocolysis
(Betamemitics is CI)

Question 26

diabetic women who recieve antantal steroid for lung maturation

Answer 26

should have additional insulin and should be closely montiored

Question 26

Protocol of diabetic women who recieve antantal steroid for lung maturation

Answer 26

should have additional insulin and should be closely montiored

Question 27

Mode and timing of delivery in type 1 or 2 DM

Answer 27

• IOL, elective CS bet. 37 to 38+6
• Elective birth bef. 37w (if complications)

Question 28

Mode and timing of delivery in GDM

Answer 28

• IOL, elective CS no later than 40+6
• elective <40+6 if not delivered by 40+6 or complications

Question 29

VBAC with Diabetic women?

Answer 29

Not contraindicted

Question 30

What to do if you used general anasthesia on Diabetic woman

Answer 30

Blood glucose should be monitored every 30 mins. from induction till birth.. woman should be conscious

Question 31

Glycemic control during labour

Answer 31

• Glucose should be 4-7 mmol/L
• if not: start IV dextrose & Insulin infusion
• Type 1: IV dextrose & Insulin infusion from onset of labour.

Question 32

Fasting plasma glucose test after birth should be done at?

Answer 32

6-13 weeks after birth

Question 33

Fasting plasma glucose test after birth below 6 mmol/L
or
HbA1c test below 39mmol/L (5.7%)

Answer 33

• low probability of having diabetes at present
• have moderate risk of developing type 2

Question 34

Fasting plasma glucose test after birth bet. 6- 6.9 mmol/L
or
HbA1c test below 39-47mmol/L (5.7-6.4%)

Answer 34

High risk of developing type 2 diabetes

Question 35

Fasting plasma glucose test after birth over 7 mmol/L
or
HbA1c test 48 mmol/L (6.5%)

Answer 35

• Likely to ahve type 2 diabetes
• Offer diagnostic test for confirmation

Question 36

If ater birth fasting plasma glucose or HbA1c is negative

Answer 36

Annual HbA1c test