DM in Pregnancy Flashcards
What are the 2 groups of patients?
- Preexisting diabetes
2. Diabetic during/from being pregnant
What are 4 complications of pre-existing diabetes?
- Macrosomia (large babies) and associated traumatic delivery
- Delayed organ maturation
- Fetal growth restriction (IUGR- Intrauterine growth restriction)
- Congenital Anomalies
What organ is delayed in development with pre-existing diabetes in Mom?
Lung
What congential anomalies are assocaited with pre-existing diabetes in mom?
- Cardiac
- Neural Tube
- Sacral agenesis: Caudal regression
What is the L:S ratio indicating fetal maturity for a healthy patient? What about for a diabetic mother?
2: 1
3: 1
What should BS be kept at with pre-existing diabetes to avoid complications?
70-90
-They NEED PERFECT CONTROL
What are fetal complications of gestational diabetes?
- Macrosomia and associated traumatic delivery
- Delayed organ maturation
- FGR and IUGR
NO CONGENTIAL ABNORMALITIES
When does gestational diabetes normally present?
Last half…3rd trimester
What are the 2 circumstances of pre-exisiting diabetes?
- Can be previously diagnosed
- Present, but not yet diagnosed
-SO ALWAYS DO A FASTING BLOOD SUGAR ON PREGGO LADIES IN 1ST TRIMESTER
When do you screen for gestational diabetes?
Beginning of the 3rd trimester or just before
-24-48 weeks gestation: Usually presents in last half of pregnancy
What is the 1st step screening test for gestational diabetes?
1hr 50g Glucola test No fasting (although better change of passing if you do fast), drink glucose (50g) in water and draw labs in 1 hour
If the value of the 1hr 50G Glucola test is above what, do you have to move on and do the diagnostic test for gestational diabetes?
Over 140 (really 135)
If their 1hr 50G Glucola test was 150, what’s next?
3 hour glucose tolerance test
What is the loading dose for the 3 hour glucose toelrance test?
100G
-Remember, non-preggo it is 75
What are the fasting, 1, 2, 3 hour values for the 3 hour glucose tolerance test in a preggo lady?
Fasting: 95
1 Hour: 180
2 Hour: 155
3 Hour: 140
Is the 3 hour glucose tolerance test fasting?
YES (8 hours)
So when do you say a lady has gestational diabetes?
If 2 abnormal values are found on the glucose tolerance test (now, it’s really just 1 value)
White classification, what does A mean?
Gestational diabetes
What is the difference between A1 and A2?
A2 requires insulin, A1 doesn’t
So fancy wording for A1?
Abnormal GTT, normal values- Treat with diet and exercise, no insulin is needed
Fancy wording for A2?
Abnormal GTT, abnormal values- Treat with diet and exercise, insulin is needed
So you get a letter other then A for White classification, what does that mean?
Overt (pre-existing) diabetes
-Different letters dictate the severity of the underlying diabetes
What is initial treatment for gestational diabetes?
- Diet and exercise
2. If fasting or post-prandial values are still elevated–> Insulin
What are the 3 components of antepartum management of gestational diabetes?
- Serial US
- Serial tests for fetal well being: NST, CST, BPP, Cord Doppler Studies
- Maintain normal glucose levels (Euglycemic)
Why isn’t fundus measurement good enough with gestational diabetes?
Because fundus can also account for this like placenta, amniotic fluid, other crap floating around in your belly… whereas a US will tell us exactly how big baby is, which is what we are worried about (too big/too little)
In a non-pregnant diabetic, what is goal for blood glucose?
150
If you are prego, what are you blood sugar goals?
70-90 fasting, 2 hour post-prandial under 120
What does brittle diabetes mean?
Even with treatment, sugars are all over the place and require treatment multiple times a day… most prego ladies with diabetes get diabetes like this
During labor (intrapartum) what do you do for your diabetic patient?
If they require insulin….IV insulin at a rate of 0.5-2.0 units of insulin per hour, maintain glucose levels of 80-120
Why do insulin requirements drop sharply after delivery?
Insulin antagonists from the placenta are no longer present
True or False: Most insulin dependent diabetics do not need insulin for the 1st 48-72 hours after delivery
TRUE
- Monitor glucose every 6 hours and treat if glucose goes over 150
- After that 24-36ish window, their insulin levels can go crazy again
Do gestational diabetics need insulin post-partum?
No
What do you do to test is a gestational dibetic returned to normal?
A 75**g GTT at 6-8 weeks post partum
-Do the test for non-preggo since they delivered already
What future monitoring is required for someone with gestational diabetes?
Yearly screening with fasting BS for dibetes
Do patients with gestational diabetes have an increased likelihood of becoming diabetic later in life?
YESSS (this is different from HTN during pregnancy)
True or False: History of previous gestational diabetes usually does not result in future pregnancies with gestational diabetes
FALSE
True or False: History of previous gestational diabetes increases likelihood for future type 2 diabetes
TRUE
What is recommended yearly for patients with a history of gestational DM?
Yearly FBS
