Exam 2- Diabetes Obesity Substance Abuse Flashcards
Patients with DM need what to start a safe pregnancy?
- HBA1c less than 7%
a patient with DM and is pregnant is consider what?
A high risk pregnancy
what trimester is GDM usually diagnosed in pregnant women?
usually in the 2nd or 3rd trimester
Pregnancy is a diabetogenic state.. meaning?
meaning that pregnancy can cause diabetes
What can a pt with GDM do to increase their good outcome in their pregnancy?
Well managed diabetes can result in the same outcome as other pregnant women.
most important in pt w GDM
Current DM classification system with pregnancy
- Pregestational diabetes
- Type 1
- Type 2:
- Gestational diabetes
Pregestational diabetes
Pregestational diabetes – known prior to pregnancy
- Type 1: Absolute insulin deficiency due toautoimmune
beta cell destruction. - Type 2: Insulin resistance or deficiency due to a
progressive loss of beta cell insulin secretion frequently on the background of insulin resistance.
Gestational diabetes
Gestational diabetes – diagnosed during
pregnancy
- any degree of glucose intolerance
with the onset or recognition during pregnancy.
- Usually diagnosed in the second or third trimester of pregnancy (when the placenta is fully functioning and can release hormones that cause insulin resistance)
Gestational Diabetes-
pathophysiology
*Existence of pancreatic beta cell dysfunction
prior to pregnancy.
*Increased insulin resistance
- Due to diabetogenic hormones secreted by the placenta:
Diabetogenic hormones secreted by the placenta:
*Growth hormone
*Human placental lactogen
*Progesterone
*Corticotropin releasing hormone
DM Complications in Pregnancy
- Macrosomia
- big baby + can cause birthing problems
-risk of c/s - Birth trauma (shoulder dystocia)
- Hypoglycemia
- d/t N/V
- Maternal complications included
preeclampsia and cesarean birth.
Screening: in pts with GDM
- Risk analysis of all pregnancies at 1st
prenatal visit ** - Additional screening again at 24-28 weeks gestation (glucose tolerance testing)
- One or more abnormal values confirm a diagnosis of gestational diabetes.
Pregestational Diabetes: preconception counseling includes what?
- Management of diabetes
- HBA1c less than 7%
- Identify and evaluate long-term
complications
Pregestational Diabetes: Poor glycemic control leads to?
- Birth defects
- Macrosomia complications
- Congenital malformations (renal, cardiac,
skeletal, and CNS). These defects occur before 8 weeks gestation
**so preconception
counseling is crucial **
Have glucose management prior to pregnancy.
Care during pregnancy + main focus on ?
- Nutritional management
- Physical Activity
- Pharmacologic Therapy
**Focus is on tight glucose control! **
Pharmacologic Therapy used when in GDM pts?
If nutrition and exercise is not adequate alone
Oral medications used as tx of GDM
*People tend to manage better with oral so standard of care may be changing to oral *
*Glyburide (DiaBeta) & Metformin
- both do not
cross the placenta and cause fetal and
neonatal hypoglycemia.
ACOG still recommends what to be used as the first line therapy to control glucose levels?
insulin be used as a
first-line therapy to control glucose levels rather than oral agents.
Insulin requires what interventions?
- Frequent blood glucose measurements
are necessary
-insulin dosage
adjusted on levels.
Fetal well being screenings with a diabetic client
Fetal well being:
- NST (nonstress test)
- BPP
- Ultrasound for
size (of baby)
Care of the diabetic client + birth plan
Determining the best time for birth (may
be need for medical induction of labor.
Care of the diabetic client during labor
- Monitor glucose levels every 1-2 hours
- Maintain below 110 mg/dL
- Insulin requirements d/t the drop after birth-
hypoglycemia
Care of the diabetic client after delivery
- Glycemic abnormalities of GDM usually resolve.
- Diagnosis of GDM puts women at risk for future type 2 diabetes. 50% increased risk
- Future screening and prevention efforts
Care of the diabetic client: education
- Dietary changes
- Glucose monitoring
- Exercise
- Medication
