exam 2 endocrine and metabolism Flashcards
Preg complicated by DM
An endocrine disorder characterized by hyperglycemia.
Caused from lack of insulin or lack of insulin effect
Key to optimal pregnancy outcome is strict glucose control
absolute insulin insufficiency. Requires administration of exogenous insulin.
T1DM
an insulin resistance with varying degrees of insulin deficiency
T2DM
any degree of glucose intolerance with onset or recognition during pregnancy
GDM
Effect of Pregnancy on Insulin Requirements in 1st Trimester?
Insulin production increased –> increased peripheral use of insulin –> results in decreased blood glucose (hypoglycemia).
Fetus siphons glucose from mother across placenta
N&V may –> drop in maternal blood glucose
Human placental lactogen (HPL) is secreted. This is an insulin antagonist.
Insulin Requirements in 2nd and 3rd Trimesters?
By the end of the pregnancy, insulin requirements increase as much as 4 times the usual amount of insulin
With expulsion of placenta –> abrupt drop of hormones and return to pre-pregnant state. Insulin needs decrease.
Maternal Risks and Complications?
Worsening of pre-existing disease vascular problems - retinopathy
Hypoglycemia 1st half of pregnancy
Hyperglycemia - Ketoacidosis 2-3rd trimesters (high blood values)
Preeclampsia and Eclampsia
Polyhydramnios in 10-20% of diabetic
Dystocia (shoulder)
Fetal Glucose and Insulin?
At first baby gets glucose from Mom
Baby pancreas produces own insulin by 10 weeks gestation
What are the possible effects on the baby if mom has DM?
Macrosomia r/t excess glucose from Mom
Large for gestational age (LGA)
IUGR r/t maternal vascular involvement
Delayed lung maturity - RDS
Hypoglycemia after birth
Congenital anomalies
- Neural tube defects
- Skeletal defects (Sacral agenesis)
Screening and Testing to R/O GDM?
50 gram oral glucose tolerance test
No fasting
May be routine for all clients at 24-28 weeks gestation
50 g oral glucose cola solution is given - blood is drawn in one hour
Glucose >130-140 mg/dL is positive - follow-up
3 hour oral glucose tolerance test (OGTT)
No caffeine or smoking 12 hours before the test
Load CHO (at least 3 days) - fasting p midnight (NPO)
100 g glucola - blood drawn at fasting, 1, 2, 3 hours
Positive test if 2 or more values equal or exceed
Values of OGGT?
FBS < 95 mg/dL
1 hour < 180 mg/dL
2 hour < 155 mg/dL
3 hour <140 mg/dL
Management of DM During Pregnancy?
glucose monitoring
diet
exercise
insulin therapy
Glucose Monitoring to help Achieve Euglycemia?
Target ranges:
Premeal/Fasting >65mg/dL but < 105mg/dL
Postmeal (1 hour) <140mg/dL
Postmeal (2 hour) < 120mg/dL
2am – 6am > 60 mg/dL
What is the long term monitoring?
Glycosylated hemoglobin A1c
- Shows what blood sugar has been over the past 2-6 weeks
- Some Hgb remains saturated with glucose for the life of the RBC
- Levels between 4 – 6.5% indicate good blood sugar control. Numbers > 6%, fair - poor control.
Urinalysis and cultures
Glycosylated hemoglobin measure of control over previous 6 weeks
2.5- 5.9% = good control 6-8% = fair control > 8.0% = poor control
dietary management with DM?
Based on blood glucose levels
Goal is to minimize wide fluctuations of glucose levels in order to avoid
Diet Management: Calories?
Based on BMI
35cal/kg/IBW/day (Non-obese) –> 25/kg/IBW/ day (Obese client)
Meals – 3X/day with 2 -3 snacks
CHO – no more than 55%
Regular meals – no skipping meals/snacks
Night snack with protein & at least 25 g complex carb are important to prevent a drop in blood glucose during the night
exercise with DM?
Exercise monitored very closely
30-60 minutes walking or swimming a day or 10-20 minutes period throughout the day
Snack of protein or complex CHO before exercise
Monitor glucose before, during and after exercise
insulin therapy with DM?
2/3 of daily insulin dose is given at breakfast combination of intermediate or long-acting and short-acting insulin
1/3 of day insulin is given in the evening combination of long- and short-acting insulin
