exam 2: gestational diabetes

Question 1

normal changes in insulin sensitivity and metabolism in early pregnancy

Answer 1

increased insulin response due to growth of placenta and increased maternal fat storage

Question 2

normal changes in insulin sensitivity and metabolism in late pregnancy

Answer 2

reduced insulin sensitivity due to growth of fetus
- normally compensated by increased insulin secretion

Question 3

gestational diabetes definition

Answer 3

hyperglycemia during pregnancy in otherwise non-diabetic women
- diagnosed with 24-28 week OGTT
- usually appears around week 24 of gestation in the rapid growth of gestation after fetus has formed (not associated with defects in fetal development)

Question 4

gestational diabetes
effect of fetus

Answer 4

affects growth of fetus and can lead to macrosomia
- fetus has access to excessive glucose, which produces high levels of insulin and stores excess glucose as fat

Question 5

gestational diabetes
complications

Answer 5

• damage to baby during birth, particularly shoulders
• neonatal hypoglycemia
• breathing problems as high glucose or high insulin levels may delay maturation of lungs (most common before 37 weeks)
• increased risk of developing T2DM

Question 6

gestational diabetes
maternal insulin resistance

Answer 6

• inability of target tissues to respond to insulin
• insulin does not cross placenta, but glucose does
• factors secreted by placento into maternal circulation

Question 7

placental hormones suspected in gestational insulin resistance

Answer 7

• CRH-cortisol
• progesterone
• placental growth hormone
• placental lactogens

Question 8

CRH-cortisol in gestational insulin resistance

Answer 8

• both increase as pregnancy progresses
• glucocorticoids oppose insulin action

Question 9

progesterone in gestational insulin resistance

Answer 9

increases as pregnancy progresses

Question 10

placental growth hormone in gestational insulin resistance

Answer 10

released during last half of gestation

Question 11

placental lactogens in gestational insulin resistance

Answer 11

• increases as pregnancy progresses

Question 12

actions of placental lactogen in fetus

Answer 12

• IGF production
• amino acid uptake
• ornithine decarboxylase activity
• pulmonary surfactant production

Question 13

actions of placental lactogen in mother

Answer 13

• lactation
• IGF production
• ACTH production
• Ca2+ transport
• peripheral insulin resistance

Question 14

hormones that increase b-cell mass during pregnancy

Answer 14

• prolactin
• placental lactogen

Question 15

prolactin

Answer 15

stimulates b-cell proliferation
mutations in PRL receptor associated with gestational diabetes

Question 16

placental lactogen

Answer 16

activates PRL (high affinity) and GH receptors (low affinity)

Question 17

treatment of gestational diabetes
diet

Answer 17

• small meals
• complex carbohydrates
• avoid sugary foods

Question 18

treatment of gestational diabetes
insulin

Answer 18

• gold standard
• does not cross placenta

Question 19

treatment of gestational diabetes
glyburide

Answer 19

works but may harm fetus

Question 20

treatment of gestational diabetes
metformin

Answer 20

works; crosses placenta and does not harm fetus

Question 21

treatment of gestational diabetes
thiazoladinediones

Answer 21

not used

Question 22

treatment of gestational diabetes
goal levels

Answer 22

fasting: 95mg/dL
1h pp: 130-140mg/dL
2h pp: 120-127 mg/dL