GDM

Question 1

define gestational diabetes

Answer 1

new onset insulin resistance with pregnancy that resolves after birth

Question 2

2 most common complications of gestational diabetes for the neonate

Answer 2

macrosomia

neonatal hypoglycaemia

Question 3

long term complication of gestational diabetes for the mother

Answer 3

raised risk of type 2 diabetes

Question 4

who is screened for gestational diabetes and when? and how?

Answer 4

anybody with a risk factor

is given an OGTT

at 24-28 weeks gestation

Question 5

risk factors for gestational diabetes (that warrant an OGTT at 24-28 weeks)

Answer 5

previous gestational diabetes

BMI >30

previous macrosomic baby (>4.5kg at birth)

Black, middle eastern, south Asian

first degree relative with gestational diabetes

Question 6

other than risk factors for gestational diabetes, why else may a pregnant patient be offered an OGTT? (3)

Answer 6

large for gestational age baby

glucose on urine dip

polyhydramnios

Question 7

what is the process of an OGTT?

Answer 7

fasting sugar is taken

patient is given a 75g glucose drink

blood sugar is taken 2 hours later

Question 8

results indicating gestational diabetes:

fasting sugar

2 hours sugar

Answer 8

> 5.6mmol

> 7.8mmol

Question 9

how is foetal growth and amniotic fluid volume measured for patients with gestational diabetes?

Answer 9

4 weekly USS from 28 weeks to 36 weeks

Question 10

management of gestational diabetes:

fasting sugar <7

(3 options)

Answer 10

trial a diet and exercise regime for 1-2 weeks

then start metformin if this fails

then add insulin if this fails

Question 11

management of gestational diabetes:

fasting sugar >7

Answer 11

start insulin and metformin

Question 12

management of gestational diabetes:

fasting sugar >6 and macrosomia/other complications

Answer 12

start insulin and metformin

Question 13

medical management of gestational diabetes for those who cannot tolerate metformin or decline insulin

Answer 13

glibenclamide (Sulfonylurea)

Question 14

target glucose levels:

fasting

1 hour post meal

2 hours post meal

too low

Answer 14

<5.3

<7.8

<6.4

<4 is too low

Question 15

true or false: patients with pre-existing diabetes need higher folate doses for the first 12 weeks of pregnan

Answer 15

rue - they need to take the 5mg folate

Question 15

true or false: patients with pre-existing diabetes need higher folate doses for the first 12 weeks of pregnan

Answer 15

rue - they need to take the 5mg folate

Question 16

how is type 2 diabetes managed in pregnancy?

Answer 16

insulin and metformin only

Question 17

which complication of diabetes can rapidly progress in pregnancy?

Answer 17

retinopathy can rapidly progress in pregnancy - review by an ophthalmologist should be booked at booking and at 28 weeks

Question 18

planned delivery for patients with pre-existing diabetes

planned delivery for patients with gestational diabetes

Answer 18

between 37 and 38+6/40

can deliver any time up to 40+6

Question 19

how are blood sugars controlled during labour for patients with T1DM?

Answer 19

a sliding scale insulin regime may be used

can also be used for poorly controlled T2DM

Question 20

how long will patients with gestational diabetes need to take their medications for after birth?

when will they need follow-up?

Answer 20

they can stop taking their medications immediately after birth

they will need to do a repeat OGTT at 6 weeks

Question 21

consequences of birth and breastfeeding on pre-existing diabetes

Answer 21

increased insulin sensitivity i.e. patients should be wary of hypoglycaemia

Question 22

5 neonatal issues arising from diabetes in the mother (other than macrosomia)

Answer 22

neonatal hypoglycaemia

neonatal jaundice

polycythaemia

congenital heart disease

cardiomyopathy

Question 23

abnormally low blood sugar in a neonate is…

Answer 23

<2mmol

Question 24

treatment of neonatal hypoglycaemia (2)

Answer 24

IV dextrose

nasogastric feeding