GDM

Question 1

What is the A1c and BG goal for pre-existing diabetes during pregnancy?

Answer 1

A1c <6%
Pre-meal/fasting glucose: 60 to 99 mg/dL
peak postprandial: <129 mg/dL

Question 2

Why is planed pregnancy important?

Answer 2

Fetal organ formation takes place in first 8 weeks and uncontrolled glucose may result in spontaneous abortion or congenital abnormalities (neural tubal, heart, kidneys)

Question 3

What happens at 18 weeks gestation when the placenta is fully grown and functioning?

Answer 3

The fetus can now develop metabolic complications secondary to the maternal hyperglycemia

Question 4

What us the most common complication of the 2nd and 3rd trimester - maternal hyperglycemia?

Answer 4

neonatal hypoglycemia

Question 5

What is the maternal complication of uncontrolled glucose?

Answer 5

Preeclampsia (hypertension), preterm labor and delivery, c-section, pyelonephritis

Question 6

What is the target blood pressure in GDM?

How is B/P treated in GDM?

Answer 6

110/65 - 129-79

Calcium channel blocker and labetalol. ACE and ARBS are contraindicated

Question 7

What is the screening for GDM?

Answer 7

Screen all women at 1st prenatal visit
Test between 24-28 weeks for those with average risk
Use 75 gram OGTT

Question 8

When is GDM diagnosed?

Answer 8

Fasting >95 mg/dL
1 hour post OGTT >180 mg/dL
2 hours post OGTT >150mg/dL

Question 9

Daily carb allowance for pregnant women and non-pregnant women?

Answer 9

Pregnant: 175 grams/day over 3 small-moderate meals and
2-4 snacks
Non-pregnant: 130 grams per day

Question 10

Insulin requirements during pregnancy

Answer 10

Insulin resistance tends to increase during GDM.

Insulin requirements increase in late gestation and generally do not decline until after delivery

Question 11

BG targets for pregnant women

Answer 11

Targets are the same for women with/out DM
Fasting & premeals <95
1 hour post-prandial <140
2 hour post-prandial <120

Question 12

Nutritional goals for gestational diabetes

Answer 12

Maintain euglycemia while consuming enough calories and carbs to promote appropriate weight gain and avoid maternal starvation ketosis

Question 13

Calorie restriction for GDEM with BMI >30

Answer 13

30 -33% calorie restriction. Approximately 25 cal/kg ob body wit. This has shown

Question 14

As pregnancy progresses, what happens to insulin needs

Answer 14

Insulin needs increase d/t wt gain and increased placental hormones especially during the last trimester
Placenta hormones help baby grow at the same time these hormones block the action of the mother’s insulin resulting in increased insulin needs.

Question 15

Pregnancy weight goals

Answer 15

Underweight 28-40 lbs
Normal 25-35
Overweight 15-25
Obese 11-20

Question 16

Diabetes medication safe in pregnancy

Answer 16

Insulin, metformin, SU preferred in this order

Insulin doesn’t cross the placenta and doesn’t affect the baby

Question 17

Considerations for exercise in pregnancy with these diagnosis

Answer 17

Hypertension
Eye, kidney, heart problems
Damage to small or large blood vessels
Nerve damage

Question 18

NPH pharmacodynamics

Answer 18

Onset of action 1-2 hours
Average peak 4 hours (range 4-5 hours)
Duration of action 10-20 hours
vials are good for 30 days
pens are good for 14 days

Question 19

Emotional stages associated with chronic disease diagnosis (similar to Kubler-Ross stages of grief)

Answer 19

Denial
Anger
Bargaining
Depression/anxiety 
Acceptance

Question 20

Denial

Answer 20

This stage can be dangerous for people with chronic illness/pain because at this stage if they are in denial about their illness or pain, they may not take the necessary steps to get themselves the treatment they need.
Example: “It’s not a big deal, it will go away”

Question 21

Anger

Answer 21

Anger is a necessary stage of the healing process. Be willing to feel your anger, even though it may seem endless. The more you truly feel it, the more it will begin to dissipate and the more you will heal.

Example: “This isn’t fair! I didn’t do anything to deserve this!”

Question 22

Bargaining

Answer 22

This is the stage where we want more than anything for life to be what it once was. We become entrenched in “if only” or “what if” statements. Guilt is often bargaining’s companion. The “if only’s” cause us to find fault in ourselves and what we “think” we could have done differently. We may even bargain with the pain or illness because we would do anything not to feel it anymore.

Example: “Please just don’t let this ruin my life”.

Question 23

Depression/anxiety

Answer 23

After bargaining, our attention moves squarely into the present. Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined. This depressive stage feels as though it will last forever. It is important to understand that this depression is not a sign of mental illness. It is the appropriate response to a loss.
Example: “I’m going to be in pain forever so why even bother”.

Question 24

Acceptance

Answer 24

This stage is about accepting the reality of your situation and recognizing that this new reality is the permanent reality. We learn to live life with it. It is the new norm with which we must learn to live. We must make adaptations and alterations to our lives. We must find new things that bring us joy.

Example: “I’m not going to let this define me. I will learn to deal with this the best I can”.