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Endocrine 2 > Gestational and T1D > Flashcards

Gestational and T1D Flashcards

1
Q

Diabetes Type 1

  • MOA
  • are oral agents effective in tx?
A
  • autoimmune disease that destroys the pancreatic beta cells causing absolute insulin deficiency . NO INSULIN PRODUCED!
  • NO! they are ineffective! Insulin therapy is required!
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2
Q

Diabetes Type 2

-MOA

A

-MOA: decreased insulin release and insulin resistance(lack of insulin receptors), glucose cant get into the cells and glucose levels rise.

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3
Q

T1D

  • age at onset
  • presentation
A
  • dx in children and young adults, bimodal distribution: 1st peak 4-6years of age, 2nd peak 10-14years of age.
  • Presentation: polydipsia, polyuria, weigth loss even though polyphagia, hyperglycemia(most common) and ketonemia, DKA(second), may be silent (asymptomatic)
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4
Q

What is osmotic diuresis that occurs with DKA? Tx of DKA?

A
  • high glucose levels spill into the urine taking water, Na, and K along with it causing polyuria and dehydration.
    tx: IV fluids, insulin, management of intercurrent illnesses, infection.
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5
Q

Triad of Hyperglycemia

what are some other sx?

A
  • polyuria
  • polydipsia
  • polyphagia

other sx:
-fatigue, blurred vision, pruritus,

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6
Q

Dx of Diabetes

A
  • Fasting Blood sugar greater than 126 on two separate occasions.
  • Random Blood sugar greater than 200mg
  • A1C greater than 6.5%
  • Urine Dipstick test (+ for glucose and ketones) (glucose starts spilling into the urine when serum glucose is greater than 180.)
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7
Q

How to differentiate between T1D and T2D?

A
  • T1D: will have pancreatic autoantibodies
  • Insulin and C-peptide levels:
  • -High fasting insulin and C-peptide levels suggest T2D.
  • -low levels of insulin and c-peptide suggest T1D.
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8
Q

Diabetes Management

A
  • balancing act, reach target glycemic goals
  • insulin treatment
  • support
  • pt and family education short term and long term management.
  • -disease process
  • -insulin
  • -blood glucose testing
  • -testing for ketonuria
  • -hypoglycemia
  • diet and exercise
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9
Q

Self-monitoring blood glucose, who is it for?

A
  • all patients with DM who use insulin

- most patients who take other glucose lowering medications.

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10
Q

Therapeutic goals fo glycemic controls

A
  • Adults: less than 7% A1C
  • Older adults: less than 7.5% A1C
  • Complex/intermediate health: less than 8.0%
  • very complex/poor health: less than 8.5%

Pediatric Pts:

  • 13-19: 7.5%
  • 6-12: greater than 8%
  • toddlers: less than 8.5% but greater than 7.5%
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11
Q

Insulin replacement therapy

A
  • Multiple daily injections:
  • -long acting insulin w/ premeal boluses of rapid or short acting insulin
  • Premeal bolus based on:
  • pre-meal blood glucose
  • estimated amount of carbs to be consumed
  • expected level of exercise after the meal
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12
Q

Lab evaluation of T1D

A
  • HbA1C
  • fasting lipid profile
  • liver function test (LFT)
  • TSH
  • Celiac disease screening
  • Kidney profile
  • -serum creatinine and GFR
  • -urine albumin to creatinine
  • -UA
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13
Q

Gestational Diabetes GD)

  • MOA
  • how many weeks in does this occur?
A

MOA: insulin receptors do not function properly. Hormonal changes(from placenta) make cells less responsive to insulin, leading to insulin resistance.
*moms insulin doesnt cross the placenta but her glucose does. Baby produces more insulin to counter extra glucose crossing the placenta leading to insulin resistance in mom and therefore hyperglycemia.

-20-24th week of pregnancy

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14
Q

Moms with GD typically have ____ babies.

A

-macrosomia…“fat” baby, increased birth weight

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15
Q

Risk factors for GD

A
  • Age, women over 25
  • Family hx (if close family member has type 2)
  • weight: being overweight before pregnancy
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16
Q

When do we screen pregnant women for GD?
What tests do we use?
What might the results indicate?

A
  • 24-28weeks, unless showing signs of DM then screen sooner.
  • *Glucose Challenge Test: 50g of oral glucose, wait one hour and redrawn blood glucose.
  • blood glucose above 130 requires a 2nd test for dx.

-3hr glucose tolerance test; done in AM after overnight fast. 100g oral glucose, glucose drawn 1hr, 2hr, and 3hr
**having at least two instances of abnormal blood glucose levels at any hour indicates GD.
–Positive values:
Fasting greater than 95
1hr greater than 180
2hrs greater than 155
3 hrs greater than 140

17
Q

what is shoulder dystocia?

A

when baby shoulders too big to move through the birth canal. Obstetrical emergency.

18
Q

Hypoglycemia in the baby? when/why might this happen?

A

-low blood sugar shortly after birth. Baby is used to recieving large amounts of glucose from the mother, their own insulin production is high.

19
Q

Why might baby be jaundice after birth?

A

-perhaps d/t high levels of insulin production which tends to produce extra RBC in utero, after birth BRC break down = bilirubin.

20
Q

DM may cause stillbirth or death in baby, true or false?

A

True. :( if GD goes undetected a baby has increased risk of stillbirth or death as a newborn.

21
Q

Complications for mom d/t GD

A
  • preeclampsia: HTN, edema, proteinuria during pregnancy
  • polyhydramnios: excess amniotic fluid around the baby
  • operative delivery (c-section)
  • -d/t macrosomia
  • -GD isnt a reason to do c-section

-T2D or Gestational diabetes in another pregnancy

22
Q

Tx of GD

A
  • control BS; diet and exercise
  • women who dont achieve adequate glycemic control may start insulin–FBG greater than 95 or one hour post-prandial BG greater than 130, two hour glucose greater than 120 on two or more occasions

*insulin is FIRST LINE rather than other oral anti-hyperglycemia agent during pregnancy.

23
Q

Optimal Glycemic Goals of GD

  • preprandial
  • 1hr post meal
  • 2hr post meal
A
  • preprandial: less than 95mg/dl
  • 1hr post meal: less than 140
  • 2hr post meal: less than 120
24
Q

After delivery women rarely require insulin in the postpartum period, true or false?

Does breastfeeding improve glycemic control?

Women with GD should be tested for diabetes how long after delivery?

A
  • True, insulin resistance quickly resolves and so does the need for insulin.
  • yes, breast feeding improves glycemic control.
  • 6-8weeks after delivery

Endocrine 2 (10 decks)

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