gestational diabetes

Question 1

gestational diabetes

Answer 1

diabetes triggered by pregnancy

caused by reduced insulin sensitivity during pregnancy and resolves after birth

Question 2

significant complication

Answer 2

macrosomia which is risk for shoulder dystocia

Question 3

screening

Answer 3

anyone with risk factors should have OGTT at 24-28wks

Question 4

risk factors

Answer 4

prev GDM
prev macrosomic baby 
BMI >30 
ethnic - black carribean, middle eastern, south asian 
FHx diabetes

Question 5

who has OGTT

Answer 5

patient with risk factors

pt with features suggestive of GDM

Question 6

features that suggest gestational diabetes

Answer 6

large for dates fetus
polyhydramnios
glycosuria

Question 7

how is OGTT done

Answer 7

performed in morning after a fast
pt drinks 75g Glc drink
BG measured before drink and 2 hours after

Question 8

OGTT - normal results

Answer 8

fasting < 5.6

2 hrs < 7.8

Question 9

OGTT - result of GDM

Answer 9

fasting > 5.6

2 hrs > 7.8

Question 10

Mx - fasting Glc <7

Answer 10

trial of diet + exercise up to 2wks

metformin then inuslin

Question 11

Mx - fasting Glc >7

Answer 11

start insulin +/- metformin

Question 12

Mx - fasting Glc >6 and macrosomia

Answer 12

start insulin +/- metformin

Question 13

Mx - option for women who decline insulin/can’t tolerate metformin

Answer 13

glibenclamide (a sulfonylurea)

Question 14

target levels: fasting

Answer 14

5.3

Question 15

target levels: 1 hr post meal

Answer 15

7.8

Question 16

target levels: 2hrs post meal

Answer 16

6.4

Question 17

pre-existing diabetes: before conception

Answer 17

aim for good glucose control

5mg folic acid

Question 18

pre-existing diabetes: Mx T2DM

Answer 18

metformin and insulin

other oral diabetic medications should be stopped

Question 19

retinopathy screening when

Answer 19

booking

28wks

Question 20

pre-existing diabetes: planned delivery

Answer 20

37 - 38+6

Question 21

pre-existing diabetes:T1DM in labour

Answer 21

sliding insulin scale regime

insulin and dextrose infusion titrated to BG levels

Question 22

postnatal care

Answer 22

GMD - can stop taking diabetic medications

pre-existing DM - lower insulin doses and be wary of hypos

Question 23

babies of mothers with diabetes are at risk of

Answer 23

neonatal hypoglycaemia
polycythemia 
jaundice
congenital heart disease
cardiomyopathy