Gestational Diabetes Flashcards
In normal early pregnancy, does insulin response increase or decrease and why?
Increases
-Because of the growth of the placenta and an increased maternal fat storage
In normal late pregnancy, does insulin sensitivity increase or decrease and why?
Decreases
-Because the fetus grows very quickly
-Nutrients is shunted away from the mother to the fetus (so mother becomes insulin resistant and does not take up as much nutrients)
In a normal pregnancy, how is late pregnancy- reduced insulin sensitivity compensated?
Increased insulin secretion by the mother
(keeps blood glucose in normal range)
What is the definition of “gestational diabetes”?
Hyperglycemia during pregnancy in otherwise non-diabetic women
When does gestational diabetes typically appear?
Around 24 weeks
(rapid growth stage of gestation)
What are the complications of gestational diabetes?
-Damage to baby during birth (because baby is extra fat)
-Neonatal hypoglycemia
-Breathing problems for baby (high glucose/insulin can delay lung maturation)
What is “fetal programming”?
When a mother has gestational diabetes, the risk of developing Type 2 diabetes later in life is increased for both the mother and the baby
Does insulin cross the placenta?
NO
Does glucose cross the placenta?
YES
-how fetus steals nutrients from mother
How are CRH (corticotropin-releasing hormone) and Cortisol suspected to cause gestational insulin resistance?
-Placental hormones that increase as pregnancy progresses
-Glucocorticoids oppose insulin action
Which hormones (Besides CRH and Cortisol) that are released from the placenta, are suspected to contribute to gestational insulin resistance?
Progesterone
Placental GH (GH-v)
Placental Lactogens (PL)
Which two hormones increase beta-cell mass during pregnancy?
Prolactin
Placental lactogen
What are the two components to treatment of gestational diabetes?
Diet and Medications
How should a patient with gestational diabetes adjust their diet?
-Eat small meals with complex carbs
-Avoid sugary foods
What is the gold standard medication used in treating gestational diabetes patients?
Insulin
Does insulin cross the placenta?
NO
Which two medications that cross the placenta can be used to treat gesational diabetes?
Which medication is better?
Glyburide
—works, may harm fetus, not recommended
Metformin
—works, does not harm fetus, BETTER CHOICE
Which medication group should never be used to treat gestational diabetes?
Thiazoladinediones
