Gestational Diabetes

Question 1

When is testing for GDM?

Answer 1

high risk = immediate, average risk = 24-28wks, low risk = none if meet guidelines

Question 2

Requirements for low risk of GDM, i.e. no testing

Answer 2

< 25yo, no fam hx, no prior GDM, nml wt, no hx poor outcomes or abn glucose tolerance

Question 3

Dx of GDM

Answer 3

ave risk = 2 step: if > 130-140mg/dL and < 185mg/dL 1hr after 50g glucose load then do 3hr OGTT; high risk do OGTT

Question 4

Risks from GDM

Answer 4

c-section, preeclampsia, polyhydramnios, DM later on (both), macrosomia, shoulder dystocia, hypoglycemia & death after birth, obesity,

Question 5

Management of DM

Answer 5

decrease calorie intake if overweight, diet changes/carb restriction, BG < 95 in AM and < 130 after meal; glyburide or insulin; exercise!

Question 6

When do you being insulin?

Answer 6

FBG > 105 or post prandial > 140. Goal is < 90 FBG and 1hr PPG < 130 (Don’t use lantus or glargine). inject 1 unit for every 30 above 130 1 hr after meals