Gestational Diabetes Flashcards
What are the different ways you can have diabetes in pregnancy? (don’t over think it)
1) have type 1 before pregnancy
2) have type 2 before pregnancy
3) get diabetes during pregnancy (gestational diabetes)
How is type 1 different from type 2 in terms of what to expect with the pregnancy?
type 1 typically leads to growth restriction (olighydramnios)… much more likely to develop DKA
type 2 typically leads to macrosomia and polyhydramnios
What is the pathophys behind why women get gestational diabetes?
the placenta makes this hormone called “human placental lactone (hPL)” that promotes lipolysis and causes a decrease in glucose uptake (induces a insulin resistant state)
What is the significance of a mom with diabetes?
6X risk of congenital anomalies!!!
namely: cardiac septal defects, CNS disorders, renal probs, and limb deformities (caudal regression syndrome)
What is required to diagnose gestational diabetes?
1) at 24-28 weeks: drink a 50-gram “glucola” and check blood sugar 1 hour after … and 140 mg/dL is the magic number
2) after a “failed” 1-hour… do the 3 hour test where you drink 100-gram “glucola” and if 2 of 4 are present then you have your diagnosis:
- fasting > 95
- 1-hour > 180
- 2-hour >155
- 3-hour >140
After diagnosis how is their GDM managed?
Either with exercise, diet… if that doesn’t work then typically a combination of intermediate-acting NPH and fast-acting regular insulin
What are the patients “goals” with GDM?
Patient should keep a logbook and shoot for:
1) fasting
If GDM is not well-controlled, what is the mother at risk for during her pregnancy and delivery?
1) shoulder dystocia
2) excessive maternal weight gain
3) macrosomia
4) preeclampsia
5) C/S
6) UTI/kidney infection (glucose in urine)
If a patient has gestational diabetes and delivers without complication… is she in the clear?
NO! 50% of women with GDM go on to develop type 2 DM later in life. Also, glucose tolerance screen is advocated 2-4 months after delivery to detect the 3-5% who remain diabetic.
