Gestational Diabetes and Diabetes in Neonates

Question 1

What is GDM?

Answer 1

• Gluc intolerance beginning/ first recognized during pregnancy
• Due to metabolic/hormonal changes
• Usually returns to normal postpartum

Question 2

What are the risks to mom and baby?

Answer 2

Mom:

• Perinatal complications
• Increases risk for later development of diabetes

Baby:

• Respiratory distress syndrome
• Hypocalcemia, hyperbilirubinemia
• Severe hypoglycemia due to over-stimulated insulin secretion

Question 3

Describe prediabetes

Answer 3

• High risk for development of DM
• Normal fasting gluc <5.6
• Impaired fasting gluc 6.1-6.9
• Impaired GTT 7.8-11
• HbA1C 6.0-6.4

Question 4

Describe glucose levels in neonates

Answer 4

• Blood gluc much lower than adults; 1.7
• Common causes: maternal diabetes, glycogen stores deplete rapidly if birth is stressful (gluconeogenesis may not be mature yet)
• Usually transient (if it persists, baby should be checked for metabolic disorders)

Question 5

Describe glycogen storage diseases

Answer 5

Most common:

• G6P deficiency type 1 (von Gierke disease)
• Severe hypoglycemia (glycogen not converted back to gluc.)
• Excess pyruvate produced (metabolic acidosis, ketonemia, increased lactate, increased alanine)
• Hyperlipidemia, uricemia, growth retardation
• Hepatomegaly fr. glycogen build up
• Liver biopsy; pos glycgoen stain
• Control by avoiding hypoglycemia
• Corrected by liver transplant

Question 6

Describe galactosemia

Answer 6

• “Failure to thrive” in infants (diarrhea, vomiting)
• Congenital deficiency of 1 of 3 enzymes for galactose metabolism in liver
• Can lead to liver failure, acute renal tubular failure, cataracts

Question 7

Lab findings with galactosemia

Answer 7

• Hypoglycemia, hyperbilirubinemia, galactose accumulation in blood, urine and tissue after ingesting milk
• Lab ID: Clinitest

Question 8

Treatment for galactosemia

Answer 8

• Artificial milk with no lactose

- If untreated; mental retardation, cataracts, liver failure, death