Gestational Diabetes and Obesity Flashcards
When are women screened for gestational diabetes?
24-28 weeks
What is gestational diabetes?
glucose intolerance dx in pregnancy
–> insulin resistance state d/t increased prolactin, placental lactogen, growth hormone, progesterone and cortisol
What is White’s Classification system?
grades gestational diabetes
A1: controlled with diet
A2: controlled with diet and insulin
to H which is worst (heart disease)
D-H: end organ damage
Describe prevalence of gestational DM
increasing d/t race and lifestyle
86% of 7% of pregnancies that are complicated by DM
When would you screen early for gestational DM?
Overweight (BMI >25)
AND
FH
High risk race
Previous large
gestational infant
Previous Hx GDM
HTN
PCOS
Increased A1C
Hx of CVDWhat happens if you screen for GDM by risk factors alone?
miss 50% gestational DM cases
What is the 2 step approach to screen DM?
1 hr glucose tolerance test
–> not dependent on prior oral intake
If abnormal–> 3hr glucose tolerance test
**dx if both abnormal or 1hr over 200
What is an abnormal glucose tolerance test result?
130-140 mg/dL using 50g glucose
What happens if you have over 200mg/dl after 1hg glucose tolerance test?
diabetes education
–>don’t need to do 3hr test
Do you need to be fasting for a 3hr glucose tolerance test?
yes
Do you need to be fasting for a 1 hr glucose tolerance test?
No
What are alternative screens to the 2 step approach for GDM?
2hr glucose test with 75g glucose
HgA1C
Fasting glucose
Random glucose
What are treatments via diet and exercise for GDM while pregnant?
Dietary: caloric intake based on weight
–> 50 carb, 25 protein and fat
Moderate exercise 3-5x week, 150min/week
**Walk after meals
What is the testing regimen for GDM?
Daily monitoring
Fasting and 1-2 hrs postprandial
–>fasting should be less than 95
–>2hr less than 120
–>1hr less than 140
When does glucose peak postprandial?
90 minutes
What can help achieve euglycemia in GDM 70-80% of the time?
dietary changes
What are potential oral hypoglycemic agents for DGM?
glyburide
metformin
What is the gold standard to treat GDM?
insulin
–> may refuse d/t not comfortable, so use oral agents
If a woman refuses to take insulin, what oral med is first line?
metformin
Describe the action of metformin
crosses placenta, stimulates glucose uptake in peripheral tissues
–> inhibits hepatic gluconeo
Describe glyburide
Sulfonylurea
–>binds pancreatic B cell K/ATP receptors
increases insulin sensitivity
2.5-20mg
What is starting dose of insulin to treat GDM?
.7-1 unit/kg
mix long and short acting
**does not cross placenta
What is the mother at risk for if she has GDM?
preeclampsia
large for gestational age
delivery trauma
Describe states for increased risk for type 2 DM after birth
4x more likely in first 5 years
–>high in latina women
70% develop within 20 years after pregnancy
