Insulin therapies and gestational diabetes

Question 1

What does a normal beta cell do?

Answer 1

basal insulin to suppress ketosis, hepatic glucose production, and to support anabolism
then, lots of insulin is released with meals
there is a dawn pheonomenon: insulin secretion is high at dawn
there is a dip at 2 in the morning

Question 2

What are the advantages of continuous subcutaneous insulin pumps?

Answer 2

less hypoglycemia, less DKA, you can program the dawn phenomenon, helps with grazing, improves HbA1C, and is more predictable at insulin delivery

Question 3

What are the disadvantages of continuous subuctaneous insulin pumps?

Answer 3

cost, infrequent site infections, size of a pager, body image

Question 4

What are innovations in glucose monitoring?

Answer 4

continous glucose monitoring: more meaningful than point in time sticks because it tells you what the trend is and catches spikes
we can also use HbA1C (picture of last 90 days), fructosamine (amt of sugar attached to albumin), 1,5 anhydroglucitol (repciprocal relationship with glucose)

Question 5

What are the stats on diabetes in pregnancy

Answer 5

3-5% of pregancies
may be transient
may be type 1 or type 2
30-50% later develop type 2

Question 6

Why is pregnancy an insulin resistant state?

Answer 6

because the fetus wants it to be.
fetus secretes human placental lactogen, esp from middle of pregnancy to wk 32
this increases insulin resistance and stresses the pancreatic beta cells

Question 7

What are some consequences of gestational diabetes?

Answer 7

large and immature babies
greatly increased fetal morbidity and mortality and anomalies
screening performed at 24-28 wks
materal diabetes greatly increases the risk of diabetes in the offspring. risk is much greater with maternal diabetes than paternal diabetes. probably due to impaired early insulin secretion rather than decr. insulin sensitivity

Question 8

What is the target for HbA1C during pregnancy?

Answer 8

about 5.5% or less (very difficult!)