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GDM & PRE-EXISTING DM > Medication Management of Diabetes in Pregnancy ADA BOOK > Flashcards

Medication Management of Diabetes in Pregnancy ADA BOOK Flashcards

1
Q

Are insulin pumps used safely and successfully during pregnancy?

A

Yes

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2
Q

In a comparison between multiple daily injections and continuous subcutaneous insulin infusion (CSII) in pregnancy, were there significant differences in pregnancy outcomes or glycemic control?

A

No

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3
Q

What is the usual basal infusion rate of insulin in pregnancy?

A

<50% of the total daily dose of insulin

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4
Q

How many infusion rates do many women require throughout the day?

A

At least three

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5
Q

During which time period is the lowest basal dose usually administered to help prevent nocturnal hypoglycemia? In pregnancy?

A

Midnight to 4:00 A.M.

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6
Q

Between which times should the basal rate of insulin be increased in response to earlier increased secretion of cortisol and growth hormone level?

A

4:00 A.M. and 10:00 A.M.

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7
Q

What the reason of increase in basal infusion rates, meal boluses, and insulin sensitivity factor in pregnancy?

A

Increase in contra-insulin hormones

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8
Q

What percentage of the total daily dose of insulin is given as meal boluses?

A

> 50%

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9
Q

How are fixed boluses for insulin pump therapy usually distributed throughout the day?

A

30% given at breakfast, 25% at lunch, 25% at dinner, and the remaining 15–20% given with snacks

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10
Q

What are the disadvantages of insulin pump therapy?
3 reasons?

A

Cost, potential for hyperglycemia, and potential for diabetic ketoacidosis

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11
Q

What is important for patients to do in order to anticipate insulin needs? 4 things

A

-Perform blood glucose monitoring and
-carbohydrate content of the upcoming meal,
-preprandial blood glucose,
-level of exercise

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12
Q

Do women with T1D using continuous glucose monitoring have improved neonatal outcomes?

A

Yes

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13
Q

Can correction dosing be continued in pregnancy?

A

Yes

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14
Q

How many times daily is it reasonable to measure blood glucose levels in women with T2D or GDM?

A

Four times

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15
Q

What are the essential principles for any successful insulin regimen?

A

Observation of glucose patterns and gradual dose adjustments

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16
Q

What factors need to be considered for dosage adjustments?

A

Medication compliance, life circumstances, exercise, and dietary patterns

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17
Q

What is the first-line agent for medication management of diabetes during pregnancy according to the American College of Obstetricians and Gynecologists?

A

Insulin

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18
Q

Which type of insulin is considered the least immunogenic?

A

Human insulin

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19
Q

What do insulin analogs tend to provide in terms of glycemic control and patient satisfaction?

A

Better glycemic control and patient satisfaction

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20
Q

According to a retrospective cohort study, does first-trimester exposure to insulin analogs increase the risk of major congenital anomalies compared to human insulin?

A

No, it does not increase the risk

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21
Q

What is the typical basal regimens during pregnancy?

A

Twice-daily injection of intermediate-acting NPH insulin or a daily or twice-daily injection of a long-acting insulin analog

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22
Q

What change did the Food and Drug Administration (FDA) make to the classification of insulin detemir during pregnancy?

A

Changed it to pregnancy category B

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23
Q

What is the FDA pregnancy category for insulin glargine?

A

Category C

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24
Q

Are there robust efficacy and safety data available for using glargine during pregnancy?

A

No, the data is not robust

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25
Q

Is there currently identified risks for using insulin degludec during pregnancy?

A

No, there are no currently identified risks

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26
Q

Which short-acting insulin analogs are considered safe to use during pregnancy?

A

Insulin lispro and insulin aspart

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27
Q

Are there sufficient data available for the use of glulisine during pregnancy?

A

No, data in pregnancy are limited

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28
Q

Why should premixed insulins be avoided during pregnancy?

A

Doses cannot be adjusted independently

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29
Q

Is detemir increasingly included in pregnancy insulin algorithms instead of NPH?

A

Yes, it is increasingly included

30
Q

What must detemir not be mixed with?

A

Rapid-acting insulin

31
Q

How is the total insulin amount divided when using long-acting and rapid-acting insulin?

A

40% is given using long-acting insulin, and 60% is given using rapid-acting insulin

32
Q

What is the recommended blood glucose concentration during active labor?

A

Maintain blood glucose concentration in the desired range
70-110

> 120 start insulin infusion

33
Q

What is the purpose of an insulin drip during labor?

A

Reduce the risk of neonatal hypoglycemia

34
Q

What is the best regimen for a woman with an insulin pump during labor?

A

Typically discontinue the pump and utilize an IV insulin drip

35
Q

What is the management for planned induction of labor?

A

Adjust insulin dose the night before elective induction

36
Q

When should the bedtime dose of intermediate-acting insulin be given before planned elective cesarean delivery?

A

The night before surgery

37
Q

What are the only oral diabetes medications widely used in pregnancy?

A

Glyburide and metformin

38
Q

How does metformin act in the body?

A

Decreases hepatic gluconeogenesis, increases glucose uptake in peripheral tissues, and decreases glucose absorption in the gut

39
Q

What is the starting dose of metformin?

A

500 mg

40
Q

What are the possible positive effects of metformin?

A

Less gestational weight gain, lower rates of gestational hypertension, and neonatal hypoglycemia

41
Q

What percentage of women treated with metformin will ultimately need insulin?

A

Up to one-half

42
Q

Does metformin cross the placenta?

A

Yes

43
Q

What is the primary difference in body fat composition in infants of mothers on metformin compared to insulin?

A

More subcutaneous than intra-abdominal fat

44
Q

When should metformin be discontinued in pregnant women?

A

Upon achieving pregnancy if the indication was ovulation induction or polycystic ovarian syndrome

45
Q

How does glyburide act in the body?

A

Increases insulin release from beta cells in the pancreas

46
Q

What should be up-titrated to address elevated fasting blood glucose upon waking?

A

Evening or before-bed intermediate- or long-acting insulin

47
Q

How can elevated preprandial blood glucose levels be addressed?

A

By up-titrating the morning intermediate- or long-acting insulin

48
Q

What are the recommended steps to address episodes of hypoglycemia?

A

Take four glucose tablets or 1/2 cup of juice and recheck blood glucose in 15 min

49
Q

What should be prescribed to patients expected to deliver before 32 weeks of gestation?

A

Magnesium sulfate

50
Q

What should be avoided in women with diabetes to prevent rapid elevations in maternal glucose concentration?

A

Sympathomimetics like terbutaline and ritodrine

51
Q

What medications may be used for tocolysis in women with diabetes?

A

Indomethacin or calcium channel blockers

52
Q

What should be checked frequently during corticosteroid administration?

A

Blood glucose concentrations

53
Q

What is the usual dose of betamethasone for fetal lung maturation?

A

Two doses of 12 mg given intramuscularly (IM) 24 h apart

54
Q

What is the goal of maintaining plasma glucose concentration during labor?

A

Between 70 mg/dL

55
Q

What are the potentially devastating effects of hyperglycemia on the fetus during pregnancy?

A

Risk of congenital defects with hemoglobin A1c >10% during organogenesis.

56
Q

What are the long-term risks associated with hyperglycemia during pregnancy?

A

Macrosomia, preterm birth, respiratory distress, obesity, and type 2 diabetes later in life.

57
Q

Why is blood glucose control more unstable in women with type 1 diabetes during the first trimester?

A

Transfer of glucose and gluconeogenic substrate to the fetus.

58
Q

How do insulin requirements change in women with type 1 diabetes during the first trimester?

A

Insulin requirements often diminish by 10-20% compared to before conception.

59
Q

When does the diabetogenic stress of pregnancy typically ensue?

A

In the mid-trimester.

60
Q

What is the energy economy switch that occurs in the mother during the second trimester?

A

Switch from glucose-based to lipid-based energy economy to spare glucose for fetal growth.

61
Q

How much can insulin requirements increase during the second and third trimesters?

A

As much as twice the total daily dosage of insulin needed before pregnancy.

62
Q

What leads to evolving disease process or new diagnosis of gestational diabetes mellitus?

A

Failure of endogenous insulin production to increase.

63
Q

What causes increased insulin resistance in pregnancy?

A

Increased maternal production of cortisol and placental production of contra-insulin hormones.

64
Q

How do postpartum insulin requirements change in women with preexisting diabetes?

A

They often drop by 50% and must be recalculated based on postpartum weight, diet, exercise, and plans for breastfeeding.

65
Q

When can medication be discontinued for women with gestational diabetes mellitus?

A

Immediately after delivery.

66
Q

What is the total daily dosage of glyburide?

A

The total daily dosage of glyburide is 2.5–20 mg.

67
Q

How is glyburide commonly prescribed?

A

Glyburide is most commonly prescribed in two daily doses.

68
Q

Does glyburide cross the placenta?

A

Yes, glyburide does cross the placenta.

69
Q

How does glyburide perform compared to insulin and metformin?

A

Glyburide generally performs poorly compared to insulin and metformin.

70
Q

What are the higher rates associated with glyburide use?

A

Glyburide use is associated with higher rates of neonatal hypoglycemia and macrosomia.

71
Q

Is long-term follow-up data available for children exposed to glyburide in utero?

A

No, there are no long-term follow-up data available for children exposed to glyburide in utero.

GDM & PRE-EXISTING DM (2 decks)

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