Module 9 (Exam 3) Diabetes Flashcards
Gestational Diabetes
A classification of diabetes with onset or first recognition during pregnancy
Polyhydramnios
Greater than normal amounts of amniotic fluid
Carbohydrate Metabolism
- Insulin
- Beta cells of pancreas
- Makes glucose available to body cells
- Diabetes
- Inadequate insulin and/or inability to use insulin for carbohydrate metabolism
Type I Diabetes
Insulin deficiency
Exists prior to pregnancy
Type II Diabetes
Insulin resistance
Incidence of gestational diabetes
Prevalence varies in direct proportion to prevalence of type II diabetes in a given segment of society
7% incidence
GDB Risk Factors
- BMI greater than 25-29 (overweight) or greater than 29 (obese)
- Chronic HTN
- Maternal age greater than 25
- Family history of diabetes
- History fetal macrosomia
- Unexplained fetal death in utero
- Multigestation
Early pregnancy diabetogenesis
- Insulin sensitivity
- Little alteration in maternal metabolic rate
- Potential for hypoglycemia
Late pregnancy diabetogenesis
- Insulin resistance
- Placental hormones block insulin usage
- Potential for hyperglycemia
- Placental hormones favor fetal growth
- Human placental lactogen and progesterone and estrogen
Why do insulin needs decline during the 1st trimester?
Insulin sensitivity
Why do insulin needs dramatically increase during the 2nd and 3rd trimesters?
- Insulin resistance peaks
- Placental blockers hamper insulin usage
Why do insulin needs dramatically decrease postpartum?
Placental delivery negates hPL
Screening for GDM
- Glucose Challenge Test
- Routine screening at 24-28 weeks gestation
- 50G oral glucose solution
- 1 hour postprandial blood draw
- Acceptable level is greater than 140mg/dl
- Finding of greater than or equal to 140mg/dl calls for a Oral Glucose Tolerance Test
Oral Glucose Tolerance Test
- Fasting blood glucose
- 100G oral glucose solution
- Postprandial blood draws every hour X 3
Diagnostic Criteria:
Fasting: greater than 95mg/dl
1 hour: greater than 180 mg/dl
2 hours: greater than 155mg/dl
3 hours: greater than 140mg/dl
What conditions must be met for a diagnosis of GDB?
Elevated fasting plasma glucose level
OR
Two or more elevated postprandial plasma glucose levels
Medical Management of GDB
- Goal: Euglycemia (FBG is less than 95mg/dl)
- Glucose monitoring
- Dietary monitoring
- Exercise
- Pharmacologic intervention
- Insulin
- Oral agents may be acceptable (Glyburide/glucophage)
Delivery of a baby whose mother has GDB
- Amniocentesis to assess lung maturity
- LS ratio 2:1 in non-diabetic woman - 3:1 in a diabetic woman
- PG must be present
- Delivery at 38-39 weeks
- R/t decline in placental function
Nursing management of GDB
- Self-care instruction and support
- Lifestyle modification
- Dietary Management
- Approach a caloric restriction with caution
- Refer to a registered dietician or nutritionist
- Guidelines: carbohydrate counting, exchange system
Hyperglycemia symptoms
- Fatigue, drowsiness
- Hot, dry skin
- Thirst, dry mouth
- Frequent urination
- Rapid, deep respiration
- Headache
- Fruity breath
Hypoglycemia
- Tremors
- Diaphoresis
- Cold, clammy skin
- Hunger
- Blurred vision
- Disorientation
- Irritability
Effects on the infant of a diabetic mother
- Excessive glucose in utero
- Stimulates development of RBCs
- Polycythemia leads to neonatal hyperbilirubinemia
- Stimulates pancreatic growth
- Large pancreas results in more insulin
- Insulin acts as a growth hormone that leads to fetal macrosomia
- Insulin delays surfactant production therefore increasing the potential for respiratory distress syndrome
Delivery and PP for the infant of diabetic mother
- Risk for birth related complications including pre-term birth and macrosomia
- Impaired respirartory function r/t delayed surfactant production
- Risk for hypoglycemia r/t increase in insulin production
- Risk for hyperbilirubinemia r/t polycthemia
Pre-exisiting diabetes concerns (type 1)
- Increased risk for spontaneous abortion and fetal malformations
- Preeclampsia
- Polyhydramnios
- Uterine overdistention, fetal polyuria
Criteria for Fasting BG
Greater than 95mg/dL
If this criterion is met, GBD is diagnosed
Criteria for 1 hour BG
Greater than 180mg/dL
this plus one other abnormal value = GBD
Criteria for 2 hour BG
Greater than 155 mg/dL
this plus one other abnormal value = GBD
Criteria for 3 hour BG
Greater than 140 mg/dL
this plus one other abnormal value = GBD
Criteria for Glucose Challenge Test (GCT)
Acceptable level is less than 140 mg/dL
Finding of greater than or equal to 140 mg/dL
