Pre-Diabetes and Gestational Diabetes

Question 1

Pre-Diabetes

Answer 1

Higher than normal blood glucose

Patients are at high risk for developing DM and CVD

Question 2

Two Types of Pre Diabetes

Answer 2

Before Meal (Impaired Fasting Glucose)
Spike after a meal (Impaired Glucose Tolerance)

Question 3

Pre-DM associated with:

Answer 3

Obesity
Dyslipidemia (High TG, Low HDL)
Hypertension

Question 4

Risk Factors for Pre-DM

Answer 4

Family history of DM2
Age >45 y.o.
AA, East Asian, Laatino, Pacific Islanders
Obesity
CVD
HTN
Dyslipidemia
PMH of gestational DM
Sedentary lifestyle
Women with PCOA
Suspected insulin resistance

Question 5

Pre-DM Fasting Glucose

Answer 5

100-125

Question 6

Pre-DM 2 hr Post-Glucose Load

Answer 6

140-199

Question 7

Pre-DM A1c

Answer 7

5.7-6.4%

Question 8

Screening for Diabetes in Asymptomatic Adults

Answer 8

BMI >25 and additional RF
>45 y.o.
Repeat every three years

Question 9

Pancreas in T2 DM

Answer 9

Decreased insulin and amylin secretion and increased glucagon

Question 10

Kidney in T2 DM

Answer 10

Decreased incretin secretion and action

Question 11

Liver in T2 DM

Answer 11

Increased gluconeogenesis and insulin resistance

Question 12

Fat in T2 DM

Answer 12

Increase lipolysis and insulin resistance

Question 13

Muscles in T2 DM

Answer 13

Decreased glucose uptake and increased insulin resistance

Question 14

Similarities between IFG and IGT

Answer 14

Caused by insulin resistance

Caused by defect in insulin secretion

Question 15

IFG difference

Answer 15

Liver

Impaired glucose utilization Increased gluconeogenesis

Question 16

IGT difference

Answer 16

Muscles

Impaired glucose utlization

Question 17

Modifiable RF for T2DM

Answer 17

Overweight and obese
Sedentary lifestyle
IFG or IGT
Metabolic syndrome

Question 18

Non-Modifiable RF for T2DM

Answer 18

Ethnicity
Family history 
Age
Gender
PCOA
Gestational DM

Question 19

Metformin treatment for Pre-DM IF:

Answer 19

Obese BMI >35
<60 years old
Women with prior GDM

Question 20

Gestational Diabetes

Answer 20

Glucose intolerance of variable severity with onset or first recognition during pregnancy
But, not DM recognized in the first trimester

Question 21

Macrosomia

Answer 21

In a newborn
Birth weight above the 90th percentile on the intrauterine growth curve
Birth weight above 4500 g

Question 22

Fetal complications

Answer 22

Still birth
Aberrant fetal growth
Hypoglycemia & hypocalcemia
Bilirubinemia & polycythemia
Respiratory complications
Should dystocia

Question 23

Screening

Answer 23

Pt with RF at first prenatal visits

Screen for GDM at 24-28 wks using a 75 g 2hr OGT

Question 24

Diagnosis Criteria

Answer 24

24-28 wks 75 g glucose load
Fasting: >92
1 hr: >180
2 hr: >153

Question 25

Step 1 Diagnostics Criteria

Answer 25

50 g non-fasting glucose load test measuring plasma glucose at 1 hr
If >140, go to step 2

Question 26

Step 2 Diagnostics Criteria

Answer 26

Perform a fasting 100 g OGTT measuring plasma glucose at 3 hrs
Diagnoses with GDM if blood glucose is > 140 3 hrs after glucose load

Question 27

Pharmacotherapy Insulin is recommended in pregnant pts who

Answer 27

FPG >105 OR
1hr PP >155 OR
2hr PP >130 OR
Fetal abdominal circumference > 75th percentile in early 3rd trimester

Question 28

What insulin should be used in elevated FPG?

Answer 28

NPH 0.4 u/kg at bedtime 
Long Acting (Glargine) 0.4 u/kg at bedtime

Question 29

What insulin should be used in elevated PP?

Answer 29

Rapid Acting (Lispro/Aspart) before meals
1.5 u/10 g of carbs in breakfast
1u/10 g of carbs in lunch and dinner meals

Question 30

Monitoring Interventions

Answer 30

SMBG: 3-4X daily (fasting and 1/2 after each meals)
HbA1c
Urine ketone monitoring for pts on strict calories restriction

Question 31

Goal PP

Answer 31

<95

Question 32

Goal 1 hr PP

Answer 32

<140

Question 33

Goal 2 hr PP

Answer 33

<120

Question 34

Postpartum Screening

Answer 34

6-12 weeks after
Every 3 years
Start TLC and/or metformin if pts have h/o GDM have preDM