Pre-dx Diabetes and Pregnancy

Question 1

First Trimester:

1) Insulin requirements increase or decrease?
2) Why is there a change in insulin requirement? (3)
3) N/V can increase risk of _____? aka______?

Answer 1

1)  Decrease
2)
a)  hPL (human placental lactogen) produced by placenta makes maternal cells resistant to insulin 
b)  Fetal demands and minimal
c)  Mother is eating less due to N/V
3)  hypoglycemia, aka insulin shock

Question 2

Second Trimester:

1) Insulin requirements increase or decrease?
2) By end of pregnancy insulin requirements may change by how much?
3) Why/what is causing the change in insulin requirements?

Answer 2

1) Increase
2) double or quadruple
3) Placenta maturation and hPL

Question 3

1) During Labor Insulin requirements increase or decrease?

2) Why the change in insulin requirements? (2)

Answer 3

1) Increase
2)
a) Mother is administered IV glucose to address increase energy needs required for labor
b) More insulin needed for the increase of serum glucose level due to IV glucose

Question 4

Usually an abrupt _____ in insulin requirements occurs after passage of the _____ and the resulting loss of___ in maternal circulation

Answer 4

decrease
placenta
hPL

Question 5

Decrease in renal threshold for glucose leads to_____?

Answer 5

Higher incident of glycosuria

Question 6

Increase risk of ketoacidosis at ____serum glucose levels

Answer 6

lower vs non pregnant diabetic women

Question 7

T or F Vascular disease related to diabetes will progress during pregnancy?

Answer 7

T

Question 8

__?____ may occur contributing to vascular changes

Answer 8

HTN

Question 9

Renal impairment may result in (2)

Answer 9

Nephropathy

Retinopathy

Question 10

Pregnant women with diabetes carry higher risk of complications such as (2)

Answer 10

Prenatal mortality

Congenital anomalies

Question 11

Tight Metabolic Control: Fasting blood glucose level

Answer 11

95 mg/dl or less

Question 12

Tight Metabolic Control: Pre-meal values

Answer 12

100mg/dl or less

Question 13

Tight Metabolic Control: 2-hour postprandial glucose leve

Answer 13

120 mg/dl or less

Question 14

LATE First Trimester:

1) Insulin requirements increase or decrease?
2) What is responsible for change in insulin requirement?
3) hPL causes (2)

Answer 14

1) Increase
2) hPL (human placental lactogen) produced by placenta makes maternal cells resistant to insulin
3)
a) Increasing maternal glucose circulating to be available for fetus
b) Increase demand of maternal pancreas to produce more insulin

Question 15

T or F:

1) Maternal Glucose crosses the placenta?
2) Maternal insulin crosses the placenta?

Answer 15

1) True

2) False