Pre-existing Diabetes and Auto-Immune Flashcards
Define: Type 1 diabetes mellitus
Also called
- Insulin dependent diabetes or
- Juvenile diabetes.
- Autoimmune destruction of insulin-producing (beta cells) of the pancreas
- Results in total insulin deficiency.
Explain: How Insulin works after a meal
- digestion breaks down carbs into sugar molecules inc. glucose/aminoacids
- glucose/aminoacids are absorbed into the blood stream- BGL rise quickly
- rise in BGL trigger beta cells in pancreas to secrete insulin which moves into the blood stream
- Insulin enables glucose to enter the cells in the body particularly the muscle and liver cells
- Here insulin and other hormones determine whether glucose will be burned for energy or stored for future use
List causes of Type 1 DM
Autoimmune disease Genetic (10% chance of aquiring from a direct relative) Environmental factors (e.g. viral infection)
List symptoms of Type 1 DM
Hyperglycemia Polyuria Polydipsia Lipidemia Polyphagia Glycosuria Ketoacidoses Ketouria Macular degeneration
How is Diabetes diagnosed
Fasting or Random <5.5: diabetes unlikely
Fasting 5.5-6.9 OR Random 5.5-11.0: Diabetes uncertain- Oral GTT
Fasting >7.0 OR Random >11.1: Diabetes likely
Describe: Treatment for Type 1 DM
Can deliver Insulin fast, regular, intermediate or slow
Insulin Pump
- catheter directly into abdominal skin
- delivers insulin directly into the system
- controlled by a small digital device that is programmed with the correct doses
What are complications/outcomes of Type 1 diabetes
Heart disease Renal disease Retinopathy Vascular disease Neuropathy Thyroid disease
Fertility: Decreased fertility (recurrent yeast infections, decreased lubrication, painful sex) Delayed menarche (menstruation) Premature menopause Male effects
What are the effects of Type 1 Diabetes on pregnancy
Miscarriage Congenital abnormality (brain and neural tube defects, cardiac defects, ambiguous genitalia) SGA Preterm birth Preeclampsia, Perinatal mortality, LGA Key – tight blood sugar control before conception and throughout pregnancy
Explain: Diabetes in pregnancy
In pregnancy the woman’s body uses glucose for energy and growth of the fetus
- its production is controlled and regulated by the hormone insulin
- Insulin production increases in pregnancy to manage rising glucose levels and is a normal physiological response to growing a baby and supplying enough energy as well
- when a pregnant woman’s body is less receptive to the regulating effects of insulin it struggles to control the amount of glucose within the blood stream
- which leads to increased glucose levels
This process is intensified when a woman has diabetes prior to pregnancy and increases insulin resistance
Explain: Treatment/Management of diabetes in pregnancy
- Pre-conception counselling
- Regulation of HbA1c – good long term glucose control
Pregnancy
- Medical r/v after booking in
- Regular monitoring
- Multi-disciplinary management
- Growth u/s
Labour/Birth
- Delivery plan
- CTG
- Pead if needed
Postnatal
- Check for neonatal hypoglycaemia
- r/v insulin regimne
- BF safe
Define: Type 2 Diabetes
Adult onset
- Hyperglyaceamia
- Insulin deficiency
- Insulin resistance
- Innapropriate or excessive glucagon
Family history plays a role in this type of diabetes
List risk factors/ causes of Type 2 DM
>45 years of age, Overweight/obese Hypertensive Cardiovascular disease Had GDM
List symptoms of Type 2 diabetes
Polyuria- production of abnormally large volumes of dilute urine
Polydypsia- abnormally great thirst
Polyphagia- excessive hunger or increased appetite and is one of the 3 main signs of diabetes
Weight loss
Recurrent yeast infections
Recurrent UTI
Blurred vision
What are the complications/outcomes of Type 2 diabetes
Blindness (retinopathy) Kidney disease Nerve damage Amputation Cadiovascular disease: stroke, heart attack, loss of circulation in arms and legs
Fertility:
- Links with PCOS
- Alterations to the menstrual cycle
- Anovulatory cycles
- Poor quality blastocysts
- Increased c reactive protein
Describe: Treatment/Management of Type 2 DM in Pregnancy
In General: Lifestyle modification Weight loss Exercise Oral hypoglycaemics Insulin
Pregnancy
- HbAic
- Physical examination
- BGL monitoring and ongoing strategy
- Medical and diabetic r/v
- U/S
- Growth u/s
Labour/Birth
- BGL monitoring
- diabetes managment
- CTG
- Paed available if needed
What are the pregnancy complications of Type 2 diabetes
Miscarriage Cogential malformations IUGR Macrosomia Polyhydraminos FDIU
Define: Hypothyroidism
Hypothyroidism comprises a lack of thyroid hormones, thyroxine (T4) and tri-iodothyronine (T3).
List symptoms of Hypothyroidism
Weight gain Constipation Cold intolerance Alopecia Dry skin Hoarseness Lethargy Ataxia Cognitive impairment Bradycardia
Explain: Treatment/Management of Hypothyroidism in Pregnancy
Pregnancy
- treatment immediately upon diagnosis
- if TSH rises: adjust Thyroxine dose
- Check fT4 and TSH at booking and 4-6wkly throughout pregnancy
Labour/Birth
- Treat as normal
Postnatal
- r/v Thyroxine dose
- Neonatal screening required
- BF safe
- Ch fT4 nad TSH 6wks postpartum
Define: Thyrotoxicosis
is the clinical syndrome caused by high serum concentrations of thyroid hormones.
Typically caused by Graves disease: an autoimmune condition in which thyrotoxicosis is caused by autoantibodies to the thyroid stimulating hormone receptor (TSHR).
List signs and symptoms of Thyrotoxicosis
- Heat intolerance
- Weight loss (despite good appetite)
- Insomnia
- Agitation
- Tremor
- Retraction of the upper eyelid
- Sweating
- Tachycardia and bounding pulse
- Diarrhoea
- Oligo- or amenorrhoea
Complications of Thyrotoxicosis
Graves ophthalmopathy
Graves dermopathy
Explain: Treatment/Management of Thyrotoxicosis in pregnancy
Pregnancy
- Thyrotoxicosis- increased risk of miscarriage. Diagnosis difficult as symptoms mimicl pregnancy
- Graves disease improves
- U/S
- blood tests
Labour/Birth
- High risk medical management
- Continuous fetal monitoring (fetal tachycardia)
- Paed notified once established
Postnatal
- neonate r/v: may required antithyroid medication
- Encourage BF
- Maternal thyroid hormone levels rechecked at 6wks
Define: Systemic Lupus Erythematosus (SLE)
With lupus erythematosus, the body produces autoantibodies against its own connective tissue.
(SLE): the most common variation of lupus affecting the entire body including serous membrane, kidneys, joints, and skin
