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Complex Care 2 > Pre-existing Diabetes and Auto-Immune > Flashcards

Pre-existing Diabetes and Auto-Immune Flashcards

1
Q

Define: Type 1 diabetes mellitus

A

Also called

  • Insulin dependent diabetes or
  • Juvenile diabetes.
  • Autoimmune destruction of insulin-producing (beta cells) of the pancreas
  • Results in total insulin deficiency.
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2
Q

Explain: How Insulin works after a meal

A
  • 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
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3
Q

List causes of Type 1 DM

A 
Autoimmune disease
Genetic (10% chance of aquiring from a direct relative)
Environmental factors (e.g. viral infection)
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4
Q

List symptoms of Type 1 DM

A 
Hyperglycemia
Polyuria
Polydipsia
Lipidemia
Polyphagia 
Glycosuria
Ketoacidoses
Ketouria
Macular degeneration
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5
Q

How is Diabetes diagnosed

A

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

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6
Q

Describe: Treatment for Type 1 DM

A

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
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7
Q

What are complications/outcomes of Type 1 diabetes

A 
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
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8
Q

What are the effects of Type 1 Diabetes on pregnancy

A 
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
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9
Q

Explain: Diabetes in pregnancy

A

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

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10
Q

Explain: Treatment/Management of diabetes in pregnancy

A
  • 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
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11
Q

Define: Type 2 Diabetes

A

Adult onset

  • Hyperglyaceamia
  • Insulin deficiency
  • Insulin resistance
  • Innapropriate or excessive glucagon

Family history plays a role in this type of diabetes

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12
Q

List risk factors/ causes of Type 2 DM

A 
>45 years of age, 
Overweight/obese 
Hypertensive
Cardiovascular disease
Had GDM
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13
Q

List symptoms of Type 2 diabetes

A

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

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14
Q

What are the complications/outcomes of Type 2 diabetes

A 
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
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15
Q

Describe: Treatment/Management of Type 2 DM in Pregnancy

A 
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
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16
Q

What are the pregnancy complications of Type 2 diabetes

A 
Miscarriage
Cogential malformations
IUGR
Macrosomia
Polyhydraminos
FDIU
17
Q

Define: Hypothyroidism

A

Hypothyroidism comprises a lack of thyroid hormones, thyroxine (T4) and tri-iodothyronine (T3).

18
Q

List symptoms of Hypothyroidism

A 
Weight gain
Constipation
Cold intolerance
Alopecia
Dry skin
Hoarseness
Lethargy
Ataxia
Cognitive impairment
Bradycardia
19
Q

Explain: Treatment/Management of Hypothyroidism in Pregnancy

A

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
20
Q

Define: Thyrotoxicosis

A

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).

21
Q

List signs and symptoms of Thyrotoxicosis

A
  • Heat intolerance
  • Weight loss (despite good appetite)
  • Insomnia
  • Agitation
  • Tremor
  • Retraction of the upper eyelid
  • Sweating
  • Tachycardia and bounding pulse
  • Diarrhoea
  • Oligo- or amenorrhoea
22
Q

Complications of Thyrotoxicosis

A

Graves ophthalmopathy

Graves dermopathy

23
Q

Explain: Treatment/Management of Thyrotoxicosis in pregnancy

A

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
24
Q

Define: Systemic Lupus Erythematosus (SLE)

A

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

25
Q

List signs and symptoms of Systemic Lupus Erythematosus (SLE)

A 
Classic ‘butterfly rash’ (malar rash) on cheeks 
Weight loss
 Fatigue and headaches 
Fever with flu-like symptoms
Arthralgia (joint pain without swelling)
26
Q

What are some of the complications of Systemic Lupus Erythematosus (SLE)

A

Acute and chronic infection
Nausea, vomiting and diarrhoea
Alopecia (hair loss) Photosensitivity Arthritis and sometimes early morning stiffness
and others…

27
Q

Explain: Treatment/Management of Systemic Lupus Erythematosus (SLE)

A

Pregnancy

  • Pregnancy complications are generally reduced if the lupus is mild or stable, particularly at conception
  • multidisciplinary care
  • Full antenatal bloods for baseline
  • record medical history and medications
  • Medical r/v

Labour/Birth

  • High risk management
  • vaginal birth safe if no falre up present
  • Teds for LSCS
  • Continuous EFM

Postnatal

  • increased risk of lupus flare up
  • prompt return to maternal drug regimen
  • BF NOT safe
  • neonate monitoring
28
Q

List complications of Systemic Lupus Erythematosus (SLE) in pregnancy

A 
IUGR
Preterm birth
FDIU
Miscarriage
Congential abnormalities
Increased risk of hypertensive disease
Lupus flare up

Complex Care 2 (8 decks)

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