Pre-gestational diabetes

Question 1

What are dietary recommendations in pregnancy?

Answer 1

incr calories by 300 cal/day in 2nd and 3rd rtreimster
40-50% from carbs, 15-30% from protein, 20-35% from fat

Question 2

What are action profiles of insulin?

Answer 2

Lispro/Aspart: onset 1-15 min, peaks 1-2 hours, last 4-5 hrs
Regular insulin: onset 30-60 min, peaks 2-4 hours, last 6-8 hours
NPH onset 1-3 hours, last 13-18 hours
Glargine onset 1-2 hours, NO PEAK, last 24 hours
Determir: onset 1-3 hours, last 20 hours

Question 3

What are risk factors for DKA in pregnancy?

Answer 3

new onset diabetes, infections (influenza, UTI), for compliance, pump failure, treatment with b-mimetic tocolytics and antenatal corticosteroids

Question 4

What are neonatal consequences of poorly controlled pre gestational DM?

Answer 4

hypoglycemia, respiratory distress, polycythemia, organomegaly, electrolyte disturbances, hyperbilirubinemia

Question 5

What are long term health risks for pre gestational DM?

Answer 5

5-10% pregnant patients will develop chTN
- cardiac anomalies=greatest perinatal mortality risk

Question 6

What is diabetes management in pregnancy?

Answer 6

Insulin needs per trimester: 0.7, 0.8, 0.9
- Divide day by 2/3 in AM and 1/3 in PM
- Divide AM: 2/3 long-acting and 1/3 short acting