Pregnancy with DM

Question 1

True or false: Nonnutritive sweeteners approved by the FDA are also safe in pregnancy

Answer 1

True; however, consider limiting to 3 servings per less per day

Question 2

In the first trimester, women with DM1 may experience _____ in their insulin requirements

Answer 2

Decrease

Question 3

Why may retinopathy increase during pregnancy?

Answer 3

Due to increase in hormones (IGF-1), estrogen, progesterone and cortisol

HTN is the most important risk factor associated with progression of retinopathy in pregnancy

Question 4

Which site of SMBG is best in pregnancy?

Answer 4

Finger stick

Question 5

What are A1c recommendations during pregnancy?

Answer 5

<6.0-6.5% (early gestation)

< 6.0% (2nd and 3rd trimeters)

Question 6

What are the TIR goals during pregnancy?

Answer 6

Goals: 63-140 mg/dL
% of readings TIR >70%
% reads TBR <4% and TAR <25%

Question 7

What class are lispro, aspart detemir, regular, and NPH insulin, glyburide, and Metformin classified as during pregnancy?

Answer 7

Category B

Question 8

What class of medication is insulin glulisine, glargine, and degludec classified during pregnancy?

Answer 8

Category C

Question 9

What determines insulin requirements in pregnancy?

Answer 9

Current weight, gestation age, BG results, and caloric intake

Question 10

What are insulin requirements during pregnancy?

Answer 10

1st: 0.7-0.8 u/kg
2nd: 0.8-1.0 u/kg
3rd: 0.9-1.2 u/kg

Question 11

What is the definition of GDM?

Answer 11

Diabetes dxd in 2nd or 3rd trimester of pregnancy that is not clearly either type 1 or type 2 DM

Question 12

What are the two methods used to dx GDM?

Answer 12

2 step approach using OGTT following a positive result from the 50 g oral glucose challenge test

1 step approach using 75 g OGTT

Question 13

When should screening for GDM be done?

Answer 13

in asymptomatic pregnant women after 24 weeks gestation

Question 14

What are the cut offs for a GTT when dx’d GDM?

Answer 14

Fasting > 95
1 hour > 180
2 hour > 155
3 hour > 140 mg

Question 15

What does the evidenced based GDM nutrition practice guidelines suggest when dividing CHO intake into meals/snacks?

Answer 15

3 small to moderate meals and 2-4 snacks.

Question 16

In GDM, what is the most difficult blood glucose level to manage?

Answer 16

post breakfast, due to higher hormonal levels in the AM. Consensus is to restrict CHO at breakfast to 15-45 g. Cereal is discouraged

Question 17

When should GDM pt’s monitoring their BG?

Answer 17

Fasting and post meal glycemic levels; no definitive research to support 1 vs 2 hour testing

Question 18

What are the most common types of insulin used in GDM pregnancy?

Answer 18

NPH and rapid acting analogs

Question 19

What are the glycemic goals for a patient with GDM?

Answer 19

Fasting: <95 mg/dL
1 hour after: < 140 mg/dL
2 hours after <120 mg/dL

Question 20

Which oral DM meds may be used in pregnancy?

Answer 20

Glyburide and Metformin

Question 21

When should pt’s dx’d with GDM be screened for DM?

Answer 21

6-12 weeks after delivery uisng the 75 g OGTT for nonpregnant individuals

If normal, testing should be repeated at 3 year intervals

Question 22

How many abnormal BG tests are needed to dx GDM using the 75 g OGTT?

Answer 22

One; any of the following qualify:
Fasting: 92 mg/dL
1 h: 180 mg/dL
2 h: 153 mg/dL

Question 23

How many abnormal BG results are needed to dx GDM using 100 g OTT

Answer 23

Two

Done following + test for 50 g OGT. If load is >130 after 50 g GLT, proceed to 100 g OGTT

Fasting: 95
1 hr: 180
2 hr: 155
3 hr: 140