Reviewer #5

Question 1

Normal glucose level

Answer 1

70 mg/dL to 100 mg/dL

Question 2

State characterized by the destruction of beta cells in the pancreas that usually to absolute insulin deficiency.

Answer 2

Type 1 DM

Question 3

Autoimmune destruction of the beta cells results in?

Answer 3

Immune-mediated DM

Question 4

Forms that have no known cause?

Answer 4

Idiopathic type 1

Question 5

State that usually arises because of insulin resistance combined with a relative deficiency in the production of insulin.

Answer 5

Type 2 DM

Question 6

Condition of abnormal glucose metabolism that arises during pregnancy.

Answer 6

Gestational DM

Question 7

State between “normal” and “diabetes” in which the body is no longer using and secreting insulin properly.

Answer 7

Impaired glucose homeostasis

Question 8

State when fasting plasma glucose is at least 110 but under 126 mg/dL

Answer 8

Impaired fasting glucose

Question 9

State when results of the oral glucose tolerance test are at least 140 but under 200 mg/dL in the 1 hr sample

Answer 9

Impaired glucose tolerance

Question 10

Defined as glucose intolerance of varying severity with onset or first recognition during pregnancy.

Answer 10

Gestational DM

Question 11

The most important perinatal concern in this group is?

Answer 11

Macrosomia with resulting birth trauma

Question 12

% of women that develops diabetes in the
ensuing 20 years and this is linked with obesity.

Answer 12

50%

Question 13

% of high-risk women tested positive for GDM after 26 weeks of gestation.

Answer 13

40.4 %

Question 14

Filipino women commonly develop?

Answer 14

GDM

Question 15

In 10 women how many has GDM?

Answer 15

1 or 2

Question 16

Diabetes that antedates pregnancy?

Answer 16

Pre-Gestational Diabetes

Question 17

Pregnancies which are complicated by pre-gestational diabetes, type-1 or type-2, carry what?

Answer 17

Risk to both mother and fetus beyond the effects on fetal growth and development in
mid and late pregnancy.

Question 18

Risk factors for GDM screening

Answer 18

> Hx of DM
Given birth to large infants (4kg)
Hx of recurrent fetal loss
Persistent glycosuria
Age: > than 25 years
Px of glucose intolerance or DM in pregnancy
Obesity (> 15% of non pregnant ideal body wt)
Px of stillbirth, unexplained neonatal death, congenital malformations, prematurity.

Question 19

Presence of reducing sugars in the urine

Answer 19

Glycosuria

Question 20

Underweight value in Pre-gestational BMI

Answer 20

less than 18.5

Question 21

Overweight value in Pre-gestational BMI

Answer 21

25 to 30 or greater

Question 22

GDM is caused by?

Answer 22

Placental production of human placental lactogen (HPL) and progesterone.

Question 23

Other hormones that may contribute to GDM

Answer 23

Prolactin and Cortisol

Question 24

As placenta develops

Answer 24

Estrogen decreases as HPL and progesterone rise

Question 25

Most marked in the third trimester at which time GDM most often occurs

Answer 25

Insulin resistance

Question 26

Major fetal growth hormone

Answer 26

Insulin

Question 27

Most insulin sensitive tissue

Answer 27

Fat

Question 28

Screening is ideally initiated between

Answer 28

24th to 28th weeks of pregnancy

Question 29

Low risk

Answer 29

No screening

Question 30

Average risk

Answer 30

24 to 28 weeks

Question 31

High risk

Answer 31

ASAP

Question 32

Measurement of plasma glucose 1 hour after ingesting 50 g of glucose.

Answer 32

Glucose Challenge Test (GCT)

Question 33

Women with elevated GCT values requires

Answer 33

Oral glucose tolerance test

Question 34

Measurement of plasma glucose after ingesting 100 g of glucose.

Answer 34

Oral Glucose Tolerance Test (OGTT)

Question 35

What criteria detects 54% more women with GDM than the NDDG criteria

Answer 35

CC criteria

Question 36

Not useful in gestational diabetes mellitus

Answer 36

Urine glucose monitoring

Question 37

May be useful in detecting insufficient caloric or carbohydrate intake in women treated with calorie restriction

Answer 37

Urine ketone monitoring

Question 38

Effects of GDM on the fetus

Answer 38

> Neonatal hypoglycemia > Macrosomia > Jaundice > Hyperviscosity > Birth trauma > Prematurity > Hyaline membrane disease > Apnea and Bradycardia

Question 39

Big baby syndrome

Answer 39

Macrosomia

Question 40

Stimulates excessive somatic growth mediated by

Answer 40

Insulin-like Growth Factors (IGFs)

Question 41

Affects 10-25% of all pregnant women with GDM

Answer 41

Pre-eclampsia

Question 42

High incidence of chorioamnionitis and postpartum endometritis

Answer 42

Infections

Question 43

High incidence caused by exaggerated uterine distension

Answer 43

Postpartum bleeding

Question 44

More common due to fetal macrosmia and cephalo-pelvic disproportion

Answer 44

Cesarean section

Question 45

Dietary therapy

Answer 45

> Refer to dietitian > High fiber CHO diet > Avoid concentrated sweets

Question 46

When Dietary Therapy Fails

Answer 46

Insulin and Oral Hypoglycemic Agents

Question 47

Oral Hypoglycemic Agents

Answer 47

Glyburide and Metformin

Question 48

Normal value of Amniotic Fluid

Answer 48

5 to 25 cm AFI (Amniotic Fluid Index)

Question 49

*If the fasting value is > 95 mg/dL, or 1 hr value > 130-140 mg/dL or 2 hr value > 120 mg/dL

Answer 49

Insulin therapy is needed

Question 50

Only for routine obstetric indication GDM alone is not an indication

Answer 50

C section

Question 51

Maternal hyperglycemia in labor

Answer 51

Fetal Hyperinsulinemia

Question 51

Cesarean delivery may reduce the likelihood of brachial plexus injury in the infant that weigh

Answer 51

> 4.5 Kg fetus

Question 52

A normal concentration of glucose in the blood.

Answer 52

Euglycemia

Question 53

Give insulin only if blood sugar

Answer 53

Greater than 120 mg/dL

Question 54

Delivery usually at

Answer 54

38 weeks

Question 55

If beyond 38 weeks

Answer 55

increased risk of intrauterine death without an increase in RDS

Question 56

Early delivery may be indicated for

Answer 56

> Women with poor glycemic control > Fetal problems

Question 57

In order to prevent neonatal hypoglycemia.

Answer 57

The goal is to maintain normoglycemia

Question 58

Start dextrose to maintain basal nutritional requirements

Answer 58

150-200 ml/hr of 5% dextrose

Question 59

Post delivery keep patients on

Answer 59

Dextrose-normal saline

Question 60

Hypoglycemia occurs in __% of macrosomic patients

Answer 60

50%

Question 61

If neonate is symptomatic give?

Answer 61

Bolus of 2- 4 ml/kg, IV, 10% dextrose

Question 62

Fasting blood glucose concentrations should be

Answer 62

Less than 105 mg/dL

Question 63

One hour postprandial concentrations should be

Answer 63

Less than 140 mg/dL

Question 64

Before starting regular food intake, administer?

Answer 64

One half of the pre-delivery dose

Question 65

If the pt’s postpartum GTT is normal, she should be re-evaluated at a minimum of?

Answer 65

3 years interval with a fasting glucose.