Special Populations

Question 1

What are the maternal risks associated with diabetes during pregnancy?

Answer 1

-Retinopathy
-Pre-eclampsia

Question 2

How do we prevent pre-eclampsia?

Answer 2

Aspirin 81-150 mg/day
-start at 12-16 weeks if no contraindications

Question 3

What is the goal A1C for a patient with diabetes pre-conception?

Answer 3

<6.5%

Question 4

What is the target FBS during pregnancy?

Answer 4

70-95

Question 5

What is the 1-hr postprandial target during pregnancy?

Answer 5

110-140

Question 6

What is the 2-hr postprandial target during pregnancy?

Answer 6

100-120

Question 7

What is the goal A1C during pregnancy?

Answer 7

<6% ideally
<7% if necessary to prevent hypoglycemia

Question 8

In early pregnancy, how does the body react to insulin?

Answer 8

Sensitivity increases
*hypoglycemia can occur
(less insulin required)

Question 9

In late pregnancy, how does the body react to insulin?

Answer 9

Resistance increases and Total daily Insulin dose increases
(more insulin required, about 2-3 times more)

Question 10

What may a rapid reduction in insulin requirements during pregnancy indicate?

Answer 10

Placental insufficiency

Question 11

What changes occur to previous Type 1 diabetics during pregnancy?

Answer 11

-Increased hypoglycemia risk in first trimester
-Decreased hypoglycemia awareness
-Increased risk of DKA (increases stillbirth risk)
-Insulin sensitivity increases and eventually returns to normal after placenta delivery

Question 12

What changes occur to previous Type 2 diabetics during pregnancy?

Answer 12

-Co-morbidity risk is higher
-More common to have pregnancy loss in 3rd trimester than with Type 1
-Need to control weight!!!
-Require high insulin doses during pregnancy (may require concentrated insulin)
*Discontinue ACEIs, ARBs, and Statins

Question 13

What is the preferred diabetes treatment in pregnancy?

Answer 13

Insulin

Question 14

What is the starting dose of insulin in pregnancy?

Answer 14

0.7-1 units/kg/day

Question 15

What medication can be used if patient is pregnant and cannot receive insulin?

Answer 15

Metformin

Question 16

For patients with gestational diabetes and prediabetes, what treatment plan should they follow to decrease the progression to diabetes?

Answer 16

Lifestyle Changes and Metformin

Question 17

For patients with gestational diabetes, what test should be run postpartum?

Answer 17

OGTT 4-12 weeks postpartum

Check for diabetes every 1-3 years

Question 18

How does Type 2 diabetes in children differ from Type 2diabetes in adults?

Answer 18

-More rapid decline in B-cell function
-Accelerated development of complications

Question 19

What is the target A1C for pediatric populations?

Answer 19

< 7% (similar to adults)

Question 20

For Type 1 diabetes in pediatric populations, what is the preferred treatment?

Answer 20

Insulin
*pump therapy preferred

Question 21

what is the treatment for Type 2 diabetes in pediatric populations?

Answer 21

A1C < 8.5%: Metformin!

A1C > or = 8.5% or BS > or = 250mg/dL without acidosis who are symptomatic: Basal Insulin + Metformin

Question 22

In pediatric populations, if the patient is not at goal on metformin and insulin, what is the next treatment we use?

Answer 22

GLP-1’s

Question 23

In pediatric populations, if the patient is not at goal on metformin, basal insulin, and a GLP-1 what is the fourth treatment we can add?

Answer 23

Bolus insulin
(or change to insulin pump therapy)

Question 24

At what glucose level should insulin be initiated at the hospital?

Answer 24

> or = 180 mg/dL

Question 25

What is the target glucose level in the hospital?

Answer 25

140-180 mg/dL *do not want control to be too tight because it could lead to hypoglycemia

Question 26

What insulin is preferred for noncritically ill hospitalized patients?

Answer 26

Bolus -along with use of correction factor/insulin sensitivity factor

Question 27

What is the A1C target for elective surgery?

Answer 27

<8%

Question 28

What is the target blood glucose during the perioperative period?

Answer 28

100-180 mg/dL

Question 29

How much should basal insulin be reduced before surgery and when?

Answer 29

Reduce basal insulin the evening before surgery by 25%

Question 30

When should metformin be withheld before surgery?

Answer 30

On the day of surgery

Question 31

When should SGLT2 inhibitors be held before surgery?

Answer 31

3-4 days before

Question 32

When should other oral glucose-lowering medications be held before surgery?

Answer 32

The morning of surgery

Question 33

How should other forms of insulin be adjusted before surgery?

Answer 33

NPH: give half dose the morning of Long-Acting or Pump Basal: Give 75-80% the morning of