special populations Flashcards
kania pt 4
what are the maternal risk of gestational diabetes?
retinopathy –> must have dilated eye exam before pregnancy and in first trimeter; must be monitored at every trimester and postpartum
pre-eclampsia –> take aspirin starting at 12-16 weeks if no CI
what can a woman do pre-conception to prevent gestational diabetes?
if have diabetes –> have counseling and establish multidisciplinary team
family planning
goal A1c –> under 6.5%
what is the FBS target in pregnancy?
70 to 95 mg/dL
what is 1-hr postprandial target in pregnancy?
110 to 140 mg/dL
what is the 2-hour postprandial target in pregnancy?
100 to 120 mg/dL
what is A1c target in pregnancy?
under 6%
under 7% if necessary to prevent hypoglycemia
how does insulin sensitivity change throughout pregnancy?
early –> enhanced, hypoglycemia can ensue especially in T1DM
16 weeks –> resistance increases and TDD increases by 5% per week through week 36 (up to 2-3x start)
third trimester –> placental aging causes insulin level off
what does a rapid reduction in insulin requirement signify in pregnancy?
that the placenta is not developing sufficiently
something is wrong
what are some complications that can occur with pregnant T1DM pts?
increased risk of hypoglycemia in first trimester
decreased hypoglycemia awareness due to hormone changes
increased risk of DKA –> prescribe ketone strips, may cause still births
sensitivity to insulin
what are some complications that can occur with pregnant T2DM patients?
increased risk for comorbidities (HTN, etc) –> d/c potentially harmful medications like ACEis, ARBs, and statins
weight gain (control based on BMI)
requirement of high insulin dose –> maybe even concentrated insulin
what is the BP target in pregnant T2DM?
110 to 135/85 mmHg
when is pregnancy loss common in diabetes pts?
T2DM –> 3rd trimester
T1DM –> 1st trimester
what does treatment of gestational diabetes look like?
insulin preferred
metformin if pt cannot take insulin
avoid glyburide/glipizide (due to macrosomia and birth injury)
minimal data with other agents
what is the dosing for insulin in gestational diabetes?
0.7 to 1 units/kg/day
divide dose between basal/bolus
adjust base on response
why is metformin just ok to treat gestational diabetes?
only use if pt cannot take insulin due to it crossing the placenta
may be associated with pre-term birth
d/c if using for PCOS by end of 1st semester
how should gestational diabetes be treated postpartum?
check OGTT 4-12 weeks postpartum
then check for diabetes every 1-3 years due to increased risk
what are unique features of diabetes in pediatrics?
important to determine the true diagnosis of T1 vs T2
treating T2DM in youth is different than in adults
target A1c goal of 7% is similar to adults
why does T2DM look different in youth?
more rapid decline in B-cell function (might look more like T1 for a while)
more accelerated development of diabetes complications
how would you treat T1DM in pediatrics?
insulin (pump preferred but make sure they have education)
use of cGM!!
work with school systems for proper management
how would T2DM be treated in pediatrics?
medical nutrition therapy + exercise
based on A1c
if patient presents with ketoacidosis –> treat with SQ or IV insulin
how would a child with an A1c < 8.5 and T2DM be treated?
metformin first
based on renal function
how would a T2DM child with an A1c greater than 8.5%, blood sugar over 250 mg/dL without acidosis, and symptoms be treated?
basal insulin and metformin
how would a child not on goal who are already on metformin and insulin be treated?
GLP-1RAs and/or empagliflozin if older than 10 yo
how would a child who is not at goal on metformin, GLP-1RA, empagliflozin, and basal insulin be treated?
begin bolus insulin or change to insulin pump therapy
**harder to approve by insurances
