Type 2 Diabtetes Mellitus

Question 1

What is type 2 diabetes?

Answer 1

• usually presents in middle age or later life, but current trend for earlier presentation
• categorised by 2 metabolic defects
  —> insulin resistance
  —> impaired insulin secretion
• earlier in disease patients respond to diet or oral hypoglycaemic agents, but may ultimately require insulin treatment

Question 2

What are some of the complications?

Answer 2

• microvascular complications - caused by chronic hyperglycaemia
• microvascular disease
• miscarriage
• congenital malformations
• IUGR
• macrosomia
• polyhydramnios
• IUFD

Question 3

How is it treated?

Answer 3

• lifestyle modification (increasing physical activity and reducing dietary energy consumption)
• oral anti diabetic agents (metformin)
• insulin injections

Question 4

What is the midwives role during pregnancy?

Answer 4

• ensure taking 5mg folic acid
• advise and assist woman to achieve blood glucose levels of <5mmol/l pre meals and <7mmol/l post meals
• referral to combined clinic
• ensure screening is carried out
• advise on weight management
• discuss plans for infant feeding ?colostrum harvesting
• ensure plan for delivery has been made
• all others plans same as type 1