Unit 8: Glucose Regulation and Maladaptive Behavior Flashcards
What is hyperglycemia values?
> 140
What are hypoglycemic values?
<70
What is the main energy source for the fetus?
glucose
What are the metabolic changes associated with glucose and the first trimester?
Insulin production increases
Tissue glycogen stores increase
Hepatic glucose production decreases
These three things lead to decreased fasting glucose levels
What are the metabolic changes associated with glucose and the 2nd/3rd trimester?
Mother becomes more insulin resistant due to increase need of glucose for the fetus (18-36 weeks)
What is key to optimal outcomes when dealing with diabetes?
Strict maternal glucose control
What maternal risks and complications come from having pregestational diabetes?
Hydramnios
Increased risk for hemorrhage
Hypo or hyperglycemia
Ketoacidosis (>200)
Preterm birth
Preeclampsia
Macrosomia (increase fetus weight)
Increase miscarriage
Increase risk of infection
What are fetal and neonatal risks with pregestational diabetes?
Increased mortality risk
Congenital malformations (3x high occurrence)
Respiratory distress syndrome
Prematurity
Intrauterine Fetal Demise
Hypoglycemia
Jaundice
Antepartum interventions to manage pregestational diabetes
Review self-monitoring, diet, and exercise
Lab tests (UA, A1c, baseline renal function)
Prenatal visits 1-2 weeks then a couple times a week during 3rd trimester
Insulin therapy
Intrapartum interventions to manage pregestational diabetes
Monitor closely and get glucose levels every hour
Insulin infusion (regular insulin) on separate line
Postpartum interventions to manage pregestational diabetes
Encourage breastfeeding - reduces need for insulin
Watch insulin levels (should return to normal after placenta is delivered)
What are the insulin needs during pregnancy?
Need insulin more often because of the amount of glucose the fetus needs
What is gestational diabetes?
Carbohydrate intolerance that is identified during 2nd or 3rd trimester
What are risk factors for gestational diabetes?
Family hx
Obesity
HTN
Glycosuria
25yrs or older
Previous stillbirth or malformed/macrosomic fetus
What is the screening for gestational diabetes mellitus?
1 hr: 50g oral glucose followed by a plasma glucose measurement 1hr later
3 hr: overnight fast and at least 3 days of unrestricted diet; avoid caffeine and smoking
What are antepartum interventions to manage gestational diabetes?
Education and support - make sure they know it isn’t their fault they have this
Diet and exercise
Pharmacologic therapy
Self-monitoring - strict control needed
Fetal surveillance
What are intrapartum interventions to manage gestational diabetes?
Target range 80-110 mg/dL
Rapid-acting insulin
May not need IV insulin (may not be hourly checks)
Avoid dextrose solutions
Anticipate macrosomia, CPD
What are postpartum interventions to manage gestational diabetes?
Return to normal glucose levels after birth
Reassess 4-12 weeks postpartum
Lifestyle modifications decrease risk for developing type 2
What are the maternal and fetal effects of drug abuse?
Miscarriage
Altered nutrition to fetus
Structural abnormalities in fetus
Decreased access to/compliance with health care increases fetal risk
Increased exposure to violence
Increased risk for mental health
What are the screening procedures for prenatal substance exposure?
Screened on their first visit
Asked about OTC, prescriptions, caffeine, alcohol, nicotine, and illicit drug use
Screen for mental health and partner violence
What is the assessment done for prenatal substance exposure?
Obtain a medical history
Complete labs and physical examination
What interventions can be done for prenatal substance abuse?
Education
Breastfeeding exposure
Group programs
Outpatient monitoring
