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