W1L4 GDM

Question 1

Def

Answer 1

Diagnosed in 2nd/3rd trimester that not clearly either preexisting type 1/2 diabetes

Question 2

Classification

Answer 2

1-Pregestational(1st tri)

2-Gestational diabetes(2nd/3rd)

Question 3

Risk factors

Answer 3

• Fam his diabetes
• Past his of ges dia
• Age >25y
• Previous delivery baby >4kg
• Polycystic ovary syndrome
• Current use of glucocorticoids
• Prepreg bmi >30kg/m2

Question 4

Effects of pregnancy on diabetic state?

Answer 4

• Hyperinsulinemia & increase insulin resistance
• Diabetic retinopathy worsens.
• Diabetic nephropathy
• xaffect somatic/autonomic neuropathy

Question 5

Effects of diabetes on pregnancy?

Answer 5

Fetal and neonatal complications:

• Congenital malformations
• Macrosomia w asso shoulder dystocia & increase cesarean delivery
• Neonatal: Hypoglycemia, erythrocytosis

Maternal complications:

• Spontaneous abortion.
• Hypertension/preeclampsia.
• Polyhydramnios.
• Infections
• Recurrence gd in preg
• increase risk type 2 diabetes

Question 6

how to screen?

Answer 6

A- One step approach:
75g 2H oral gluc tolerance test,criteria:
-Fasting plasma glucose ≥92 mg/dL but <126 mg/dL
-1H ≥180 mg/dL
-2H ≥153 mg/dL).

B- Two step approach:
1H plasma glucose after 50g oral gluc ≥130 mg/dL go to 100g 2H oral gluc tolerance test.
-Fasting : 95 mg%
-1h : 180 mg%
-2h: 155 mg%
-3h: 140 mg%

Question 7

What are the glycemic targets in a patient with hyperglycemia during pregnancy?

Answer 7

• Fast gluc conc ≤ 95 mg/dL.
• Preprandial gluc conc ≤ 100 mg/dL.
• 1H postprandial gluc conc ≤ 140 mg/dL
• 2H postprandial gluc conc ≤ 120 mg/dL
• Gluc lvl should not <60 mg/dL.

Question 8

How to Manage?

Answer 8

1. Diet:
   - aim: prevent weight gain.
   - Ideal=30 kcal/kg/day
   - overweight & obese=22-25 kcal/kg/day
   - morbidly obese=12-14 kcal/kg/day
2. Insulin:
   regular insulin, NPH insulin, insulin aspart, insulin lispro, insulin detemir
3. Oral medications:
   - Glyburide & metformin(refuse insulin)