Diabetes in Pregnancy

Definitions

100

Name characteristics associated with DM Type 1

Absolute insulin deficiency, islet cell antibodies, immune mediated, increased risk of DKA and hypoglycemia

200

Name characteristics associated with DM Type 2

Defective insulin sensitivity and beta cell secretion, Insipidous onset with increased risk in older obese women, Strong genetic component

300

What is the diagnostic criteria for DM 2

Diagnosed with random glucose >200 or fasting >126

400

How is GDM diagnosed

50g glucola, 1 hr >140mg/dL identifies 80% of all women with GDM

500

What is the definition of fetal macrosomnia

The American College of Obstetricians and Gynecologists (2000) defines macrosomic infants as those whose birthweight exceeds 4500 g.

Gestational DM

100

When is screening for GDM performed (gestational wks)

Screening should be performed between 24 and 28 weeks in those women not known to have glucose intolerance earlier in pregnancy

200

How is GDM diagnosed?

Two-step procedure: 50-g oral glucose challenge test (GCT), followed by a diagnostic 100-g oral glucose tolerance test for those meeting the threshold value in the GCT.

300

When should testing for GDM be performed early in pregnancy - name risk factors for testing at OBI visit

—Severe obesity —Strong family history of type 2 diabetes —Previous history of GDM, impaired glucose metabolism, or glucosuria. If GDM is not diagnosed, blood glucose testing should be repeated at 24 to 28 weeks

400

When is insulin therapy recommended in GDM?

When standard dietary management does not consistently maintain the fasting plasma glucose at < 95 mg/dL or the 2-hour postprandial plasma glucose < 120 mg/dL Most practitioners initiate insulin therapy in women with gestational diabetes if fasting glucose levels exceeds 105 mg/dL persist despite diet therapy

500

What is the postpartum follow up for a patient with GDM?

Evaluation with a 75-g oral glucose tolerance test at 6 to 12 weeks postpartum and other intervals thereafter

Pregestational DM

100

Name neonatal risks associated with DM

hypoglycemia, RDS, hypocalcemia, hypomagnesia, hyperbilirubinemia, polycythemia

200

Name associated fetal malformations

spinal agenesis, anencephaly, renal abnormalities, situs inversus, cardiac abnormalities

300

List maternal risks of poorly controlled DM (health risks in pregnancy and outside of pregnancy)

DKA, retinopathy, nephropathy, neuropathy, infection, preeclampsia, HTN, PTD, stillbirth

400

Describe antenatal testing (starts at what gestational age and how often)

kick counts starting at 28weeks......... BPP/NST once weekly (Helfgott), twice weekly (MUSC) beginning at 32 weeks

500

What is that general management of DKA (labs, fluids, etc)

ABG, glucose, ketones, electrolytes at 1-2hr intervals Insulin: low dose IV, loading dose 0.2-0.4u/kg, maintenance 2.0-10u/hr fluids: Isotonic NaCl, total replacement in first 12hr = 4-6L, 1L in first hour, 500-1000 cc/hr for 2-4hr, run at 250cc/h until 80% replaced glucose: begin 5% D/NS when plasma level reaches 250mg/dl

Intrapartum Mgmt

100

Fingerstick goal range

70-110

200

What fluids are started initially if FSBS in goal range? What IVF are started if FSBS < 70

Normal Saline 5% Dextrose at 100-150cc/hr

300

How often are FSBS collected

latent labor: q 2hr active labor: q 1hr

400

What happens if glucose levels exceed 100 mg/dL?

Regular (short-acting) insulin is administered by intravenous infusion at a rate of 1.25 U/hr

Insulinoma

100

What is the principal glucose transporter in the placenta?

GLUT 1

200

Placenta glucose transport takes place via... (active/passive, etc)

Facilitated diffusion via GLUT glucose transporters

300

Name characteristics associated with the diagnosis of OVERT DIABETES

Women with high plasma glucose levels, glucosuria, and ketoacidosis, women with a random plasma glucose level greater than 200 mg/dL plus classic signs and symptoms such as polydipsia, polyuria, and unexplained weight loss Fasting glucose exceeding 125 mg/dL are considered by the American Diabetes Association to have overt diabetes

400

The decrease in insulin sensitivity in pregnancy is related to an increased production of placental and maternal hormones such as...

human placental lactogen, progesterone, estrogen, cortisol, and prolactin

500

What is the onset of action of short acting insulin (lispro/aspart)? What is the onset of action of NPH insulin (isophane suspension)?

onset: 1-15 minutes, peak: 1-2hr, duration 4-5hrs onset: 1-3hrs, peak: 5-7hr, duration 13-18hrs