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28 Cards in this Set
- Front
- Back
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human chorionic somatomammotropin (human placental lactogen)
what does it do? |
increases insulin resistance and generalized carbohydrate intolerance
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When do carb metabolism defects present
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late second or early third trimester
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Risks associated with gestational diabetes
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fetal macrosomia, birth injuries, neonatal hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, type II diabetes during lifetime
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When is the best time to screen for diabetes during pregnancy
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end of second trimester between 24 an 28 weeks
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Screening methods for gestational diabetes
most common lab screening test what indicates positive result what do you do in this case |
50g glucose load, measure plasma glucose 1 hr later
if 1 hr glucose level > 130 or 140, --> do glucose tolerance test 100g glucose load (after 8 h fast and 3day special carb diet) positive if 1h >165, 2h >15, 3h > 125 |
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Treatment for gestational diabetes
a. calories per day b. carbs per day c. kcal/kg ideal body wt to be ingested |
a. 2000-2200
b. 200-220g c. 30-35 kcal/kg of ideal body wt |
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Gestational diabetes treatment
carbs at breakfast? lunch and dinner? sncks? How often to moniter blood glucose? |
breakfast = 30-45g
lunch and dinner = 45-60g snacks = 15g monitor blood glucose 4 times (fasting and 3 postprandial) |
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Definition of a class 1A diabetic
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Gestational diabetes, diet controlled
(fasting <90, 1h <140, 2h <120) |
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Defn of type A2 diabetic
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Gestational diabetes, insulin controlled
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common treatment for Gestational diabetes that is commonly normal but elevates postprandially
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short acting (humalog or novalog) + med acting (NPH) in morning --> breakfast and lunch
short acting before dinner |
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Why choose humalog over regular insulin
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faster onset of action, shorter length of action
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Patient is a gestational diabetes patient class A2
What is the baby at risk for? What should you do to monitor? |
Macrosomia
Start on insulin (or oral), fetal monitoring via non-stress test or biophysical profile at 32-36 weeks (weekly or biweekly) ultrasound for estimated fetal weight at 34-37 weeks |
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In patients on insulin, when is labor scheduled for and why?
Patients with poor glycemic control? |
39 weeks induction
risk of hypoglycemia as placental function decreases towards the end of pregnancy Between 37-39 weeks |
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Patients with gestational diabetes have greater risk of what conditions?
babies of patients with gestational diabetes are at risk for what? |
GDM in subsequent pregnancies, overt diabetes (25-35%)
Increased incidence of childhood obesity and type 2 diabetes |
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Obstetric complications associated w/ diabetes in pregnancy
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polyhydramnios, preeclampsia/ecclampsia, spontaneous abortion, postpartum hemorrhage, increased c/s, congenital malformations
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congenital abnormalities associated with uncontrolled materanl diabetes
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cardiac, neural tube, caudal regression syndrome, fetal growth abnormalities, sudden intrauterine fetal demise
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fetal complications of DM
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Macrosomia --> trauma, dystocia, erb palsy
Delayed organ maturinty Congenital malformations Intrauterine death |
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Patients with type 1 diabetes
How do you work up these patients |
ECG, 24hr urine collection for creatinine/protein, HgbA1C, thyroid function (TSH and free T4), refer to opthamologist
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How does insulin regimen change during pregnancy
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first half - prior dosing regimen increases slightly
second half - increases substantially during latter half of pregnancy (insulin resistance increases) |
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Insulin Type and Dose
-time impact -target glucose level evening NPH |
-fasting
70-90mg/dL |
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Insulin Type and Dose
-time impact -target glucose level Morning humalog |
-post breakfast
100-139 |
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Insulin Type and Dose
-time impact -target glucose level Morning NPH |
Post lunch
100-139 |
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Evening Humalog
Insulin Type and Dose -time impact -target glucose level |
post dinner 100-139
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4 rules when adjusting insulin dosage
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1. set fasting between 70-90
2. only adjust 1 dosing level at a time 3. do not change by more than 20% 4. wait 24h between dosage changes |
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Type 2 diabetes + pregnancy
treatment |
NPH at bedtime (control fasting sugars) and in AM (daytime)
Take short acting humalog at meals |
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Fetal testing regimen for a mom with pregestational diabetes
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Antenatal fetal assemssment of weekly NSTs + fetal ultrasound from 32-36 weeks
biweekly testing - NST and BPP after 36 weeks Lung maturity testing at 37 weeks, deliver if NRFHT, HTN, renal disease, poor renal growth |
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How does labor affect insulin requirements
What intervention is taken for diabetic women in labor |
insulin requirements go down
give dextrose and insulin to balance blood sugars at 100-120 |
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What happens to insulin requirements after birth
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go way down because placenta is gone (which had many insulin antagonists)
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