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37 Cards in this Set
- Front
- Back
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what is type 1 diabetes?
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result of autoimmunity of beta cells of the pancreas resulting in absolute insulin deficiency and is managed with insulin
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what is type 2 diabetes?
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insulin resistance and inadequate insulin production. most prevalent, can be controlled with diet, exercise and oral glycemic agents.
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is oral hypoglycemic agents preferred in pregnant women?
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no
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how is diabetes characterized in pregnancy
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pregestational diabetes (1 or 2)
gestational diabetes |
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during pregnancy the body is in a state of insulin resistance, is this pathological or physiological?
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physiological- it is to spare glucose for the developing fetus
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what is the hormones that the placenta produces to antagonize insulin?
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Human placental lactogen
progesterone growth hormone corticotropin- releasing hormone |
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how does a normal pregnant women maintain euglycemia when there is increasing insulin resistance?
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produce even more insulin
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what are the management strategies for preexisting or gestational diabetes?
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maintain euglycemia control
minimize complications prevent prematurity |
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in the first trimester are insulin needs high or low?
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low- at the end of the first trimester insulin requirements begin to rise as glucose use and glycogen storage by mother and fetus increase
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what hormone causes resistance to the action of maternal insulin there by increasing circulating glucose for fetal use and increasing the demand on the maternal pancreas to produce more insulin?
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human placental lactogen (hPL)
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does the fetus produce its own insulin?
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yes, but it obtains its glucose from the mother across the placenta.
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t/f the amount of glucose available in maternal circulation stimulates the fetal pancreas to produce more insulin
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true
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what are some major risks for the women with DM in pregnancy?
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DKA
HTN/preeclampsia PTL spontaneous abortions polydydramnios/ oligohydramnios c-section retinopathy,nephropathy, neruopathy infection r/t hyperglycemia |
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what are the major risks for the fetus when the mother has DM
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hypoglycemia r/t fetal hyperinsulinemia
hypocalcemia and hypomagnesemia asphyxia r/t hyperglycemai/hyperinsulinemia RDS hyperbilirubinemia congential defects cardiomyopathy macrosomia |
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what is macrosomia and why is it dangerous?
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large body over 4500g puts the fetus at risk for trauma
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why would a fetus be macrosomia if the mother has DM?
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the excessive glucose that the mother is giving to the fetus acts as a growth hormone and produces a larger than normal fetus
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what is the most important self-management of DM
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SMBG- 4-8 times a day
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what is the expected glucose in a fasting pt?
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<95
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what is the expected glucose in a premeal pt?
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<105
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what is the expected glucose in a 1 hr postprandial pt? (after a meal)
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<140
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what is the expected 2 h postprandial in a pt?
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<120
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what do large amounts of ketones in the urine indicate?
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poor nutrition/inadequate food intake, sign of ketoacidosis
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should the pt keep a record of diet, BS, insulin, and activity?
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yes
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how many times a week should a pt with diabetes exercise?
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3 times a week for at least 20 min, unless contraindicated
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t/f infants of diabetic women have an increased risk for respiratory distress syndrome( RDS)?
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true- it is related to glycemic control
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what test would you use to check for fetal lung development and RDS?
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amniocentesis
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do insulin requirements change with gestation?
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yes, around 24-28 weeks gestation the requirements increase
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what are s/s of hypoglycemia?
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diaphoresis
tachy cold clammy blurred vision extreme fatigue altered LOC somnolence and pallor |
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what can you use to treat hypoglycemia?
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10-15g of carbs, it can raise your glucose by 30-40 mg/dl in 30 min
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what are s/s of ketoacidosis
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abd pain
n/v polyuria polydipsia fruity breath rapid respers |
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when should you instruct your pt with DM to call the dr?
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BS >than 200
moderate ketones in urine persistant n/v decreased fetal movement |
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why is there an increase risk for DM's to have a stillbirth?
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DM causes premature placental aging
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should phosphatidyglycerol be present in amniotic fluid?
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yes-Phosphatidylglycerol (PG) in amniotic fluid is recognized as a good indicator of fetal lung maturity
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when preforming a GTT at 24 weeks, what is considered an abnormal finding?
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a glucose of 130-140 mg/dl (depends on the dr)
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what is done if a women who test positive on a GTT?
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a 3 hour GTT is done with 100 grams of a glucose load.
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how is a 3 hour GTT done?
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100 grams of glucose is introduced and blood is drawn at 1(should be <180),2(should be <155) , and 3 hours(should be less than 140mg/dl)
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what risk does gestational diabetes have on a pregnant women after she gives birth?
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she will be at greater risk for developing type 2 diabetes
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