• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

Card Range To Study



Play button


Play button




Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

28 Cards in this Set

  • Front
  • Back
human chorionic somatomammotropin (human placental lactogen)

what does it do?
increases insulin resistance and generalized carbohydrate intolerance
When do carb metabolism defects present
late second or early third trimester
Risks associated with gestational diabetes
fetal macrosomia, birth injuries, neonatal hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, type II diabetes during lifetime
When is the best time to screen for diabetes during pregnancy
end of second trimester between 24 an 28 weeks
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
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
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)
Definition of a class 1A diabetic
Gestational diabetes, diet controlled

(fasting <90, 1h <140, 2h <120)
Defn of type A2 diabetic
Gestational diabetes, insulin controlled
common treatment for Gestational diabetes that is commonly normal but elevates postprandially
short acting (humalog or novalog) + med acting (NPH) in morning --> breakfast and lunch

short acting before dinner
Why choose humalog over regular insulin
faster onset of action, shorter length of action
Patient is a gestational diabetes patient class A2

What is the baby at risk for?

What should you do to monitor?

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
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
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
Obstetric complications associated w/ diabetes in pregnancy
polyhydramnios, preeclampsia/ecclampsia, spontaneous abortion, postpartum hemorrhage, increased c/s, congenital malformations
congenital abnormalities associated with uncontrolled materanl diabetes
cardiac, neural tube, caudal regression syndrome, fetal growth abnormalities, sudden intrauterine fetal demise
fetal complications of DM
Macrosomia --> trauma, dystocia, erb palsy

Delayed organ maturinty

Congenital malformations

Intrauterine death
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
How does insulin regimen change during pregnancy
first half - prior dosing regimen increases slightly

second half - increases substantially during latter half of pregnancy (insulin resistance increases)
Insulin Type and Dose
-time impact
-target glucose level

evening NPH

Insulin Type and Dose
-time impact
-target glucose level

Morning humalog
-post breakfast

Insulin Type and Dose
-time impact
-target glucose level

Morning NPH
Post lunch

Evening Humalog

Insulin Type and Dose
-time impact
-target glucose level
post dinner 100-139
4 rules when adjusting insulin dosage
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
Type 2 diabetes + pregnancy

NPH at bedtime (control fasting sugars) and in AM (daytime)

Take short acting humalog at meals
Fetal testing regimen for a mom with pregestational diabetes
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
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
What happens to insulin requirements after birth
go way down because placenta is gone (which had many insulin antagonists)