Diabetes in pregnancy (gestational and pre-existing)

Question 1

Insulin allows cells to absorb the glucose in the blood. What type of receptors does insulin bind with?

1 - GPCR
2 - receptors tyrosine kinase
3 - ion channels
4 - enzyme linked

Answer 1

2 - receptors tyrosine kinase

Question 2

Once inside the cell, what does insulin trigger the cell to do with glucose?

1 - glycogenesis
2 - gluconeogensis
3 - glycolysis
4 - hydrolysis

Answer 2

1 - glycogenesis
- initiate glycogen synthesis (storing glucose as glycogen) called glycogenesis

Question 3

Over 700,000 women in England and Wales give birth each year. What % of these have complications related to diabetes?

1 - 5%
2 - 15%
3 - 35%
4 - 65%

Answer 3

1 - 5%

Question 4

Over 700,000 women in England and Wales give birth each year, 5% of which have complications related to diabetes. This can present as T1DM, T2DM and gestational diabetes. Which of these is most common as a complication of pregnancy?

Answer 4

• gestational diabetes = 87.5%
• T1DM = 7.5%
• T2DM = 5%

Question 5

What is the incidence of gestational diabetes?

1 - 1-2%
2 - 10-13%
3 - 20-30%
4 - >45%

Answer 5

2 - 10-13%

Question 6

Over 700,000 women in England and Wales give birth each year, 5% of which have complications related to diabetes. Gestational diabetes is the most common complication during pregnancy. Which 2 of the following are common risk factors contributing to the increased risk of developing complications during pregnancy?

1 - pregnancy in later life
2 - obesity
3 - ethnicity
4 - hypertension

Answer 6

1 - pregnancy in later life
2 - obesity

Question 7

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. What happens to glucose production in the liver during pregnancy?

1 - glucose production reduces
2 - glucose production increases as does glycogenesis
3 - glucose production increases as does glycolysis
4 - glucose production increases as does gluconeogensis

Answer 7

4 - glucose production increases as does gluconeogensis
- hepatic glucose production increases by 16-30%

Question 8

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. What happens to insulin sensitivity during pregnancy?

1 - insulin sensitivity reduces
2 - insulin sensitivity increases
3 - insulin sensitivity remains constant

Answer 8

1 - insulin sensitivity reduces
- this ensures the foetus recieves sufficient glucose
- aprox 50-70% less effective by 3rd trimester

Question 9

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. When does gluconeogenesis and insulin resistance peak during pregnancy?

1 - 1st trimester
2 - 2nd trimester
3 - 3rd trimester

Answer 9

3 - 3rd trimester
- weeks 29-40

Question 10

Why is increased insulin resistance and gluconeogenesis important in pregnancy, especially during the 3rd trimester (weeks 29-40)?

1 - ensure mother has sufficient glucose to manage the pregnancy
2 - insulin resistance and gluconeogenesis ensure hyperglycaemia
3 - ensures baby is initially hyperglycaemic
4 - all of the above

Answer 10

2 - insulin resistance and gluconeogenesis ensure hyperglycaemia
- means there will always be glucose available to the foetus

Question 11

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. As insulin resistance increases, hepatic glucose production is able to respond to the excess insulin production. In normal pregnancy (NP) and gestational diabetes (GD) what % of hepatic glucose production is suppressed by increased insulin concentration in the blood?

1 - NP = 96% and GD = 100%
2 - NP = 100% and GD = 80%
3 - NP = 96% and GD = 80%
4 - NP and GD = 80%

Answer 11

3 - NP = 96% and GD = 80%
- GD is higher, which means patient remains in a higher hyperglycaemic state

Question 12

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. The foetus is able to secrete a hormone that opposes insulin. This hormone causes increased insulin sensitivity in an attempt to cause hyperglycaemia and ensure there is constant blood glucose supply to the foetus. What is this hormone called?

1 - insulin
2 - glucagon
3 - incretin
4 - human placental lactogen

Answer 12

4 - human placental lactogen

Question 13

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. In addition the mothers lipid metabolism changes during pregnancy. What initially happens to triglycerides (TAG) and very low density lipoproteins (VLDL) during pregnancy?

1 - VLDL increased and TAG is decreased
2 - VLDL and TAG increase
3 - VLDL and TAG are reduced
4 - VLDL decreased and TAG increased

Answer 13

3 - VLDL and TAG are reduced
- total and LDL-cholesterol initially decrease then rise in pregnancy

Question 14

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. In addition the mothers lipid metabolism changes during pregnancy. Triglycerides (TAG) and very low density lipoproteins (VLDL) initially drop during pregnancy, before doing what by week 8?

Answer 14

• progressively increase >8 weeks

Question 15

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. In addition the mothers lipid metabolism changes during pregnancy. Triglycerides (TAG) and very low density lipoproteins (VLDL) initially drop during pregnancy, before progressively rising by week 8. What are 2 hormones that have been linked with increased TAG?

1 - estrogen
2 - insulin
3 - cortisol
4 - lipoprotein lipase

Answer 15

1 - estrogen
- insulin (insulin resistance)

Question 16

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. In addition the mothers lipid metabolism changes during pregnancy. Triglycerides (TAG) and very low density lipoproteins (VLDL) initially drop during pregnancy, before progressively rising by week 8. What enzyme is decreased in the mother due to increased activity in the placenta that contributed to increased circulating lipids?

1 - estrogen
2 - insulin
3 - cortisol
4 - lipoprotein lipase

Answer 16

4 - lipoprotein lipase
- extracts lipids from lipoproteins in blood

Question 17

Do HDL levels increase or decrease by week 12 during pregnancy?

Answer 17

• increase

Question 18

Lipolysis (triglyceride metabolism into glycerol and free fatty acids) increases during pregnancy. Why does lipolysis increase during prgenancy?

1 - ensures mother does not gain too much weight
2 - ensures the foetus is warm and able to thermoregulate
3 - ensures the foetus recieves a continous energy source
4 - all of the above

Answer 18

3 - ensures the foetus recieves a continous energy source
- ensure continues energy to foetus through fatty acids and gluconeogenesis

Question 19

In pregnancy there is increased hyperglycaemia and insulin resistance. The pancreas, in an attempt to mitigate this does the following:

• increases insulin production
• attempts to restore euglycemia (normal blood glucose)

In women who are pregnant and who are unresponsive to the increased insulin secretions, what condition occurs?

1 - T1DM develops
2 - T2DM develops
3 - gestational diabetes develops

Answer 19

3 - gestational diabetes develops

Question 20

Woman who develop diabetes during pregnancy, can develop complications. Which of the following is LEAST likley to occur?

1 - pre-eclampsia (high BP and proteinuria)
2 - preterm labour
3 - worsening of diabetic retinopathy
4 - chronic kidney disease

Answer 20

4 - chronic kidney disease

Question 21

Woman who develops diabetes during pregnancy are at risk of neonatal complications. Which of the following are neonatal complications?

1 - congenital malformations
2 - macrosomia (larger than normal baby)
3 - birth injury
4 - perinatal mortality, still birth and miscarriage
5 - postnatal hypoglycaemia (can impact babies cognitive development)
6 - all of the above

Answer 21

6 - all of the above

Question 22

In babies who’s mother has gestational diabetes the cord-blood serum C-peptide levels are above the 90th %. What does this indicate?

1 - elevated insulin in mother but did not reach the foetus
2 - the foetus recieved elevated levels of insulin from the mother
3 - the baby was producing excessive levels of insulin
4 - all of the above

Answer 22

2 - the foetus recieved elevated levels of insulin from the mother
- c-peptide is a marker of insulin

Question 23

What is polyhydramnios?

1 - excessive fluid on the brain of the foetus
2 - fluid trapped in the cavities of the foetus
3 - increased pressure in the amniotic sac
4 - excessive amniotic fluid in amniotic sac

Answer 23

4 - excessive amniotic fluid in amniotic sac

Question 24

Polyhydramnios is excessive amniotic fluid in amniotic sac. This can be dangerous and lead to all of the following outcomes, EXCEPT which one?

1 - premature delivery (< 37 weeks)
2 - waters breaking early
3 - low foetus weight
4 - prolapsed umbilical cord

Answer 24

3 - low foetus weight

Question 25

When a woman is planning on having a baby, women should be advised on target plasma glucose levels to reduce the risk of diabetes in pregnancy. What is the fasting plasma glucose target?

1 - <4mmol/L
2 - >11mmol/L
3 - 4-11 mmol/L
4 - 5-3 mmol/L

Answer 25

4 - 5-3 mmol/L

Question 26

When a woman is planning on having a baby, women should be advised on target plasma glucose levels to reduce the risk of diabetes in pregnancy. What is the 1hour post prandial plasma glucose target?

1 - <4mmol/L
2 - <7.8mmol/L
3 - 4-7 mmol/L
4 - 5-9 mmol/L

Answer 26

2 - <7.8mmol/L

Question 27

What is the diagnosis of gestational diabetes based on a fasting plasma glucose (FPG)?

1 - <4mmol/L
2 - >11mmol/L
3 - >7.1 mmol/L
4 - >5.6 mmol/L

Answer 27

4 - >5.6 mmol/L

Question 28

What is the diagnosis of gestational diabetes based on a 2 hour oral glucose tolerance test (OGTT)?

1 - <4mmol/L
2 - >11mmol/L
3 - >7.8 mmol/L
4 - >5.6 mmol/L

Answer 28

3 - >7.8 mmol/L

Question 29

When a woman is planning to become pregnant, a BMI greater than what would trigger advice on losing weight given to the mother?

1 - BMI >35 kg/m2
2 - BMI >30 kg/m2
3 - BMI >27 kg/m2
4 - BMI >20 kg/m2

Answer 29

3 - BMI >27 kg/m2

Question 30

When a woman is planning to become pregnant, what supplement should be provided until 12 weeks of gestation?

1 - vitamin B1 (thiamine)
2 - vitamine B12
3 - vitmaine D
4 - vitamine B9 (folic acid)

Answer 30

4 - folic acid (B9)
- crucial for DNA and RNA and reduces risks of neural tube defects

Question 31

What testing on the eyes should be performed in a female during the pre-conception phase who is or is at risk of developing diabetes?

1 - retinal screening
2 - eye test
3 - glaucoma test
4 - contact lens test

Answer 31

1 - retinal screening
- through digital imaging

Question 32

In the conception phase females should have their kidneys assessed to assess the risk of developing diabetes, or those who may be pre-diabetic. Which of the following is NOT a typical measure that is performed?

1 - creatinine of >120micromol/L
2 - urinary albumin:creatinine ratio >30mg/mol
3 - eGFR <45ml/minute/1.73m2
4 - angiotensin-Converting Enzyme (ACE)

Answer 32

4 - angiotensin-Converting Enzyme (ACE)

Question 33

In a woman who is considering becoming pregnant and has or is at risk of diabetes, what blood test should be done monthly as the gold standard?

1 - fasting blood glucose
2 - random capillary blood glucose
3 - HbA1c
4 - OGTT

Answer 33

3 - HbA1c test

Question 34

In a woman who is considering becoming pregnant and has T1DM, what should they be advised to do in relation to their blood glucose levels?

1 - self monitor more regularly
2 - ketone testing
3 - may require increased blood glucose control medication
4 - all of the above

Answer 34

4 - all of the above

Question 35

What is the HbA1c target for women who are considering becoming pregnant?

1 - <38mmol/L
2 - <48mmol/L
3 - <58mmol/L
4 - <68mmol/L

Answer 35

2 - <48mmol/L

Question 36

If a woman has a HbA1c >86mmol/L (10%) and is considering becoming pregnant, what advise should they be given?

1 - begin taking insulin and remain on insulin throughout pregnancy
2 - lose weight and begin diabetes medication
3 - begin taking insulin until the HbA1c is <58mmol/L
4 - do not get pregnant until the HbA1c is below 48mmol/L

Answer 36

4 - do not get pregnant until the HbA1c is below 48mmol/L

Question 37

What are the 2 diabetic medications are permitted in pregnancy?

1 - insulin
2 - SGLT2 inhibitors
3 - GLP-1 agonsits
4 - metformin

Answer 37

1 - insulin
4 - metformin
- inhibits hepatic gluconeogenesis

Question 38

Some women may be on cholesterol and blood pressure medications prior to pregnancy. 3 of the following medications should be stopped during conception. Which one can be continued being taken?

1 - insulin
2 - statins
3 - angiotensin-converting enzyme inhibitors
4 - angiotensin-II receptor antagonists

Answer 38

1 - insulin

Question 39

When assessing a woman, which of the following are risk factors for developing gestational diabetes?

1 - BMI >30kg/m2
2 - previous macrosomic baby >4.5kg
3 - previous gestational diabetes
4 - first degree relative with diabetes
5 - ethnic minority with high incidence of diabetes
6 - all of the above

Answer 39

6 - all of the above

Question 40

If a women has any of the risk factors for gestational diabetes below:

1 - BMI >30kg/m2
2 - previous macrosomic baby >4.5kg
3 - previous gestational diabetes
4 - first degree relative with diabetes
5 - ethnic minority with high incidence of diabetes

What test should be performed prior to becoming pregnant and between weeks 24-28?

1 - OGTT
2 - HbA1c
3 - fasting glucose
4 - random capillary glucose

Answer 40

1 - oral glucose tolerance test (OGTT)

Question 41

In a patient with gestational diabetes, what is the first line treatment?

1 - insulin
2 - metformin
3 - lifestyle advise
4 - SGLT-2

Answer 41

3 - lifestyle advise
- lifestyle change (diet and exercise

Question 42

In a patient with gestational diabetes, the first line treatment is diet and exercise. If this fails (fasting plasma glucose is 7mmol/L) after 2 weeks what should the patient initially be prescribed?

1 - insulin
2 - metformin
3 - GLP-1 agonist
4 - SGLT-2

Answer 42

2 - metformin

Question 43

In a patient with gestational diabetes, the first line treatment is diet and exercise, following by metformin (after 2 weeks). If this fails after 2 weeks (fasting plasma glucose is 7mmol/L) what should the patient then be prescribed?

1 - insulin
2 - DPP4 inhibitors
3 - GLP-1 agonist
4 - SGLT-2

Answer 43

1 - insulin
- 10-20% of women with gestational diabetes take insulin
- intermediate or and/or rapid-acting insulin

Question 44

Insulin may be prescribed to a patient with gestational diabetes. What is the main risk of this?

1 - retinopathy
2 - hyperglycaemia
3 - hypoglycaemia
4 - neuropathy

Answer 44

3 - hypoglycaemia
- patients must be monitored closely

Question 45

In a female patient with gestational diabetes, what specifically should be tested if the patient already has T1DM?

1 - kidney function
2 - blood pressire
3 - ejection fraction
4 - ketones

Answer 45

4 - ketones
- risk of DKA
- if patient presents with hyperglycaemia or is unwell they should be tested for ketonaemia immediately

Question 46

What 2 diabetic medications can help reduce glucose absorption in the GIT?

1 - metformin
2 - acarbose
3 - dapagliflozin
4 - gliclazide

Answer 46

1 - metformin
2 - acarbose

Question 47

What diabetic medications can help increase lipogenesis (conversion of fatty acids and glycerol in TAG) in adipose tissue and the liver?

1 - insulin
2 - DPP4 inhibitors
3 - GLP-1 agonist
4 - SGLT-2

Answer 47

1 - insulin

Question 48

What diabetic medications can help increase glucose uptake in the muscles?

1 - insulin
2 - metformin
3 - GLP-1 agonist
4 - SGLT-2

Answer 48

2 - metformin

Question 49

What diabetic medications can help increase glycogenesis in the muscles and liver?

1 - insulin
2 - metformin
3 - GLP-1 agonist
4 - SGLT-2

Answer 49

1 - insulin

Question 50

What diabetic medications can help decrease gluconeogenesis in the liver?

1 - insulin
2 - metformin
3 - GLP-1 agonist
4 - SGLT-2

Answer 50

2 - metformin

Question 51

What diabetic medications can help increase glucose excretion through the kidneys?

1 - insulin
2 - metformin
3 - GLP-1 agonist
4 - SGLT-2 inhibitors

Answer 51

4 - SGLT2 inhibitors

Question 52

During birth and labour hourly continuous capillary blood glucose monitoring should be performed. What is the levels the blood glucose should remain within?

1 - >4mmol/L
2 - 4-7mmol/L
3 - 4-11mmol/L
4 - >11mmol/L

Answer 52

2 - 4-7mmol/L
- if not within this range then a variable rate infusion of insulin should be administered

Question 53

During birth and labour what do patients with T1DM require?

1 - insulin
2 - metformin
3 - GLP-1 agonist
4 - SGLT-2 inhibitors

Answer 53

1 - insulin
- should be delivered at s variable rate

Question 54

Following birth the baby should also be monitored, called neonatal care. If they have no clinical indications, what should happen to the baby?

1 - monitored in the PICU
2 - monitored by nurses
3 - remain with mum to enhance bonding

Answer 54

3 - should remain with mum

Question 55

Following birth the baby should also be monitored, called neonatal care. Which of the following blood measures should be taken from the baby following delivery?

1 - capillary blood glucose
2 - RBCs (polycythaemia)
3 - biliruben (hyperbilirubinaemia)
4 - Ca2+ (hypocalcaemia)
5 - Mg2+ (hypomagnesaemia)
6 - all of the above

Answer 55

6 - all of the above

Question 56

if a baby has indications of cardiac malformations that may occur due to gestational diabetes, what test should be performed 1st?

1 - chest X-ray
2 - ECG
3 - echocardiogram
4 - MRI

Answer 56

3 - echocardiogram

Question 57

Following birth, women with existing diabetes, what happens to their diabetes management?

1 - remain on what they were on during pregnancy
2 - increased dosage for a short period
3 - slowly titrate back down to pre-pregnancy levels providing their are no complications

Answer 57

3 - slowly titrate back down to pre-pregnancy levels providing their are no complications

Question 58

Following birth, women with gestational diabetes, what happens to their diabetes management?

Answer 58

• assess blood glucose for hyperglycaemia

- if ok then transfer to GP and explain about hyperglycaemia and future risk of gestational diabetes

Question 59

If a woman had gestational diabetes, there is a risk of them developing diabetes. When should a fasting plasma glucose (FPG) be tested following birth to asses the patients risk pf developing diabetes?

1 - 1-2 weeks
2 - 4-10 weeks
3 - 6-13 weeks
4 - 12-24 weeks

Answer 59

3 - 6-13 weeks

Question 60

If a woman had gestational diabetes, there is a risk of them developing diabetes. When should HbA1c be tested following birth to asses the patients risk pf developing diabetes?

1 - <2 weeks
2 - <13 weeks
3 - <26 weeks
4 - <12 months

Answer 60

2 - <13 weeks

Question 61

If a woman had gestational diabetes, there is a risk of them developing diabetes. Looking at the values below, match them with low and high risk of developing diabetes and a diagnosis of T2DM:

• FPG = <6.0 mmol/L or HbA1c = <39 mmol/mol
• FPG = >7.0 mmol/L or HbA1c = >48 mmol/mol
• FPG = 6.0-6.9 mmol/or LHbA1c =39-47 mmol/mol

Answer 61

• LOW RISK = FPG = <6.0 mmol/L or HbA1c = <39 mmol/mol
• HIGH RISK = FPG = 6.0-6.9 mmol/or LHbA1c =39-47 mmol/mol
• T2DM = FPG = >7.0 mmol/L or HbA1c = >48 mmol/mol