Diabetes Flashcards
(38 cards)
What is it?
Diabetes is a disorder in which the blood sugar level is persistently raised above the normal range
Why does it happen?
The abnormality is caused by an absolute or relative lack of insulin, secreted from the pancreatic B-cells
Diabetes is the most common pre-existing medical disorder complicating pregnancy in the UK
What is type 1 diabetes?
Beta cell destruction / total insulin deficiency
What is type 2 diabetes?
insulin resistance + insulin deficiency
What is gestational diabetes?
Any degree of glucose intolerance with onset or first recognition during pregnancy. ( Usually around 28 weeks)
What are the maternal risk factors with pre- existing and gestational diabetes?
Hypoglycaemia unawareness Ketoacidosis Deterioration in retinopathy Deterioration in nephropathy Pre-eclampsia Miscarriage Increased caesarean rate Polyhydramnious Shoulder dystocia (to a lesser degree with GDM)
What are the fetal risk factors with pre- existing and gestational diabetes?
Congenital abnormalities Macrosomia Late stillbirth Increased neonatal and perinatal mortality Neonatal hypoglycaemia Jaundice Premature birth (to a lesser degree with GDM- except congenital abnormalities)
Gestational diabetes is more common if there’s a family history of…?
FH Type 2 diabetes
What causes insulin resistance with gestational diabetes?
Placenta
What are the risk factors for gestational diabetes?
High BMI Maternal age (over 35) PCOS Previous large baby Previous GDM Previous unexplained perinatal death Ethnicity- South Asian,Black Caribbean, Middle Eastern
What are you more likely to develop later on in life if you have GDM?
Type 2 diabetes
When to screen if previous gestational diabetic?
GTT at booking
Repeat at 24-28 weeks if normal
What risk factors (arising during pregnancy) should women be offered screening for?
Macrosomia or polyhydramnious (fetal abdominal circumference or estimated fetal weight > 90th centile)
Glycosuria 2+ or more on dipstick testing on one occasion or 1+ on two occasions
A GTT after 36 weeks has a high false positive rate. After 35+6 refer to the Diabetic ANC for blood sugar monitoring
What should a fasting blood sugar be?
5.6 mmol/l or below
What should a woman’s blood sugar be 2hrs post 75g glucose?
7.8 mmol/l or below
What is a potential type 2 diabetic pre-pregnancy/possibly type 1 blood sugar?
11.1 mmol/l or above
What is the HbA1c test?
HbA1c means glycosylated haemoglobin- glucose in the blood binds to Hb
Shows the average blood glucose level over the past 2-3 months
Target below 48
How often should a GDM mother have scans?
Every 4 weeks from 28-36 weeks gestation for fetal growth and amniotic fluid volume
What is it important to monitor in a diabetic woman?
BP/Urinalysis for protein to detect hypertensive disorders
Retinopathy- opthalmology review at around 11 and 36 weeks (type 1 and 2)
Nephropathy- ACR/PCR/24 hr urine (type 1 and 2)
What is diabetic retinopathy?
Chronically high blood sugar from diabetes damage to the tiny blood vessels in the retina. The retina detects light and converts it to signals sent through the optic nerve to the brain. DR can cause blood vessels in the retina to leak fluid or hemorrhage distorting vision. In its most advanced stage, new abnormal blood vessels proliferate on the surface of the retina- scarring and cell loss in the retina
What is diabetic nephropathy?
The kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn’t able to do its job as well- can lead to complete kidney failure
How is diabetic nephropathy diagnosed?
Albumin (protein) in urine
What is metformin used for?
reduces insulin resistance
increases peripheral utilisation of glucose
used in PCOS
What should you aim to keep the blood sugar at during labour?
Between 4-7 mmol/l
