diabetes in pregnancy

Question 1

type 1 diabetes mellitus

Answer 1

• absolute insulin deficiency- typical onset

Question 2

type 2 diabetes mellitus

Answer 2

• insulin resistance- decreased insulin production- onset > 30y, may occur before- strong association with obesity

Question 3

gestational diabetes mellitus

Answer 3

diabetes first identified in pregnancy, typically resolves following birth (patient at risk for type 2 after)may be due to reduced (maternal) tissue sensitivity to action of insulinrepresents 90% of diabetes in pregnancy cases

Question 4

estrogen

Answer 4

increase = increase in cortisolinsulin antagonistplacenta produces

Question 5

progesterone

Answer 5

insulin antagonistplacenta produces

Question 6

human placental lactogen

Answer 6

insulin antagonistplacenta produces

Question 7

cortisol

Answer 7

makes glucose available to fetusinsulin antagonist

Question 8

antepartum gdm screening

Answer 8

risk assessment for ALL women at first visitscreen ALL women 24-28 weeks

Question 9

antepartum gdm screening: fasting blood sugar value

Answer 9

> 126 = gdm

Question 10

antepartum gdm screening: random blood sugar

Answer 10

> 200 = gdm

Question 11

antepartum gdm screening: 1 hour gtt (how & what)

Answer 11

chug glucose; 1 hour after finishing, test.> 140 = move to 3 hour> 175 = go straight to endocrinologist

Question 12

antepartum gdm screening: 3 hour gtt (how & what)

Answer 12

takes 4 hours and fasting!- draw blood, chug glucose- draw blood @ 1, 2, 3 hours after

Question 13

fetal kick counts (when & what)

Answer 13

@ 24 weeks, daily through delivery

Question 14

fetal echocardiogram (when & what)

Answer 14

initial HbA1c elevated20-22 weeks?

Question 15

bpp (when & what) type i dm

Answer 15

32 weeks through delivery

Question 16

bpp (when & what) type ii dm

Answer 16

40 weeks through delivery

Question 17

bpp (when & what) iugr, preeclampsia

Answer 17

26 - 28 weeks through delivery

Question 18

non-stress test

Answer 18

biweekly?

Question 19

contraction stress test

Answer 19

if bpp not available?

Question 20

polycythemia

Answer 20

Increased number of erythrocytes per volume of blood- may be caused by large placental, fetus, or maternal-fetal transfusion- may be attributable to hypovolemia resulting from movement of fluid out of vascular into interstitial compartment

Question 21

glucose levels to maintain during labor+ how often+ when to ketone

Answer 21

80 - 120 mg/dl plasma70 - 110 mg/dl whole blood (capillary)assess glucose q 1-2 hours (q 2-4 hours for gdm)assess ketones periodically and for glucose > 200 mg/dl

Question 22

hyperglycemia s/s

Answer 22

• increased appetite, thirst (unusual)- loss of weight, strength, stamina- leg cramps, muscle fatigue- nausea, vomiting

Question 23

hypoglycemia s/s

Answer 23

• increased appetite- sweating- loc, irritability, headache- palpitations- weakness, lethargy

Question 24

hypoglycemic episode IV response

Answer 24

discontinue IV insulin (glucose

Question 25

diabetic ketoacidosis (what is it)

Answer 25

metabolic acidosis (pH

Question 26

diabetic ketoacidosis s/s

Answer 26

- hyperventilation- mental lethargy- dehydration- hypotension- abdominal pain, nausea, vomiting- fruity odor breath- blood glucose levels

Question 27

postpartum gtt

Answer 27

75 g 2 hour by postpartum week 6 to 8