Diabetes in special situations

Question 1

Complications of diabetes in pregnancy

Answer 1

stillbirth
neonatal death
major malformation
big baby (macrosmia)
premature delivery
C-section

Question 2

Why are pregnant women more susceptible to DKA?

Answer 2

pregnancy is a state of insulin resistance
pregnancy is a state of accelerated starvation
nausea and vomiting in pregnancy
lower buffer capacity

Question 3

Describe gestational diabetes screening

Answer 3

75g OGTT at 24-28 weeks in high risk individuals (obese, 1st degree relative with DM, hx of stillbirth or big baby >4.5kg, ethnic origin of high risk)

Question 4

Management of gestational diabetes mellitus

Answer 4

close obstetric management
glucose monitoring
diet, food diary, exercise
metformin
glibenclamide
insulin if:
- fasting glucose >7 and 6-6.9 if macrosomia/polyhydramnios present
- postprandial >7.8