Flashcards in Diabetes Type I and Gestational Diabetes Deck (20):
What is the pathophysiology of gestational diabetes?
Hormonal changes make cells less responsive to insulin. Placenta produces larger quantities hormones. Babies have increased risk of being large for gestational age, low blood sugar and jaundice
Describe gestational diabetes that occurs during first half of pregnancy?
Anabolic. Pancreatic beta cell hyperplasia causes hyperinsulinemia. Increased uptake and storage of glucose
Describe gestational diabetes that occurs during the second half of pregnancy?
Catabolic. Placental hormones block glucose receptors and cause insulin resistance: Increased lipolysis, Increased gluconeogenesis, Decreased glycogenesis. Increased glucose and amino acids for the fetus
What are risk factors for gestational DM?
family history, previous child >9, glycosuria, previous stillbirth, maternal age >30, obesity
What are adverse pregnancy outcomes of gestational DM?
excess amniotic fluid (polyhydraminos), birth trauma/operative delivery, increased risk of developing type II DM
What is the classic triad of diabetes presentation?
polyuria, polydipsia, polyphagia
What causes polyphagia associated with diabetes?
Mitochondria can’t get the glucose so metabolizes fat and protein in the body. The amount of glucagon stays the same. Liver convert the fat and protein into ketones for energy
What causes lack of energy associated with diabetes?
High levels of glucose in the blood but the cells are lacking because insulin isn't there to allow entry into the cells--->can't make energy
What are the stages of type I diabetes?
I Genetic Susceptibility,II Triggering, III Active autoimmunity, IV Progressive metabolic abnormalities, V Overt Diabetes, VI Insulin Dependence
What causes blurred vision associated with untreated diabetes?
glucose enters the fluid and distorts the light. goes away with controlled glucose levels
What lab results diagnose diabetes?
Fasting blood sugar (FBS) >126 on two separate occasions. Random plasma glucose >200. Oral glucose tolerance test >200. Glycosylated hemoglobin (HgA1C) >6.5%. Loss of C-peptide <0.8ng/dl. Urine dipstick testing- glucose/ketones in urine
What are the microvascular complications of diabetes?
Diabetic Retinopathy (most common cause of blindness in the United States). Diabetic Nephropathy (most common cause of renal failure). Neuropathy (usually legs/feet but can be autonomic e.g. erectile dysfunction)
What are the macrovascular complications of diabetes?
Cardiovascular Disease (CAD, MI,). Cerebrovascular Disease (TIA and Stroke), and Peripheral Arterial Disease
When should insulin dependent diabetics check their blood glucose?
fasting AM, before and after meals, before/during/after excercise, before bedtime
When are insulin pumps recommended?
recurrent severe hypoglycemia, wide fluctuations in blood glucose levels, suboptimal diabetes control, microvascular/macrovascular complications, or insulin regimen that compromises lifestyle
What is the glycemic index?
describes what happens after eating carbs. different types of carbs affect plasma glucose in variable ways. Ex: glucose drink results in rapid rise of levels whereas an apples results in a slower rise
How can a UA miss diabetic ketoacidosis?
urine may be negative for ketones if severe renal insufficiency exists. the test reacts strongly to acetoacetic acid, but not with beta hydroxybutyrate. In DKA, most of the ketones present are in the form of beta hyroxybutyrate
What should be included in the comprehensive annual exam of diabetics?
BP, fundoscopic exam, thyroid palpation, skin examination, neurological, foot examination
What labs should be included in the comprehensive annual exam of diabetics?
HbgA1C, lipid profile, LFTs, TSH, CMP