DM in Pregnancy

Question 1

What are the 2 groups of patients?

Answer 1

1. Preexisting diabetes

2. Diabetic during/from being pregnant

Question 2

What are 4 complications of pre-existing diabetes?

Answer 2

1. Macrosomia (large babies) and associated traumatic delivery
2. Delayed organ maturation
3. Fetal growth restriction (IUGR- Intrauterine growth restriction)
4. Congenital Anomalies

Question 3

What organ is delayed in development with pre-existing diabetes in Mom?

Answer 3

Lung

Question 4

What congential anomalies are assocaited with pre-existing diabetes in mom?

Answer 4

1. Cardiac
2. Neural Tube
3. Sacral agenesis: Caudal regression

Question 5

What is the L:S ratio indicating fetal maturity for a healthy patient? What about for a diabetic mother?

Answer 5

2: 1
3: 1

Question 6

What should BS be kept at with pre-existing diabetes to avoid complications?

Answer 6

70-90

-They NEED PERFECT CONTROL

Question 7

What are fetal complications of gestational diabetes?

Answer 7

1. Macrosomia and associated traumatic delivery
2. Delayed organ maturation
3. FGR and IUGR

NO CONGENTIAL ABNORMALITIES

Question 8

When does gestational diabetes normally present?

Answer 8

Last half…3rd trimester

Question 9

What are the 2 circumstances of pre-exisiting diabetes?

Answer 9

1. Can be previously diagnosed
2. Present, but not yet diagnosed

-SO ALWAYS DO A FASTING BLOOD SUGAR ON PREGGO LADIES IN 1ST TRIMESTER

Question 10

When do you screen for gestational diabetes?

Answer 10

Beginning of the 3rd trimester or just before

-24-48 weeks gestation: Usually presents in last half of pregnancy

Question 11

What is the 1st step screening test for gestational diabetes?

Answer 11

1hr 50g Glucola test
No fasting (although better change of passing if you do fast), drink glucose (50g) in water and draw labs in 1 hour

Question 12

If the value of the 1hr 50G Glucola test is above what, do you have to move on and do the diagnostic test for gestational diabetes?

Answer 12

Over 140 (really 135)

Question 13

If their 1hr 50G Glucola test was 150, what’s next?

Answer 13

3 hour glucose tolerance test

Question 14

What is the loading dose for the 3 hour glucose toelrance test?

Answer 14

100G

-Remember, non-preggo it is 75

Question 15

What are the fasting, 1, 2, 3 hour values for the 3 hour glucose tolerance test in a preggo lady?

Answer 15

Fasting: 95
1 Hour: 180
2 Hour: 155
3 Hour: 140

Question 16

Is the 3 hour glucose tolerance test fasting?

Answer 16

YES (8 hours)

Question 17

So when do you say a lady has gestational diabetes?

Answer 17

If 2 abnormal values are found on the glucose tolerance test (now, it’s really just 1 value)

Question 18

White classification, what does A mean?

Answer 18

Gestational diabetes

Question 19

What is the difference between A1 and A2?

Answer 19

A2 requires insulin, A1 doesn’t

Question 20

So fancy wording for A1?

Answer 20

Abnormal GTT, normal values- Treat with diet and exercise, no insulin is needed

Question 21

Fancy wording for A2?

Answer 21

Abnormal GTT, abnormal values- Treat with diet and exercise, insulin is needed

Question 22

So you get a letter other then A for White classification, what does that mean?

Answer 22

Overt (pre-existing) diabetes

-Different letters dictate the severity of the underlying diabetes

Question 23

What is initial treatment for gestational diabetes?

Answer 23

1. Diet and exercise

2. If fasting or post-prandial values are still elevated–> Insulin

Question 24

What are the 3 components of antepartum management of gestational diabetes?

Answer 24

1. Serial US
2. Serial tests for fetal well being: NST, CST, BPP, Cord Doppler Studies
3. Maintain normal glucose levels (Euglycemic)

Question 25

Why isn't fundus measurement good enough with gestational diabetes?

Answer 25

Because fundus can also account for this like placenta, amniotic fluid, other crap floating around in your belly... whereas a US will tell us exactly how big baby is, which is what we are worried about (too big/too little)

Question 26

In a non-pregnant diabetic, what is goal for blood glucose?

Answer 26

150

Question 27

If you are prego, what are you blood sugar goals?

Answer 27

70-90 fasting, 2 hour post-prandial under 120

Question 28

What does brittle diabetes mean?

Answer 28

Even with treatment, sugars are all over the place and require treatment multiple times a day... most prego ladies with diabetes get diabetes like this

Question 29

During labor (intrapartum) what do you do for your diabetic patient?

Answer 29

If they require insulin....IV insulin at a rate of 0.5-2.0 units of insulin per hour, maintain glucose levels of 80-120

Question 30

Why do insulin requirements drop sharply after delivery?

Answer 30

Insulin antagonists from the placenta are no longer present

Question 31

True or False: Most insulin dependent diabetics do not need insulin for the 1st 48-72 hours after delivery

Answer 31

TRUE - Monitor glucose every 6 hours and treat if glucose goes over 150 - After that 24-36ish window, their insulin levels can go crazy again

Question 32

Do gestational diabetics need insulin post-partum?

Answer 32

No

Question 33

What do you do to test is a gestational dibetic returned to normal?

Answer 33

A 75****g GTT at 6-8 weeks post partum -Do the test for non-preggo since they delivered already

Question 34

What future monitoring is required for someone with gestational diabetes?

Answer 34

Yearly screening with fasting BS for dibetes

Question 35

Do patients with gestational diabetes have an increased likelihood of becoming diabetic later in life?

Answer 35

YESSS (this is different from HTN during pregnancy)

Question 36

True or False: History of previous gestational diabetes usually does not result in future pregnancies with gestational diabetes

Answer 36

FALSE

Question 37

True or False: History of previous gestational diabetes increases likelihood for future type 2 diabetes

Answer 37

TRUE

Question 38

What is recommended yearly for patients with a history of gestational DM?

Answer 38

Yearly FBS