Gestational and T1D Flashcards
Diabetes Type 1
- MOA
- are oral agents effective in tx?
- autoimmune disease that destroys the pancreatic beta cells causing absolute insulin deficiency . NO INSULIN PRODUCED!
- NO! they are ineffective! Insulin therapy is required!
Diabetes Type 2
-MOA
-MOA: decreased insulin release and insulin resistance(lack of insulin receptors), glucose cant get into the cells and glucose levels rise.
T1D
- age at onset
- presentation
- dx in children and young adults, bimodal distribution: 1st peak 4-6years of age, 2nd peak 10-14years of age.
- Presentation: polydipsia, polyuria, weigth loss even though polyphagia, hyperglycemia(most common) and ketonemia, DKA(second), may be silent (asymptomatic)
What is osmotic diuresis that occurs with DKA? Tx of DKA?
- high glucose levels spill into the urine taking water, Na, and K along with it causing polyuria and dehydration.
tx: IV fluids, insulin, management of intercurrent illnesses, infection.
Triad of Hyperglycemia
what are some other sx?
- polyuria
- polydipsia
- polyphagia
other sx:
-fatigue, blurred vision, pruritus,
Dx of Diabetes
- Fasting Blood sugar greater than 126 on two separate occasions.
- Random Blood sugar greater than 200mg
- A1C greater than 6.5%
- Urine Dipstick test (+ for glucose and ketones) (glucose starts spilling into the urine when serum glucose is greater than 180.)
How to differentiate between T1D and T2D?
- T1D: will have pancreatic autoantibodies
- Insulin and C-peptide levels:
- -High fasting insulin and C-peptide levels suggest T2D.
- -low levels of insulin and c-peptide suggest T1D.
Diabetes Management
- balancing act, reach target glycemic goals
- insulin treatment
- support
- pt and family education short term and long term management.
- -disease process
- -insulin
- -blood glucose testing
- -testing for ketonuria
- -hypoglycemia
- diet and exercise
Self-monitoring blood glucose, who is it for?
- all patients with DM who use insulin
- most patients who take other glucose lowering medications.
Therapeutic goals fo glycemic controls
- Adults: less than 7% A1C
- Older adults: less than 7.5% A1C
- Complex/intermediate health: less than 8.0%
- very complex/poor health: less than 8.5%
Pediatric Pts:
- 13-19: 7.5%
- 6-12: greater than 8%
- toddlers: less than 8.5% but greater than 7.5%
Insulin replacement therapy
- Multiple daily injections:
- -long acting insulin w/ premeal boluses of rapid or short acting insulin
- Premeal bolus based on:
- pre-meal blood glucose
- estimated amount of carbs to be consumed
- expected level of exercise after the meal
Lab evaluation of T1D
- HbA1C
- fasting lipid profile
- liver function test (LFT)
- TSH
- Celiac disease screening
- Kidney profile
- -serum creatinine and GFR
- -urine albumin to creatinine
- -UA
Gestational Diabetes GD)
- MOA
- how many weeks in does this occur?
MOA: insulin receptors do not function properly. Hormonal changes(from placenta) make cells less responsive to insulin, leading to insulin resistance.
*moms insulin doesnt cross the placenta but her glucose does. Baby produces more insulin to counter extra glucose crossing the placenta leading to insulin resistance in mom and therefore hyperglycemia.
-20-24th week of pregnancy
Moms with GD typically have ____ babies.
-macrosomia…“fat” baby, increased birth weight
Risk factors for GD
- Age, women over 25
- Family hx (if close family member has type 2)
- weight: being overweight before pregnancy
When do we screen pregnant women for GD?
What tests do we use?
What might the results indicate?
- 24-28weeks, unless showing signs of DM then screen sooner.
- *Glucose Challenge Test: 50g of oral glucose, wait one hour and redrawn blood glucose.
- blood glucose above 130 requires a 2nd test for dx.
-3hr glucose tolerance test; done in AM after overnight fast. 100g oral glucose, glucose drawn 1hr, 2hr, and 3hr
**having at least two instances of abnormal blood glucose levels at any hour indicates GD.
–Positive values:
Fasting greater than 95
1hr greater than 180
2hrs greater than 155
3 hrs greater than 140
what is shoulder dystocia?
when baby shoulders too big to move through the birth canal. Obstetrical emergency.
Hypoglycemia in the baby? when/why might this happen?
-low blood sugar shortly after birth. Baby is used to recieving large amounts of glucose from the mother, their own insulin production is high.
Why might baby be jaundice after birth?
-perhaps d/t high levels of insulin production which tends to produce extra RBC in utero, after birth BRC break down = bilirubin.
DM may cause stillbirth or death in baby, true or false?
True. :( if GD goes undetected a baby has increased risk of stillbirth or death as a newborn.
Complications for mom d/t GD
- preeclampsia: HTN, edema, proteinuria during pregnancy
- polyhydramnios: excess amniotic fluid around the baby
- operative delivery (c-section)
- -d/t macrosomia
- -GD isnt a reason to do c-section
-T2D or Gestational diabetes in another pregnancy
Tx of GD
- control BS; diet and exercise
- women who dont achieve adequate glycemic control may start insulin–FBG greater than 95 or one hour post-prandial BG greater than 130, two hour glucose greater than 120 on two or more occasions
*insulin is FIRST LINE rather than other oral anti-hyperglycemia agent during pregnancy.
Optimal Glycemic Goals of GD
- preprandial
- 1hr post meal
- 2hr post meal
- preprandial: less than 95mg/dl
- 1hr post meal: less than 140
- 2hr post meal: less than 120
After delivery women rarely require insulin in the postpartum period, true or false?
Does breastfeeding improve glycemic control?
Women with GD should be tested for diabetes how long after delivery?
- True, insulin resistance quickly resolves and so does the need for insulin.
- yes, breast feeding improves glycemic control.
- 6-8weeks after delivery
