NURS 4500 Class #3 DIABETES

Question 1

What are the risk of GDM for the pregnant person and fetus/newborn

Answer 1

1. 2x risk of hypertensive disorders (pre-eclapsia)
2. Infection
3. Large for geatational age
4. Trauma and injuries during birth
5. Macrosomia, caesarian birth, shoulder dystocia, birth trauma, prematurity
6. Fetal hypoglycemia, IUGR, intrauterine fetal death, fetal lung immaturity
7. Neonatal hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia

Question 2

What are risk factors of developing GDM

Answer 2

1. > = 35 y/o
2. BMI of 30 or above
3. Prediabetic
4. High risk group
5. Parents or siblings with T2DM
6. Personal hx of GDM
7. Previous infant > 4.0kg birthweight (macrosomia)
8. Currently on corticosteroid medication
9. Acanthosis nigricans or PCOS

Question 3

When do we screen for GDM

Answer 3

24-28 weeks

*if risk factors for type 2 diabetes, screen at initial prenatal visit with A1C
*if normal result, screen GDM at 24-28 weeks with 50g OGTT

Question 4

What is the normal number of

Random non fasting 50g OGTT

1hr PG ????? Is normal

Answer 4

Less than 7.8

Question 5

When 1hr PG is greater or equal 7.8 mmol/L, what is the next step?

Answer 5

need to continue to step 2: 75g OGTT

Question 6

What is the number of PG that is indicator pf gestational diabeter

Answer 6

PG of greater than or equal 11.1

Question 7

What is the glocose target of GDM when fasting?

Answer 7

< 5.3 mmol/L

Question 8

What is the glucose target after 1-hr postprandial (PP)

Answer 8

< 7.8 mmol/L

Question 9

What is the glucose target after 2-hr postprandial (PP)

Answer 9

< 6.7

Question 10

What is the noaml BMI

Answer 10

18.5-24.9

Question 11

What is the normal weight gain

Answer 11

25-35 (lbs) / 11.5-16 (kg)

Question 12

What is the FASTING glycemic target

Answer 12

3.8-5.2 mmol/L

Question 13

What is the glycemic target 1 Hr PP

Answer 13

5.5-7.7 mmol/L

Question 14

What is the glycemic target 2h postprandial?

Answer 14

5.0-6.6 mmol/L

Question 15

What are the ANTEPARTUM management of GDM

Answer 15

1. Diet
2. Exercise
3. Monitot blood glucose levels
4. Weight gain according to BMI

+ pharmacological therapy
+ fetal surveillance
+ induction may be offered between 38-40 weeks depending on circumstance

Question 16

Management of GDM during INTRAPARTUM

Answer 16

1. Monitor glucose closely, keep between 4-7 mmol/L
2. Hydration (may require IV fluids)
3. Insulin may be required
4. Motinoring of uterine activity & FHR

Question 17

Management of GDM POSTPARTUM

Answer 17

1. STOP insulin & diabetic diet
2. Encourage chest/breastfeeding for at least 4 months!
3. Should have screening for T2M during the 6 weeks to 6 months PP
4. Education re: planning for another pregnancy

Question 18

It’s pathogenesis is a group of metabolic diseases chracterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both

Answer 18

T2DM

Question 19

What is the folic acid recommendation for diabetic pts

Answer 19

1mg daily x 3 months prior to pregnancy and for the 1st trimester, then reduce to 0l4mg for the remainder of the pregnancy

Question 20

What is the optimized glucose management prior to pregnancy of pt w diabetes

Answer 20

A1C of less than equal to 7.05

Question 21

How often should diabetic patients have prenatal visit during term 1 & 2

Answer 21

Every 1-2 weeks

Question 22

Frequency of prenatal visit of diabetic patients during term 3

Answer 22

1-2x each week

Question 23

When does Daily Kick counts should be started

Answer 23

26 weeks!

Question 24

How often is fetal assessment done at 36 weeks till birth?

Answer 24

Every week

Question 25

At 28 weeks to 36 weeks

Answer 25

Every 3-4 weeks