Practice

Question 1

What OGTT, Polycose + HbA1c results would indicate GDM?

Answer 1

OGTT Fasting: >/=5.5 mmol/L
OGTT 2hr >/=9 mmol/L

Polycose 1 hr >11

HbA1c >=50 mmol/L

Question 2

Routine diabetes screening for low risk pregnant woman?

Answer 2

HbA1c with booking bloods. If normal HbA1c & no GDM risk factors, polycose at 24-28wk. Discuss option of diagnostic OGTT test.

Question 3

How often is a polycose falsely normal in women with GDM?

Answer 3

25%

Question 4

Clinical indications for OGTT after 30 weeks?

Answer 4

Macrosomia or polyhydramnios. If after 32wks, consult

Question 5

Risk factors for GDM? (11)

Answer 5

1. PCOS
2. Chronic hypertension
3. Steriod or antipsychotic meds
4. Family history of diabetes
5. Glycosuria
6. Macrosomia
7. HbA1c 41-19
8. Prev GDM/macrosomia/PET/perinatal loss/preterm birth
9. Over 30
10. Excessive weight gain in pregnancy
11. Ethnicity

Question 6

Meds for T1/T2DM for PET prevention?

Answer 6

5mg folic acid, Aspirin + calcium

Question 7

What are the glucose targets

Answer 7

Fasting <5
1hr <7
2hr post prandial <6-6.5
(nb T1D may have modified targets)

Question 8

When should metformin be avoided (4)?

Answer 8

If there is significant IUGR, ongoing maternal weight loss, PET or significant GI upset.

Question 9

Maternal complications of GDM (6)?

Answer 9

1. PET/Hypertensive disorders
2. Birth trauma
3. LSCS
4. UTI
5. Increased risk T2D
6. Need for IOL

Question 10

Are brands of insulin interchangeable?

Answer 10

No.

Question 11

Care for T1D intrapartum

Answer 11

Glucose/Insulin infusion and follow protocol for testing BSLs and adjusting rate

Question 12

Care for GDM (diet/metformin) intrapartum

Answer 12

Monitor glucose 2hrly

Question 13

What is the follow up for GDM patients postpartum?

Answer 13

HbA1c @ 3months PP, then annually

Question 14

Define hypoglycaemia:

Answer 14

CBG <4 (some say 3.5)

Question 15

Symptoms of hypoglycaemia (12)

Answer 15

Sweating, dizziness, rapid HR, shaking, anxiety, weakness/fatigue, confusion, irritability, hunger, pins and needles in lips/tongue, impaired vision, headache.

Question 16

Diet composition for diabetes:

Answer 16

<10% saturated or polyunsaturated fat
15-20% Protein
30% Fat
50% Carbohydrate

Question 17

How often should a woman change the needle on her pricker?

Answer 17

Every 2-4days

Question 18

Should a woman eat when she is taking short or long acting insulin?

Answer 18

Short

Question 19

What should women check for on an insulin vial?

Answer 19

Expiry date, cracks, floating particles

Question 20

Where should spare insulin be stored?

Answer 20

In the fridge, not in the door

Question 21

Diabetes diet basic advice

Answer 21

Healthy plate - 1/2 veggies, 1/4 protein, 1/4 carbs
Water for drinks
Don’t skip meals

Avoid foods high in saturated fat such as fatty meat, fried foods, chips, cream, mayonnaise, butter, coconut oil, coconut milk.

Avoid foods high in sugar such as lollies, chocolates, cakes, soda, cordial, sports drinks, energy drinks

You’re not eating for two, once you’re full you don’t need to force yourself to keep eating, healthy portion sizes are also important

Question 22

When does GDM usually develop (gestation)?

Answer 22

After 24wk

Question 23

What are the three forms of insulin?

Answer 23

1. Rapid and short acting (abdo)
2. Intermediate acting
3. Long acting (buttocks/thighs)

Question 24

What colour are humalog rapid acting and novorapid (rapid acting)

Answer 24

clear

Question 25

What colour are novomix (rapid + intermediate) and humalog mix (rapid + intermediate)

Answer 25

cloudy

Question 26

When should treatment regime be reassessed (how many readings out of range)?

Answer 26

10% of readings above treatment targets

Question 27

At what stage of pregnancy do women become more insulin resistant?

Answer 27

16-20wks

Question 28

What are the glucose targets intrapartum?

Answer 28

4-7

Question 29

BSL frequency intrapartum for T2D or GDM on insulin?

Answer 29

Hourly

Question 30

Growth scan frequency if diabetic but NO other risk factors

Answer 30

28+36wks

Question 31

How long should BSLs be monitored postnatally

Answer 31

48hrs (or until discharge)

Question 32

Symptoms of Hyperglycaemia

Answer 32

Extreme thirst, dry mouth, weakness, frequent urination, blurry vision, nausea, confusion, shortness of breath

Question 33

What are complex carbohydrates, give examples

Answer 33

Carbohydrates with more fibre + starch are complex carbs. High fibre: fruit, vegetables, beans, grains (e.g. quinoa, buckwheat, whole wheat pasta), nuts High starch: whole wheat bread, corn, oats, peas, rice

Question 34

What are simple carbohydrates, give examples

Answer 34

Simple carbs are sugars e.g raw sugar, fruit juice, soda, biscuits/cakes, some breakfast cereals

Question 35

What is the risk of 1st trimester hyperglycaemia for the fetus?

Answer 35

Congenital malformations

Question 36

Why does maternal hyperglycaemia cause macrosomia?

Answer 36

Insulin is a growth factor

Question 37

Why hire me? WHY BUY EXTRA MUFFINS

Answer 37

Want (the job + long term) Badgernet (experience) Experience Maori