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Gestational Diabetes
| Question | Answer |
|---|---|
| Pregestational diabetes and patients with these risk factors should be screened early in pregnancy. | 1. previous history of diabetes or gestational diabetes. 2. Obesity, BMI >30 3. abnormal glucose metabolism |
| What are the mechanisms that lead to increased circulating glucose? | Increased insulin resistance and increased glucose metabolism by the liver. |
| Percentage of pregnant women with diabetes | 6-7%, 90% of these are gestational diabetic |
| Recommended percentage of carbohydrate, fat, and protein in the diet | carb 40% fat 40% protein 20% |
| What is the goal blood sugar level during labor? | 110 mg/dL |
| Population of pregnant women who should be screened for diabetes | All pregnant women |
| This molecule can be dangerously low during the resolution of acidosis and should be monitored carefully as well as included in resuscitating fluids. What molecule is this and why is it low? | K, insulin causes K to move into cells, as the body goes into ketoacidosis more of this accumulates in the blood and is lost through osmotic diuresis. Then as insulin is given to treat the ketosis K is transported into the cells leaving the serum K low. |
| First line intervention for newly diagnosed gestational diabetes. | What is nutritional therapy |
| C section may be considered to avoid birth trauma if EFW is greater then...... | What is 4500 gms |
| Proper time in pregnancy to screen women for gestational diabetes. | Between 24 and 28 weeks |
| Insulin resistance peaks at what gestational age | 30 weeks |
| Two major outcomes improved by the treatment of gestational diabetes | 1. reduction in the number of LGA babies. 22% to 13% 2. reduction in the rate of pre-eclampsia 18% to 12% |
| What is the mechanism of action of glyburide? | Binds to beta cells and increases insulin secretion and also increases the sensitivity of peripheral tissue to insulin. |
| What is the timing of delivery recommendation for pregestational diabetics? | Delivery before the due date. In well controlled not before 39 weeks. If indicated prior to 39 weeks amnio to document fetal lung maturity. |
| Name of the person who developed classification used for diabetes during pregnancy | Priscilla White |
| These are the main hormones that contribute to insulin resistance. | hpl (human placental hormone), progesterone, ACTH, TNF alpha |
| Percentage of women with gestational diabetes who will develop diabetes later in life | 50% |
| What is the standard screening test and follow-up to diagnose gestational diabetes? | The 1 hr 50 gm glucose test, followed by the 3 hr 100 gm test |
| How often should a woman who has a history of gestational diabetes be screened for diabetes after pregnancy? | every 3 years |
| Effects of insulin | signals cells to uptake glucose, decreases gluconeogenesis, increase glycogen formation, increase lipid synthesis, etc. |
| Give the fasting, 1 hr, and 2 hr post postprandial blood sugar goals | 90, 140, and 120 |
| MOA of metformin? | Inhibits glucose absorption, inhibits gluconeogenesis, and stimulates uptake by peripheral tissue. |
| Only medication used to treat gestational diabetes that is not known to cross the placenta | Insulin |
| What does the fetal heart tracing look like in a mother with diabetic ketoacidosis? | recurrent late decelerations with minimal variability. |
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