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Diabetes
Maternal Child Test 4 PHCC
| Question | Answer |
|---|---|
| Type 3 diabetes | gestational |
| Type IV diabetes | abnormality in glucose tolerance caused by trauma or drugs |
| White's Classification B | maturity onset (TypeII), age 20 or older increased risk for hyperrtension, PIH, fetal anomalies and macrosomia |
| White's Classification C | Onset age 10-19 yrs and duration 10-19 yrs. Increased risk HTN, PIH, fetal anomalies and macrosomia |
| White's Classification D | Onset before age 10, duration > 20yrs, chronic HTN, benign retinopathy, and calcified leg vessels. Increased risk HTN, PIH, fetal anomalies and IUGR possible |
| White's Classification F | Kidneys. Diabetic nephropathy and proteinuria. Anemia, HTN, PIH, Preterm labor common, fetal anomalies and IUGR possible |
| White's Classification H | CAD, Congenital anomalies, and risk of fetal death |
| White's Classification R | Proliferative Retinopathy. Spontaneous abortion, intruterine and neonaltal loss, and congenital anomalies |
| Gestational Diabetes Classification A1 | glucose intolerance diagnosed during pregnancy amd managed by diet alone. Least risk of complications |
| Gestational Diabetes Classification A2 | glucose intolerance diagnosed during pregnancy managed by diet and insulin. Higher liklihood of macrosomia |
| White's Diabetic Classifications | are for pregestational diabetets |
| Effects of Diabetes on Insulin Requirements 1st 20 weeks. High estrogen and progesterone levels cause metabolic alterations | hypertrophy of pancreas and inc in beta cells. Suppressed gluconeogenesis Inc in insulin action in muscles and adipose tissue. The action of insulin is facilitated as a result of thses changes Lower amounts of insulin required N/V also contributes |
| Effects of Pregnancy on Inuslin Requirements 2nd Trimester | Food intake improves. Maternal glycogen stores increase. Increasein glycogen synthesis so more insulin is needed |
| Effects of Pregnancy on Insulin Requirements 2nd half of Pregnancy | Increase resistance to Insulin r/t inc levels of hPL r/t size of placenta.As placenta enlarges hPL inc |
| Effects of Insulin Requirements 2nd half of pregnancy part2 | insulinase breaks down maternal insulin. Free cortisols overide estrogen and progesterone resulting in metabolic catabolism of greater quantities of simple sugar that cross the placenta. |
| Maternal insulin does not cross placenta | But maternal glucose does. Baby makes its own insulin but cannot keep up with mothers glucose causing macrosomia |
| hPL | human placenta lactogen. Is in insulin antagonist and causes peripheral insulin resistance |
| Ketoacidosis | insulin does not increae to compensate for hPL, hyperglycemia results. Ketogenic fat increases and protein is broken down for maternal energy needs |
| Ketones Increase ='s | sodium decrease |
| Insulin requirements in Pregnancy | 1st trimester it decreases 2nd trimester increases third trimester increases again can be almost 4X pre pregnancy insulin needs. After birth quickly returns to prepregnancy levels in non breastfeeding mothers |
| N/V cause metabolic acidosis | shift from carb metabolism to fat metabolism causing an increase in ketoacids and subsequent decrease in sodium. Loss of sodium bicarb from vommiting decreases alkali reserves |
| S/S Diabetes in Pregnancy | subtle or asymptomatic 3 P's are also present in normal pregnancy. There can also be retinol changes that can lead to blindness |
| Dx of Gestational DM | Routine blood screening at 24-28 wks |
| Sullivan Test | 1 hour glucose screening test with 50g oral glusose. > 140 Glucose Tolerance Test Needed |
| Skip Sullivan Test and go straight to 3 hr GTT | if the 3 cardnal signs are present, obesity, family hx, An OB hx of LGA neonate, unexpalined stillborn, congenital anomalies, hydraminos, habitual abortions |
| 3 hr GTT | Client eats high carb diet (200g) for 2 days followed by fasting at midnight. In the morning 100g oral glucose. Blood levels drawn If two or more of the following are met or exceeded, GDM is dx |
| Blood Glucose Levels 3 hr GTT | fasting >105, 1 hr >190, 2hr > 165 3 hr >145 |
| Hemoglobin A1c | glycosylated hemoglobin good <9 Poor >12 |
| Recommended Weght Gain | 2-4 lbs/mo 1st trimester, 3-4 lbs/mo 2nd an d3rd trimester |
| Caloric Requirements | 30-40 Kcal/kg of IDEAL body wgt approx 2000 kcal 1st tri and 2500 2nd and 3rd. But calories should never be restricted during pregnancy |
| Protein Requirements | 1.5g/kg of IDEAL body wgt as compared to 0.8 non pregnant |
| Carb Intake | Complex carbs 50% of total calories no refined simple sugars |
| Oral Hypoglycemics | NEVER given during pregnancy. They cross the placenta and we have no way of testing fetus blood sugar |
| Insulin Regulation | regulated so FBS maintained between 60-90 and BG 30 minutes before meals and HS is 60-105 |
| Sample Insulin Dosing | Morning 2:1 NPH to regular (2/3 of total insulin)Evening: 1:1 NPH to regular (1/3 of total insulin) |
| Monitor Fetal Well Being | Ultrasound to estimate EDD and monitor growth, External Fetal Monitoring for placental functioning, |
| Amnio 36 wks | L/S (lung maturity) normalis 2:1 diabetics need to be slightly higher 2.5:3.1 |
| Maternal Estriol Levels | At 28-32 weeks a 24 hr urine for estriol shold be taken. should inc as pregnancy progresses drops='s placental insuffieciencyMothers with DM may have small placentas and levels may be low |
| AFP | 16-18 wks Diabetic mothers have higher risk of NTD |
| DM Pretnatal Care | Assess Blood Glucose, S/S hypo~hyperglycemia and FHT. Educate Mom how to monitor glucose and adminsiter insulin. Teach Mom an dfamily s/s hyper~hypoglycemia, perform external fetal monitoring, nutrition counseling |
| DM INtrapartum Care | Frequently deliver early, side lying vaginal delivery or c sect, maintain maternal glucose 80-100 with IV insulin |
| DM Postpartum Care | Assess Blood glucose, monitor hor Hemorrhage, infectin and PIH. Assist with breastfeeding, |
| Contraceptive Teaching DM | No oral contraceptives or IUD |
Created by:
margaretptz
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