Diabetes Mellitis
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| Diabetes Mellitus | An endocrine disorder of CHO metabolism. Results in inadequate production or utilization of insulin.
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| Diabetes-4 major signs and symptoms | Polyuria, Polydipsia, Weight Loss, Polyphagia
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| Type 1 diabetes | 1.Beta cell destruction results in absolute insulin deficiency. 2. Thought to be caused by autoimmune disorder. 3. Onset- childhood-young adult
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| Type 2 diabetes | 1.Decreased secretion and increased resistance to insulin. 2. results in partial insulin deficiency. 3. Most Common. 4. develops gradually. 5. Associated with aging, obesity, abdominal fat, sedentary lifestyle, HTN, 5. Onset- Adulthood
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| Gestational Diabetes | CHO intolerance with 1st onset in pregnancy. '
Control by diet or insulin. 2-5% of women. Glucose regulation returns to normal after birth
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| OUTCOME for Gestational Diabetes | Excellent glucose control throughout pregnancy. Absence of maternal blood vessel disease.
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| Gestational Diabetes Maternal Risk HYDRAMNIOS | Occurs in 10-20% of women with diabetes
Results in fetal hyperglycemia and excessive urination
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| Gestational Diabetes Maternal Risk PIH | Occurs more frequently in diabetic pregnancies, especially when diabetes-related vascular changes exist.
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| Gestational Diabetes Maternal Risk KETOACIDOSIS | Due to hyperglycemia, insufficient insulin and increased lipolysis.
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| Gestational Diabetes Maternal Risk LABOR DYSTOCIA | 1.Birth injuries maternal and fetal due to macrosomia. 2. Increased for C/S. 3. Diabetes related vascular changes exist.
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| Gestational Diabetes Maternal Risk INFECTION | 1. Glycosuria creates environment favorable for bacterial growth. 2. Monilial Vaginitis 3. UTI's include Cystitis and Pyelonephritis
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| Gestational Diabetes Maternal Risk RETIONPATHY | 1. Progressive changes in blood vessels in the eye with risk for retinal hemorrhage
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| Gestational Diabetes Fetal/ Neonatal Risk CONGENITAL ANOMALLIES | 1. Related to hyperglycemia in 1st trimester.2. Affects about 5%-10%, major cause mortality3. Increase in cardiac, CNS, skeletal anomalies. 4. Sacral agenesis-unique to IDMs.
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| Gestational Diabetes Fetal/ Neonatal Risk ALTERED FETAL GROWTH | 1.Macrosomia with hyperglycemia/ hyperinsulinemia 2. IURG if vascular disease perfusion
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| Gestational Diabetes Fetal/ Neonatal Risk RDS | High levels fetal insulin inhibit surfactant production
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| Gestational Diabetes Fetal/ Neonatal Risk HYPERBILIRUBINEMIA POLYCYTHEMIA/ | 1. Excess RBCs in response to fetal hypoxia 2. Results in excess bilirubin
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| Gestational Diabetes Fetal/ Neonatal Risk HYPOCALCEMIA | 1. the cause is poorly understood. 2. Watch for increased irritability, tetany
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| Gestational Diabetes Fetal/ Neonatal Risk HYPOGLCEMIA | 1. Seen in neonate when maternal source of glucose removed and neonate's hyperinsulinemia still present.
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| Preterm Birth | Early delivery as intervention for decreased fetal well-being.
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| Perinatal death | Most often related to poor placental perfusion due to vascular impairment.
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| Birth injury | related to macrosomia
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| Diagnosis 1 HOUR Glucose TEST (50 G oral glucose) Positive | >130-140 then need to take 3 hour glucose test (100 g oral glucose)
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| Diagnosis 1 HOUR Glucose TEST ( 50 G oral glucose) Negative | <130-140 then routine prenatal care is needed.
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| 3 HOUR OGTT (100 G oral glucose) Positive | if 2 or more fasting reading > 95 mg/dl
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| 3 HOUR OGTT (100 G oral glucose) Negative | if 2 or more fasting readings < 95 mg/dl.
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| During the 1st trimester the need for Insulin often ___________ | decreases
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| In the second and third trimester the need for insulin | increases
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| After the placenta passes the need for insulin | abruptly drops
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| The risk for ketoacidosis is _________ for pregnant women vs. nonpregnant. | higher
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| List 4 Maternal risks with Diabetes and pregnancy. | 1. Hydrammios
2. Pre-eclampsia-eclampsia
3. Hyperglycemia.
4. Retinopathy.
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| True or False - Ketoacidosis usually develops rapidly. | False. It usually develops slowly but if left untreated it can lead to coma and death for mom and fetus.
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| The lab values for diagnosis of gestational diabetes are equal to or above: Fasting ? mg/dl 1 hour ? mg/dl 2 hour ? mg/dl | Fasting 95 mg/dl
1 hour 180 mg/dl
2 hour 153 mg/dl
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| S&S of hypoglycemia present in new born _______ post birth | 1-2 hours
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