39 terms

NTD309 - Chapter 5

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approximately what percentage of pregnancies develop gestational diabetes?
7
what does insulin do?
tells the cell receptors to open up to accept glucose, lowering blood glucose levels
what is the ideal blood sugar range, fasting glucose?
70-126
what happens when we haven't eaten in a while?
blood sugar gets low, glucagon is released from pancrease to stimulate liver to convert glycogen to glucose to release into the bloodstream.
diabetes is the ____ leading complicated in pregnancy
2nd
the different forms of diabetes
type 1, type 2, gestational
type 1 diabetes
results from the destruction of insulin producing cells of the pnacreas
type 2 diabetes
results in the body's inability to use insulin normally or to produce enough insulin
gestational diabetes
results from a developed CHO intolerance with the first onset during the second half of a pregnancy
what is the number one cause of gestational diabetes?
unknown
what does a normal insulin chart look like for a healthy pregnancy?
normal insulin levels exist, dipping lower initially and then rising throughout the first half; a dramatic increase occurs after week 20, and delivery (week 40) results in a severe drop
what does an insulin chart look like for a pregnancy including gestational diabetes?
insulin levels progress normally for the first half of pregnancy, but fail to rise high enough in the second half so that blood glucose levels skyrocket
what is gestational diabetes?
a condition in which the glucose level is elevated during pregnancy and disappears following delivery; occurs as a result of placental hormones blocking insulin, resulting in increased insulin resistance; there is not enough insulin to overcome this resistance
why does gestational diabetes only appear halfway through and disappears right at delivery?
insulin resistance doesn't occur until halfway through the pregnancy, so more insulin isn't necessary; when the placenta is birthed, its hormones go with it and insulin resistance goes away
what do women who develop gestational diabetes appear to be predisposed to?
insulin resistance and type 2 diabetes within five years of giving birth
some maternal adverse outcomes of gestational diabetes are:
cesarean delivery to prevent shoulder dystocia, increased risk for preeclampsia during pregnancy, increased risk of type 2 diabetes, hypertension and obesity later in life, and increased risk for gestational diabetes in a subsequent pregnancy
some adverse outcomes of gestational diabetes for the baby are:
stillbirth, spontaneous abortion, congenital anomalies, macrosomia, neonatal hypoglycemia/death, increased risk of insulin resistance, type 2 diabetes, high blood pressure and obesity later in life
preeclampsia
such high blood pressure that the kidneys start to fail, causing protein to leak into the bloodstream; can lead to coma and death
what happens with the baby's organs as a result of gestational diabetes?
it has a fully functional pancreas which also tries to clear out the glucose by producing tons of insulin; it keeps producing it at birth even though the glucose levels dramatically drop, resulting in neonatal hypoglycemia
neonatal hypoglycemia
low blood sugar at birth
risk factors for gestational diabetes
obesity (central), weight gain between pregnancies, underweight, older than 35, family history, history of macrosomic nerbown deliveries, chronic hypertension, SGA mom, previous gestational diabetes in pregnancy, diabetes in mom's mom during their pregnancy (LGA at birth), low fiber intake, high-glycemic load diets, and being one of the following ethnicities: native american, hispanic, african american, south or eat asian, pacific islander, or indigenous australian ancestry
low risk factors for gestational diabetes
younger than 25, not one of the risky ethnicities, no diabetes in first degree relatives, normal prepregnancy weight and normal weight gain during pregnancy, no history of glucose intolerance, no prior obstetrical outcomes
when does glucose screening occur?
during the 24-28th week of pregnancy
what is the first glucose screening?
a 50g oral glucose challenge test
what happens if the first glucose screening is elevated?
a 3-hour 100g oral glucose tolerance test is given
what does the 2nd glucose screening consist of?
an overnight fast of less than 95mg/dL, a 1 hour after glucose load of less than 180mg/dL, a 2 hour after glucose load of less than 155mg/dL and a 3 hour after glucose load of less than 140mg/dL
how is gestational diabetes treated?
diet and exercise, plus monitoring by testing blood 4 times a day (in the morning before breakfast + 1 hour after each meal) using blood glucose meter and test strips
why might someone have to test their blood sugar before bed?
the liver is still producing insulin so it could wreak havoc over night
what is the target level for a before breakfast test?
60-95mg/dL
what is the target level for 1 hour after starting a meal test?
less than 130mg/dL
ketones may appear in urine when ____
the body does not have enough glucose to meet energy needs
ketones are produced during prenancy due to:
not enough calories, too long between meals, not enough insulin
when are ketones tested?
every morning
how often should women with gestational diabetes eat?
every 3.5-4 hours, no more than 10 overnight
LGA
large for gestational age
what factors can raise glucose levels?
carbohydrate foods, psychological stress, physical stress (illness)
what factors can lower glucose levels?
physical activity, insulin, diabetes pills,
what kind of diet should be implemented?
whole grains and high fiber foods, limited intake of simple sugars, low gi foods (foods that don't greatly raise blood glucose levels), monounsaturated fats, three regular meals and snacks
what should be the largest meal?
lunch