1. When does insulin resistance in pregnancy begin?
In the 2nd half of pregnancy
Hormones cause increased insulin resistance
2. What happens in the diabetic pregnant woman?
She is unable to increase insulin production and fails to meet the diabetogenic stress of
advancing pregnancy
Cells are starved so they start fat breakdown for energy
3. Who should be screened for gestational diabetes?
All pregnant women regardless of risk
Screen at each prenatal visit
4. 1 hr GTT
Done between 24-28 wks
Nonfasting
5. When is the 3 hr GTT done?
If the 1 hr is abnormal
Eat high CHO diet for 3 days and then fast overnight
6. What should you ask about when assessing for GDM?
,Polydipsia
Polyuria
Polyphagia
7. What is the key to success with GDM?
Compliance; involve the pt actively in care to accomplish this
8. What is essential in GDM management?
Strict glucose regulation
Done with insulin and dietary control
9. Why is insulin the drug of choice?
Some oral hypoglycemic agents are contraindicated in pregnancy
10. Meals in GDM
3 meals, 3 snacks
11. What is the most important snack?
Bedtime snack
need protein & complex carbs to prevent hypoglycemia overnight
12. What should blood glucose be at?
70-100 after fasting
< 120 2 hrs after meals
, 13. How do you evaluate fetoplacental functioning?
1) Serum alpha feroprotein screening
2) Assess fetal growth and activity
3) Fundal height
4) Nonstress test
14. When should you offer alpha feroprotein screening?
16-20 wks
15. When should nonstress tests be done?
Weekly at 28 wks
Twice weekly at 32 wks
16. L/S ratio of an IDM
3
1 because amniocentesis may be falsely elevated in a diabetic
Normal is 2
1
17. What should you teach to the woman with GDM?
1) Effects of diabetes
2) Home glucose monitoring
3) Begin exercise gradually
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