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Endocrinology ConferenceGestational Diabetes
Kashif Shaikh MD
PGY2 Internal Medicine
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Ou tline of Presentation
Case Disc ussion
Definition
PathophysiologyEpidemiology
Complications
Screening and DiagnosisTreatment and Management
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R eason for Cons u ltation:
Gestational DiabetesHPI
35 year old AAF G1P0 with PMH significant for LEEPproced u re in 1992, was admitted to OB/ GY service on03 / 10 / 22 for Cervical Cerclage placement, d ue toshortened cervix discovered on trans-vaginal US. Oneweek prior to admission, she was fo und to have 1ho u r glucose of 194 on 50gm Gl ucose challenge test
Du ring the same admission, she was managed forpost-cerclage pre-term labor with Magnesi um Su lfate,Indocin and Betamethasone.
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R eview of Systems: +ve for GE R D sx and poly u ria;PMH
HSV infection of GU tract GER D
PSH LEEP 1992 Uterine Polypectomy
FH MI in mother at the age of 52 Father had Stroke at the age of 66 One uncle with known history of Diabetes Type 2
SH
Negative for tobacco/EtoH
/Dr
ugsAllergies
NKDAMedications
Pre-natal vitamin
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Labs CBC and BMP within normal limits
HbA1c of 5.5 Her pre prandial FS BG ranges b / w 86-104 Her post prandial FS BG ranges b / w 165-204
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Definition of Gestational Diabetes
Any degree of gl ucose intolerance with onsetor first recognition d u ring pregnancy
In 1997, American Diabetes Associationincluded Type 2 Diabetes diagnosed d u ringpregnancy
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Pathophysiology
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Complications in Infant of a DiabeticMother
Spontaneo us Abortions
CNS Deformities
Muscu loskeletalDeformitiesCongenital Heart Defects
Macrosmia, which canlead to sho u lder dystocia,bone fract u re and nervepalsies d u ring delivery
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Normal Pregnant Women
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Screening and Diagnosis:Who will yo u screen?
High R isk Obesity, Age>25, Family History of Diabetes,
previo us Gestational Diabetes, Hispanic, NativeAmerican Indian, Asian and African Americans.
Screen at first pre-natal visit; if negative, screenagain at 24-28 weeks of gestation
Low R isk In the absence of above risk factors Screen at 24-28 weeks of gestation
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Screening and Diagnosis:How will yo u screen?
Ou tside US: 1 step gl ucose tolerance test with75gm or 100gm of oral gl ucose
In US: 2 step method with 50gm gl ucosechallenge test. If >130mg / dl, it is followed byoral gl ucose tolerance test
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ADA recommendations:2 Step Approach
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Hyperglycemia and PregnancyOu tcome (HAP O 2008)
Prospective, blinded, m u ltinational observationalst udy which incl uded 25000 pregnant women
It el ucidated the relationship between maternalglucose levels and adverse perinatal o u tcomes
Failed to show maternal glycemic controlthreshold for s uch o u tcomes and firm diagnostic
criteria and treatment goalsIt validated the findings of Pima Indians from1980
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1 ho u r vs 2 ho u r Post Prandial Gl ucose
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Breakfast 1 H R PP glucose
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Macrosomia
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Birth Weight v / s risk of Type 2Diabetes
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Indications for Ins u lin Therapy in GDM
Fasting blood s ugar of > 90 mg / dl and / or
1 ho u r postprandial blood s ugar
of > 120 mg / dl
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Physiological Ins u lin Secretion Profile
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Human Ins u lin V/ s Monomeric Ins u lin
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Lispro Ins u lin
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Post Prandial Hyperglycemiacomaprision between Lispro and
R eg ualr Ins u lin
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1 Ho u r PP Blood gl ucose
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Change in HbA1c
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Insu lin Antibody R esponse
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Aspart Ins u lin
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Post Prandial Gl ucoseAspart V / S R eg u lar Ins u lin
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Antibody R esponseAspart V / S R eg u lar Ins u lin
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Malformations are related to gl ucoseand Not type of Ins u lin
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Insu lin Algorithm: NPH 3 times a dayAspart or Lispro between meals and
snacks
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Insu lin Adj ustments
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R eferences