Term
| Diabetes increases the incidence of: |
|
Definition
Vaginal candidiasis
Sexual Dysfunction: anorgasmia |
|
|
Term
| Insulin resistance is associated with: |
|
Definition
| Polycystic Ovarian Disease |
|
|
Term
| Insulin and Estrogen: Estradiol |
|
Definition
| Increases adipocyte insulin binding |
|
|
Term
| Insulin and Estrogen: Metformin, TZD's |
|
Definition
| Drugs that affect insulin sensitivity also affect ovarian function |
|
|
Term
| Insulin and Estrogen: Postmenopausal Hormone Replacement Therapy |
|
Definition
| Reduces glycated hemoglobin levels |
|
|
Term
| Effects of Polycystic Ovarian Syndrome |
|
Definition
- Irregular Menses
- Masculinization
- Obesity
|
|
|
Term
| Polycystic Ovarian Syndrome is more prevalent in: |
|
Definition
|
|
Term
| Fertility and Polycystic Ovarian Syndrome |
|
Definition
- Infertility and 1st trimester spontaneous abortion are common with Polycystic Ovarian Syndrome
- Metformin therapy has shown to improve both
|
|
|
Term
| What drug has shown to improve infertility and 1st trimester spontaneous abortion in women with Polycystic Ovarian Syndrome? |
|
Definition
|
|
Term
| What is the risk with contraceptive use in diabetic women? |
|
Definition
- Estrogen and increased glucose plasma levels will both increase the risk of thrombosis
- Combination OCP's may not be appropriate for many fertile diabetic women
- Progestins may promote weight gain and increase blood glucose
- Barrier methods are ideal, but have poor compliance
|
|
|
Term
| Keys to successful pregnancy in diabetic women |
|
Definition
- Tight glycemic control 3-6 months before they get pregnant
- Centralized intensive care
- Intensive fetal monitoring and prenatal diagnosis (amniocentesis)
|
|
|
Term
| Before a women gets pregnant, assess her risk of vascular complications, such as: |
|
Definition
- Renal Disease: pre-existing renal disease is a relative contraindication to pregnancy
- Retinal Damage: even minor pre-existing retinal disease may be aggravated
|
|
|
Term
| What insulins should be used and what is the schedule during pregnancy? |
|
Definition
Basal (NPH, Ultralente)
Post-Prandial (Regular, Lispro) - TID or QID |
|
|
Term
| Fetal Effects of Maternal Hyperglycemia |
|
Definition
- Spontaneous abortion
- Fetal malformations
- Growth abnormalities
- Alveolar surface abnormalities
- Big Baby Syndrome (late pregnancy diabetes - gestational)
|
|
|
Term
| At delivery, baby should be evaluated for: |
|
Definition
hypoglycemia
hyperglycemia (rare) |
|
|
Term
| Gestational Diabetes is defined as: |
|
Definition
| Glucose intolerance or diabetes that is first diagnosed during pregnancy and resolves after delivery or loss of pregnancy |
|
|
Term
| Risk factors for Gestational Diabetes |
|
Definition
- Polycystic Ovarian Syndrome
- Obesity
- History of Gestational Diabetes or previous big baby
- Family history of diabetes (T2DM primarily)
|
|
|
Term
| Detection/diagnosis of Gestational Diabetes |
|
Definition
Immediate testing (Fasting Plasma Glucose) upon confirmation of pregnancy for women with high risk (PCOS, obesity, etc.)
High risk women (previously negative) and average risk women should have Oral Glucose Tolerance Test between 24 and 28 weeks
|
|
|
Term
| Gestational Diabetes Diagnosis: What is the test and what are the parameters? |
|
Definition
Oral Glucose Tolerance Test (possibly Gold Standard)
100 grams of solution
Patient Instructions:
- test to start in early morning
- no food or drink other than water for ~ 12 hrs
- no cigarettes for 12 hrs
|
|
|
Term
| When should women with Gestational Diabetes be screened post-partum and what are we looking for? |
|
Definition
- Women with Gestational Diabetes should be re-screened at 6-12 weeks postpartum and thereafter
- They are high risk patients for T2DM
|
|
|
Term
| Gestational Diabetes Treatment |
|
Definition
Insulin
Glyburide
Acarbose |
|
|
