Endocrinology Conference

8/6/2019 Endocrinology Conference

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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

Endocrinology Conference

Documents

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