MNT 1: GDM and complications

GDM occurs in _% of US pregnancies

8-10

risk factors for GDM

obesity, family history of DM, PMH of GDM, baby >9#, native american/asian/black/hispanic

how is normal pregnancy a state of insulin resistance?

greater mobilization of glucose and lower insulin sensitivity related to contra-insulin effect of placental hormones

therefore, food intake results in higher and prolonged high blood glucose levels

GDM pathophysiology

-Increased mobilization of glucose to provide substrate for

anabolic reactions for fetal growth/dev

-Decreased insulin sensitivity due to an increase in insulin antagonist placental hormones

in GDM, reduced beta cell fx and/or insulin resistance involved so they secrete less insulin in response to glucose load

maternal complications of gdm

preeclampsia, pre-term delivery, c-section, greater risk of future t2dm

preeclampsia

HTN, edema, albuminuria, headaches and can be accompanied by organ damage

neonatal complications of gdm

macrosomia, disproportional enlargement of trunk and shoulders, hypoglycemia after birth, long-term incr risk of t2dm and obesity

why can babies born from gdm pregnancies be hypoglycemic after birth?

baby is used to high glucose from mom, so it produces high insulin in utero

may need to provide supplemental glucose for first couple days

gdm screening for non-high-risk

24-28 weeks

glycemic goals for gdm

preprandial <95

1hr postprandial <140

2hr postprandial <120

DRI for carbohydrates in pregnancy

at least 35% of kcal, or 175g in a 2000 kcal diet

CHO is usually less well-tolerated at which meal in GDM?

breakfast, bc of increased cortisol and growth hormone

MNT for GDM includes (meals)

small, frequent meals and snacks: 3 meals a day plus 2-4 snacks

reevaluate glucose tolerance ____ weeks postpartum

6-12

contributing factors to hypoglycemia

not eating enough CHO or skipping/delaying meals

drinking too much alcohol without enough food

incr physical activity

being sick

inaccurate insulin dose

causes of nocturnal hypoglycemia

exercise without CHO

failure to have adequate evening snack

too much evening insulin

bedtime blood glucose target

90-150 mg/dL

dawn phenomenon

hyperglycemia in morning caused by hormones following normal circadian rhythms (cortisol, growth hormone) stimulating gluconeogenesis

mismatch between insulin and glucose causes hyperglycemia

MNT for dawn phenomenon

reduce CHO at HS snack or incr insulin dose

somogyi effect

rebound hyperglycemia

early morning hyperglycemia induced by hormonal response to hypoglycemia during the night

MNT for somogyi effect

incr CHO at HS snack or reduce insulin dose

dehydration is a result of ____, and a cause of ____

DKA; HHS (hyperglycemic hyperosmolar syndrome)

why is DKA higher risk in those taking SGLT-2 inhibitors?

SGLT-2 inhibitors are diuretics designed to cause incr glucose output in urine, so this can exacerbate polyuria from hyperglycemia and worsen dehydration

HHS (hyperglycemic hyperosmolar syndrome) is usually related to

dehydration and/or infection

blood glucose in DKA vs HHS

~400 in DKA, >600 in HHS

dehydration in DKA vs HHS

more severe in HHS, represents a cause instead of a result