Additional Glycemic Concerns (Test 2)

Gestational Diabetes Mellitus (GDM)

•prolonged or repeated elevated blood glucose during pregnancy

•Onsets in pregnancy, not before (about 10% of pregnancies in the US)

Risk factors for gestational diabetes

•BMI >25

•Decreased physical activity

•PMH of hypertension, dyslipidemia, or CVD

•PMH of polycystic ovarian syndrome

•Prior pregnancy with GDM

•Recent history of insulin resistance or prediabetes

-HbA1c > 5.7%

-abnormal OGTT

pathophysiology of gestational diabetes

•Pancreatic beta cell dysfunction

•Delayed response of the beta cells to the glycemic levels

•Insulin resistance secondary to hormones

•Placental hormones- lactogen and growth hormone regulate insulin receptor signaling

•Maternal hormones- estrogen, progesterone, leptin, cortisol

higher risk of birth complications

Maternal glucose crosses the placenta leading to fetal hyperglycemia and increased anabolic insulin signaling (macrosomia) leads to what?

mother with gestational diabetes

GDM typitally resolves following delivery however it can increase the risk of CVD and type 2 DM

Baby with mom having gestational diabetes

increased risk of future obesity, T2DM, CVD

-risk factors need to be assessed early in pregnancy

-blood sugars should be closely monitored throughout

-OGTT for dx

What are the tests for gestational diabetes?

A1GDM

glycemia can be managed by diet

A2GDM

medications required for adequate glycemic control

acute hyperglycemia

-is a common presentation in the ambulatory, emergency department, and inpatient hospital settings

-Often associated with failure or insufficient glycemic control in patients with known DM, however not limited to patients with DM

stress hyperglycemia

acute illness causing acute hyperglycemia precipitated by release of stress hormones (NE, epinephrine, cortisol, growth hormone release inflammation)

prednisone, dexmethasone, methylprednisone

What are the prescription steroids associated with hyperglycemia and diabetes?

acute hypoglycemia

-low blood glucose, typically <70 mg/dL

-can be due to pharmacologic, alcohol, liver failure, critical illness, adrenal failure, non-islet cell tumors

pharmacologic precipitating factor of acute hypoglycemia

especially medications utilized for diabetes- metformin, glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter 2 inhibitors, etc

alcohol

inhibits gluconeogenesis in the body but does not affect glycogenolysis, leading to glycogen store depletion

liver failure

diminished glycogen stores

critical illness

glucose utilization exceeds glucose intake, glycogenolysis, and/or gluconeogenesis

adrenal failure

decreased glucose production and increased insulin sensitivity

reactive and fasting

Acute hypoglycemia can be categorized into what?

reactive

occurs post-prandial (blood sugar increase followed by large drop)

fasting

occurs in fasted state

symptoms of acute hypoglycemia

•Tremor or trembling

•Diaphoresis

•Palpitations

•Hunger

•Drowsiness, dizziness, confusion

•Paresthesia and asthenia

•Syncope

low blood glucose

What lab result will show acute hypoglycemia?

-MUNO, MONW (metabolically unhealthy non-obese, metabolically obese normal weight)

-MHNO (metabolically healthy non-obese)

-MUO (metabolically unhealthy obese)

-MHO (metabolically healthy obese)

What are the classifications of obese phenotypes?

Metabolic syndrome

•An accumulation of metabolic risks that significantly increase the risk of ASCVD, DM, CVA, and overall morbidity and mortality

•Common complications of obesity

Metabolic syndrome diagnostic criteria (you must meet 3)

•Waist circumference: >40 inches in men and 35 inches in women

•Elevated triglycerides: ≥150 mg/dL

•Reduced HDL: <40 mg/dL in men or 50 mg/dL in women

•Elevated fasting glucose: ≥l00 mg/dL or greater (or are taking glucose-lowering meds)

•Elevated blood pressure: ≥130 mmHg systolic of ≥85 mmHg diastolic

complications of metabolic syndrome

-cancer

-HTN

-polycystic ocary syndrome

-CV disease

-dementia

-non-alcoholic fatty liver disease

-visceral obesity

-hyperlipidemia

-T2DM

central adipostity

(intra-abdominal fat) is more strongly associated with the risk of metabolic complications than overall adiposity measures

waist-to-hip ratio

What is the hallmark measurement in metabolic syndrome?

patho of metabolic syndrome

increased risk of insulin resistance, inflammation, and oxidative stress

lifestyle changes, meds for DM, HTN

As future pharmacists, how do you think we treat metabolic syndrome?