Diabetes in pregnancy all except:
Insulin resistance improves with pregnancy Carbohydrate metabolism during pregnancy:- Insulin resistance increases as the pregnancy progresses Abnormalities of carbohydrate metabolism occurs frequently during pregnancy and between 1% and 3% of all pregnant patients will show glucose intolerance. The most impoant reason that pregnancy uncovers the diabetic tendencies of asymptomatic women is the progressive increase in insulin resistance that occurs during gestation. Other reasons for the diabetogenic tendency of pregnancy are increased lipolysis and the alterations in gluconeogenesis that normally occur. During pregnancy a given dose of insulin has a greater hypoglycemic effect when administered in the first trimester than in the last. The insulin resistance occurs mainly because of the antagonistic effect of placental human chnriottic sonzatornammotropin. Insulin destruction by the kidney and placental insulinases as well as the antiinsulin effect of other hormones(coisol, estriol, progesterone) produced in large amounts during pregnancy also contributes to insulin resistance. Periconceptional counselling of the diabetic patient :? Inadequate blood sugar control often results in higher incidence of first trimester aboion, fetal congenital abnormalities, fetal macrosomia, polyhydramnios, and still bihs. But if the blood sugar is strictly controlled before conception and during the pregnancy the frequency of these abnormal outcomes approaches that of non diabetic population. It is impoant to emphasize that the time of highest risk of fetal malformations is during the periconceptional period and the period of organogenesis and that the risk can be greatly reduced by adequate glycemic control before pregnancy and during early pregnancy. Screening for diabetes during pregnancy :? The best screening test for gestational diabetes is the measurement of plasma glucose 1 hour after ingesting 50 g of glucose. The results are interpreted as:- Plasma glucose > 140 mg/c11 ---> the patient may have gestational diabetes and requires fuher testing Plasma glucose < 140 mg/d1 --> patient is not at risk Patients with abnormal screening test should be given a 3 hour glucose tolerance test. Glucose tolerance test. Normal values for 3 hour GTT are given below. If two or more of these values are abnormal, the patient has gestational diabetes. If only one value is abnormal, the patient cannot be diagnosed as having gestational diabetes. Upper limits of Normal for the 3 hour Glucose tolerance test during the pregnancy Fasting 96 mg/dl (5.3 nmol/L) One hour 172 mg/dL (9.6 nmol/L) Two hours 156 mg/dL (8.49 nmol/L) Three hour 131mg/dL (7.31 ninon) Timing of the screening The best time to screen is between 24 and 30 weeks of gestation.
Glucose challenge test is done between 24-28 week
50 gm of sugar given as screening test
Insulin resistance improves with pregnancy
Diabetes control before conception is impoant to prevent malformation