Diabetes Quiz (August 2011)

1 What is diabetes mellitus?
Diabetes Mellitus is a condition in which the amount of glucose in the blood is too high because the body cannot use it properly due to a lack of insulin. Insulin is a hormone produced by beta cells, a subset of the cells in the islets of Langerhans in the pancreas (approx. 1-2% of the mass of the pancreas), that helps the glucose to enter the cells where it is used as fuel.

2 What are the three different types of diabetes?
Type 1 – where the body makes NO insulin, this must be treated by insulin injections
Type 2 – where the body makes some but not enough, or it doesn’t work properly. Can be treated by injections, tablets or diet
Gestational – occurs during pregnancy
3 What are 5 risks to the baby if a pregnant woman has diabetes?
· 3.5 times the rate of congenital abnormalities – neural tube defects, caudal regression, cardiac and renal anomalies (not GDM)
· IUGR (worse outcomes than macrosomic infants)
· IUD/Stillbirth/Miscarriage
· Macrosomia (often accompanied with chronic hypoxia)
· Hypoglycaemia
· Perinatal morbidity levels are 3.8times higher than babies born to non diabetic mothers.
· Transient Tachypnea of the Newborn (TTN
· Respiratory Distress (RDS)
· Polycythemia

4 Name 5 signs or symptoms of diabetes
• Increased thirst
• Urinating frequently – especially at night
• Extreme tiredness
• Weight loss
• Blurred vision
• Genital itching or regular episodes of thrush
• Slow healing of wounds


5 Katie has been taking regular insulin for her diabetes in her pregnancy. She is currently 39 weeks pregnant with her first child and is now 6cm dilated, following induction by ARM and syntocinon, she has an epidural for pain relief. What monitors and infusions would Katie be attached to?
CTG
Blood Pressure Machine/cuff
Regular BM/blood sugars
Syntocinon infusion
Epidural bag infusion
Normal Saline infusion
Insulin Pump
Dextrose infusion
6 Name 5 long term complications of diabetes
Cardiovascular disease (heart problems)
Retinopathy (eye problems)
Neuropathy (nerve problems including sexual disfunction)
Nephropathy (kidney problems)
Necrobiosis Lipoidica Diabeticorum (Skin disorder)
Mastopathy (lumps in breasts)
Musculoskeletal conditions

7 Sally is a G2 P1 at 28 weeks and 1 day gestation who has been taking insulin since she was 4 years old. She is on a CTG monitor as wondered if her waters had broken, nothing was seen on speculum examination. After 20 minutes the trace is as follows, No contractions, Baseline 155bpm, Variability approximately 5bpm, No accelerations or decelerations at present. What are your thoughts on the CTG.
That it needs to be kept on longer for a true reading but nothing is abnormal at present. It may be a sleepy trace, variability is slightly reduced but this is normal for someone on insulin, the baseline is the high end of normal but she is 28 weeks so this is normal for the gestation

8 What is a Hb1Ac test?
A blood test. In the blood stream are the red blood cells, which are made of a molecule, haemoglobin. Glucose sticks to the haemoglobin to make a 'glycosylated haemoglobin' molecule, called haemoglobin A1C or HbA1C. The more glucose in the blood, the more haemoglobin A1C or HbA1C will be present in the blood. Red cells live for 8 -12 weeks before they are replaced. By measuring the HbA1C it can tell you how high your blood glucose has been on average over the last 8-12 weeks. A normal non-diabetic HbA1C is 3.5-5.5%. In diabetes about 6.5% is good.
If the woman’s HbA1c level in the first trimester is less than 8% there is a 5% chance of a fetal abnormality, if it is above 10% there is a 25% of an abnormality
9 Katie has just given birth to baby Samuel at 38 weeks gestation he weighs 3.8kg. What needs to be done for Samuel?
Normal postbirth stuff ie labels, and check for abnormalities
Keep warm
Feed ASAP
Check prefeed BMs starting before the second feed until you have three good results in a row.
10 What is DKA?
Diabetic ketoacidosis (DKA) occurs when there is consistent high blood glucose levels. This happens because of a lack of glucose entering the cells where it can be used as energy. The body begins to use stores of fat as an alternative source of energy, and this in turn produces an acidic by-product known as ketones.
Bonus Who is at risk of gestational diabetes?
Any pregnant woman. Women are more at risk if they:

• have a 1st degree family history of type II (adult-onset) diabetes
• are over the age of 35
• are obese
• have previously given birth to a macrosomic baby
• have previously given birth to a baby born with an abnormality
• have previously had a stillbirth late in pregnancy
• have persistent glycosuria