Answer to quiz GDM

 Answer

1)  The answers are A, C, D, and G. Remember from the lecture we talked about the risk factors for gestational diabetes. To help you remember the risk factors think of the word “MOMMA”. Maternal age > 25, Obese or overweight (BMI >25), Macrosomia (fetal) previous babies greater than 9 lbs, Multiple pregnancies, A history (previous diagnoses of gestational diabetes or family history of diabetes)

2)   The answer is D. Gestational diabetes is a form of diabetes that develops during pregnancy, usually during 2nd or 3rd trimester.

3)   The answers are B and C. Insulin is a HORMONE secreted by the beta cells found in the pancreas. It influences or causes cells to take in glucose from the blood. Option A and D are incorrect statements about insulin.

4)   The answer is D. If a patient has a positive 1 hour glucose tolerance test (which is administered at about 24-28 weeks), a 3 hour glucose tolerance test is ordered. If this test is abnormal, it is used to diagnose gestational diabetes.

5)   The answer is B. This is the only correct statement in the scenario. It is important the mother monitors her blood glucose level regularly and tries to maintain an euglycemic level (normal blood glucose level): 70-95 mg/dL fasting and <140 mg/dL 1 hour after meals. In most cases, once the baby is delivered, the gestational diabetes will disappear, BUT at 6-12 weeks postpartum the mother will need to be reassessed for diabetes. Remember in the lecture, according to the CDC.gov 50% of women who are diagnosed with gestational diabetes will develop Type 2 diabetes later on. There are risks and complications associated with gestational diabetes such as pre-term labor, preeclampsia, hyper/hypoglycemia, macrosomia (large baby), hypoglycemia in baby at birth etc.

6)   The answer is D. The statement should read: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is LOW. This is majorly influenced by hormones such as estrogen, progesterone, HUMAN PLACENTAL LACTOGEN (hPL) and CORTISOL.

7)  The answer is B. Euglycemic means “normal” blood glucose level. Typically a normal blood glucose level is about 70-140 mg/dL. The only option that reflects a normal blood glucose level is option B: 82 mg/dL…Option A is HYPOglycemic, Option C is slightly HYPERglycemic, Option D is HYPERglycemic.

8)   The answers are B and C. Preeclampsia is a potential complication of gestational diabetes. It can cause hypertension (option B) and protein in the urine (option C). Option A is a normal blood glucose reading, option D is a normal finding during pregnancy, and option E is a normal finding (an abnormal finding would be positive glycosuria…meaning there is glucose leaking in the urine).

9)   The answer is A. Gestational diabetes places a patient at risk for urinary tract infections because the glucose can leak into the urine leading to infection (remember bacteria thrive on glucose). This scenario tells us the patient has uncontrolled hyperglycemia, which definitely puts her at risk for glycosuria (glucose in the urine). The physician should be notified if the patient reports burning on urination so a urine analysis can be performed. All the other options are normal findings in a pregnancy at this stage.

10).  The answers are B and C. The newborn is at risk for hypoglycemia and respiratory distress. When a baby of a mom, who has gestational diabetes, is still in utero there is a constant high supply of glucose. This causes the baby to increase its fat stores (producing a large baby) and create a lot of insulin to deal with the high glucose it is receiving from mom. BUT once the baby leaves utero, the glucose supply decreases but the baby still has a lot of insulin on board. This can lead to a drop in blood glucose (hypoglycemia) at birth. In addition, uncontrolled gestational diabetes can affect lung maturity in babies and this increases the newborn’s risk of respiratory distress at birth.

11).  The answers are C, D, and F. Remember the 3 Ps for hyperglycemia: Polyphagia (frequent hunger), polydipsia (frequent thirst), polyuria (frequent urination). Sweating, confusion, and anxiety are signs and symptoms of HYPOglycemia (low blood glucose).

12). The answer is C: 24-28 weeks gestation

13)    The answer is C. A test result >140 mg/dL for 1 hour glucose tolerance test requires that the patient take a 3 hour glucose tolerance test. This test will be used to diagnose if the patient has gestational diabetes.

14). The answers are B and C. Abnormal results for a 3 hour glucose tolerance test are: Fasting >95 mg/dL, 1 hour >180 mg/dL, 2 hour >155 mg/dL, 3 hour >140 mg/dL

15). The answer is D: <140 mg/dL

16). The answer is B. Patients who’ve had gestational diabetes are at high risk for developing Type 2 diabetes. She should first follow-up with her physician at 6-12 weeks postpartum for initial blood glucose testing. After this, she should follow-up 1-3 years for blood glucose testing since there is a high risk of her developing Type 2 diabetes.