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 NEW NEW Q: DM in pregnancy  



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Author16 Posts
  #1

1. Pregnant woman cane in to the office with random blood glucose 14.8 mmol/l, Which of the following should be done

1. Do a 3 hr OFTT 100 gm

2. Fasting blood glucose

3. 2 hour OGTT 75 gm at 2 hr

4. start on insulin

5. diet control

6. start oral hypoglycemic agent

7. return to a OFTT (oral glucose tolerance test) with 50 gm



Good luck to all of you !

It was in my last Board exam and I screw up very bad. See who can answer this right !

Simple and see this every day but miss it and screw up BAD !









  #2

It should be OGTT, woman came in, 14.8 x 20.3=295 mg/dl glucose (sorry for using SI unit)


  #3

She has DM, no need for screening tests anymore. I guess insulin is the answer.


  #4

Insulin


  #5

Sure. Insulin.


  #6

Right on, Insulin

Random blood glucose over 200, you go ahead give insulin.

Thanks



  #7

thats right. give her insulin. no more testing needed.


  #8

other criteria :
fasting glucose >126 --2 times
postpradian >200--2 time



  #9

Hello,
I just registered in this seemingly friendly website.
Just to add two other circumstances in which the diagnosis of GDM is made without need to further 3-hr 100 gr OGTT:
First when the one-hour 50 gr OGTT result is more than 200, and second once the FBS is 126 or greater.
Thanks,


  #10

Dr. Surfer,

I don't think you can make the diagnosis of FBS is 126 or greater for a pregnant woman as gestational diabetics.

I was trained under the guy who wrote the book on gestational diabetics !


  #11

A fasting plasma glucose level >126 mg/dL (7.0 mmol/L) or a casual plasma glucose >200 mg/dL (11.1 mmol/L) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge. In the absence of this degree of hyperglycemia, evaluation for gestational diabetes mellitus in women with average or high-risk characteristics should follow one of two approaches:




  #12

A fasting plasma glucose level > 126 meets the threshold for the diagnosis of diabetics,

IF CONFIRMED ON A SUBSEQUENT DAY !!!!!!!!!!!!!!!!!!


  #13

A fasting plasma glucose level >126 mg/dL (7.0 mmol/L) or a casual plasma glucose >200 mg/dL (11.1 mmol/L) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge. In the absence of this degree of hyperglycemia, evaluation for gestational diabetes mellitus in women with average or high-risk characteristics should follow one of two approaches:

One-step approach: Perform a diagnostic oral glucose tolerance test (OGTT) without prior plasma or serum glucose screening. The one-step approach may be cost-effective in high-risk patients or populations (e.g., some Native-American groups).

Two-step approach: Perform an initial screening by measuring the plasma or serum glucose concentration 1 hour after a 50-g oral glucose load (glucose challenge test [GCT]) and perform a diagnostic oral glucose tolerance test on that subset of women exceeding the glucose threshold value on the glucose challenge test. When the two-step approach is employed, a glucose threshold value >140 mg/dL (7.8 mmol/L) identifies approximately 80% of women with gestational diabetes mellitus, and the yield is further increased to 90% by using a cutoff of >130 mg/dL (7.2 mmol/L).

With either approach, the diagnosis of gestational diabetes mellitus is based on an oral glucose tolerance test. Diagnostic criteria for the 100-g oral glucose tolerance test are shown in Table 1, below. Alternatively, the diagnosis can be made using a 75-g glucose load and the glucose threshold values listed for fasting, 1 hour, and 2 hours (Table 2, below); however, this test is not as well validated for detection of at-risk infants or mothers as the 100-g oral glucose tolerance test.




  #14

Gestational diabetes(GDM) is defined as glucose intolerance of variable degree with onset or first recognition during the present pregnancy. It can be screened by drawing a 1-hour glucose level following a 50-g glucose load, but is definitively diagnosed only by an abnormal 3-hour OGTT following a 100-g glucose load.




  #15

Despite the FBS is >126, most OB Doc will confirm the diagnosis with further testing in real life !


  #16

start insulin






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