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🔥+ reverses diabetes type 2 25 May 2020 Type 1 diabetes — For people with type 1 diabetes, frequent testing is the ... Accuracy of home blood sugar monitoring — Blood glucose meters ...

reverses diabetes type 2 Type 1 diabetes requires lifelong treatment once it develops. The body does not produce enough insulin, and blood glucose levels remain high ...

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Course #33401 - $60 • 15 Hours/Credits


Study Points

  1. Describe the pathophysiology, risk factors, screening, and treatment of type 1 diabetes, type 2 diabetes, gestational diabetes, and prediabetes.
  2. Explain how metabolic changes during normal gestation increase the risk for elevated blood glucose.
  3. List maternal and fetal risks of hyperglycemia during pregnancy.
  4. Identify future risks to the offspring of mothers who had diabetes during pregnancy.
  5. Describe principles of preconception counseling in women with pre-existing diabetes.
  6. Summarize the management of pregnancy in women with pre-existing type 1 or type 2 diabetes.
  7. Review studies and findings that provide rationale for the treatment of gestational diabetes.
  8. Define recommended blood glucose targets and frequency of blood glucose monitoring in gestational diabetes.
  9. Describe goals and guidelines for nutritional management of gestational diabetes.
  10. Identify the safety and efficacy of oral diabetic agents and insulin for use in gestational diabetes.
  11. Discuss interventions to prevent the development of gestational diabetes.
  12. Describe the obstetrical management of pregnancy complicated by diabetes.
  13. Describe maternal postpartum care for pregnancy complicated by diabetes.
  14. Discuss the care of the neonate born to the mother with diabetes.
  15. Identify important aspects of psychosocial care and follow-up for the woman with diabetes during pregnancy.

    1 . In normal glucose metabolism, where is unused glucose stored following the immediate postprandial period?
    A) The small intestine
    B) Muscle and liver tissue
    C) Fat tissue and pancreas
    D) Central nervous system

    DIABETES DISEASE PROCESS: A REVIEW

    Following the immediate postprandial period, unused glucose is stored in muscle and liver tissue as glycogen. The release of this stored energy is regulated by glucagon. Glucagon normally serves as the body''s pancreas cannot produce any of its own insulin for use by the body. If the individual with type 1 diabetes does not receive insulin from an outside source, he or she is likely to develop a life-threatening condition known as ketoacidosis. Patients with type 1 diabetes require insulin from an exogenous source to stay alive.

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    5 . Gestational diabetes complicates approximately what proportion of pregnancies?
    A) 0.1% to 0.5%
    B) 2% to 10%
    C) 20% to 30%
    D) 40% to 50%

    DIABETES DISEASE PROCESS: A REVIEW

    As discussed, GDM refers to diabetes that develops during pregnancy and complicates approximately 2% to 10% of all pregnancies [2]. It occurs more frequently among American Indian, Asian American, Hispanic/Latina, and Pacific Islander populations. Other risk factors for GDM include age older than 25 years, overweight/obesity, and personal history of GDM or family history of diabetes [9].

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    6 . How does normal pregnancy affect glucose metabolism?
    A) Placental hormones increase the mother''s insulin production.
    C) Normal pregnancy does not affect the mother''s metabolism of carbohydrate, fats, and protein.

    GLUCOSE METABOLISM DURING PREGNANCY

    Pregnancy is a time of hormonal fluctuation, altering a woman''s body can overcome excessive glycemia by increasing insulin production. In a healthy pregnancy, the mother''s risk for type 2 diabetes in later years.

    RISKS OF DIABETES IN PREGNANCY

    HELLP syndrome is a severe form of pre-eclampsia occurring in approximately in 5% to 12% of cases [17]. It can lead to liver hemorrhage, disseminated intravascular coagulation, pulmonary edema, kidney failure, and placental abruption. HELLP syndrome may develop after giving birth in women who had pre-eclampsia.

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    11 . Which of the following is NOT a fetal cardiac anomaly that may develop secondary to maternal diabetes?
    A) Cardiomyopathy
    B) Atrial septal defects
    C) Asymmetric septal hypertrophy
    D) Transposition of the great vessels

    RISKS OF DIABETES IN PREGNANCY

    Possible anomalies of the heart include asymmetric septal hypertrophy, transposition of the great vessels, ventricular septal defects, and/or cardiomyopathy. Approximately 30% of infants of mothers with diabetes present with one or more of these cardiac conditions [27].

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    12 . Shoulder dystocia
    A) is a minor obstetrical complication.
    B) always affects both of the infant''s head is delivered but the shoulder is unable to complete passage through the birth canal due to a discrepancy between the size of the fetal shoulders and the size of the pelvic inlet. Obstruction may affect one or both shoulders. Infants delivered after shoulder dystocia may experience brachial plexus injury, hypoxia, and even death. In addition to macrosomia, maternal obesity is also a risk factor for shoulder dystocia [31].

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    13 . What is the hypothesis of the fetal origins theory?
    A) GDM is caused by genetic factors in the fetus.
    B) Fetal hyperglycemia may be the cause of maternal GDM.
    C) Developmental overnutrition and metabolic programming play important roles in the early development of disease.
    D) Undernutrition during pregnancy initiates compensatory mechanisms in the fetus that lead to obesity later in life.

    RISKS OF DIABETES IN PREGNANCY

    The fetal origins theory provides an explanation of why exposure to hyperglycemia in the womb would predispose offspring to excess adiposity and metabolic disease later in life [36]. The theory hypothesizes that developmental overnutrition and metabolic programming play important roles in the early development of disease.

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    14 . The American Diabetes Association (ADA)recommends that women have what A1C level before attempting conception?
    A) Less than 2%
    B) Less than 6.5%
    C) Less than 10%
    D) Less than 15%

    PRECONCEPTION CARE FOR WOMEN WITH DIABETES

    The patient'' medications prior to conception. Medications that may be contraindicated in pregnancy include statins, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and some for 1 last update 25 May 2020 oral antidiabetic agents [40].The patient'' medications prior to conception. Medications that may be contraindicated in pregnancy include statins, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and some oral antidiabetic agents [40].

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    16 . If a patient with diabetes has preproliferative retinopathy or macular edema prior to pregnancy, she should
    A) have laser photocoagulation before conception.
    B) consider sterilization, as the risk of pregnancy is too great.
    C) be at low risk for progression of the disease during pregnancy.
    D) rapidly lower blood glucose levels in the month prior to conception.

    PRECONCEPTION CARE FOR WOMEN WITH DIABETES

    As such, a dilated retinal exam by an ophthalmologist is an important part of preconception care. If a patient has preproliferative retinopathy or macular edema, she should have laser photocoagulation to stabilize her retinal status before pregnancy [41]. In women with proliferative or severe nonproliferative retinopathy, the ADA recommends slowly lowering the blood glucose levels to near-normal over a six-month period before pregnancy is attempted [25].

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    17 . The oral contraceptive of choice for women with diabetes is
    A) the progesterone-only pill.
    B) low-dose combined estrogen plus progestin.
    C) high-dose combined estrogen plus progestin.
    D) Oral contraceptives are contraindicated in women with diabetes.

    PRECONCEPTION CARE FOR WOMEN WITH DIABETES

    When used as directed, oral contraceptives are 98% effective [13]. The oral agent of choice in women with diabetes is a low-dose combined the 1 last update 25 May 2020 estrogen plus progestin pill. These agents have not been associated with increasing insulin resistance, as the higher dose pills have. For postpartum women who are breastfeeding, it is safe to start low-dose contraceptives six to eight weeks after delivery [13].When used as directed, oral contraceptives are 98% effective [13]. The oral agent of choice in women with diabetes is a low-dose combined estrogen plus progestin pill. These agents have not been associated with increasing insulin resistance, as the higher dose pills have. For postpartum women who are breastfeeding, it is safe to start low-dose contraceptives six to eight weeks after delivery [13].

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    18 . According to the ADA, target pre-meal, bedtime, and overnight glycemic levels during pregnancy are
    A) 50–69 mg/dL.
    B) 60–99 mg/dL.
    C) 100–129 mg/dL.
    D) 130–149 mg/dL.

    MANAGING PRE-EXISTING DIABETES DURING PREGNANCY

    reverses diabetes type 2 teenager (👍 rice) | reverses diabetes type 2 normalhow to reverses diabetes type 2 for The ADA''s renal status is low, diabetic nephropathy during pregnancy poses other serious risks to both mother and fetus. Impaired renal function is a strong risk factor for fetal growth restriction, pre-eclampsia, and premature delivery. Even early nephropathy is associated with an increased for 1 last update 25 May 2020 risk for fetal growth restriction. There is usually a decline in the renal function of pregnant women with underlying diabetic nephropathy. As renal blood flow and the glomerular filtration rate increase by 30% to 50% during pregnancy, the risk for proteinuria increases.The ADA''s renal status is low, diabetic nephropathy during pregnancy poses other serious risks to both mother and fetus. Impaired renal function is a strong risk factor for fetal growth restriction, pre-eclampsia, and premature delivery. Even early nephropathy is associated with an increased risk for fetal growth restriction. There is usually a decline in the renal function of pregnant women with underlying diabetic nephropathy. As renal blood flow and the glomerular filtration rate increase by 30% to 50% during pregnancy, the risk for proteinuria increases.

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    25 . What lipid-lowering medications are approved for use in pregnancy?
    A) Statins
    B) Bile acid-binding resins
    C) Cholesterol absorption inhibitors
    D) None of the above

    MANAGING PRE-EXISTING DIABETES DURING PREGNANCY

    Not many cholesterol-lowering medications are safe for use during pregnancy. While statin medications are used in patients with diabetes, they are not safe during pregnancy. Bile acid-binding resins, such as cholestyramine, are the only approved lipid-lowering medications for use in pregnancy. The ADA recommends using fibric acids and niacin as secondary strategies in pregnant women who have triglyceride levels greater than 1,000 mg/dL [10].

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    26 . What is an adverse effect of maternal hypothyroidism on the fetus?
    A) Macrosomia
    B) Anal/rectal atresia
    C) Fetal hyperthyroidism
    D) Inhibited fetal brain development

    MANAGING PRE-EXISTING DIABETES DURING PREGNANCY

    Hashimoto disease, also known as autoimmune thyroiditis, is characterized by antibodies reacting against proteins in the thyroid gland and causing destruction of the gland itself, resulting in hypothyroidism. This can adversely affect glycemic control and lipid metabolism during pregnancy. Furthermore, maternal hypothyroidism can inhibit brain development and is associated with pregnancy loss and premature delivery [70].

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    27 . What is the safest treatment of hyperthyroidism during pregnancy?
    A) Radioactive iodine
    B) Levothyroxine sodium
    C) Propylthiouracil (PTU)
    D) Discontinuation of all anti-thyroid medications

    MANAGING PRE-EXISTING DIABETES DURING PREGNANCY

    reverses diabetes type 2 ankle swelling (👍 untreated) | reverses diabetes type 2 sugar levelhow to reverses diabetes type 2 for Propylthiouracil (PTU) is the safest anti-thyroid medication for use in pregnant women. Healthcare providers should closely monitor the effects of PTU and adjust dosages accordingly, as this drug can affect the fetal thyroid gland. Although radioactive iodine is a very effective treatment for other patients with hyperthyroidism, it is a contraindicated treatment during pregnancy [71].

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    28 . Which cardiometabolic risk factor appears to be the single greatest risk factor for the development of GDM?
    A) Obesity
    B) Hypertension
    C) Mild hyperglycemia
    D) Elevated total cholesterol

    GESTATIONAL DIABETES

    One study showed that the risk for GDM increased with the number of pregravid cardiometabolic risk factors [84]. According to this study, cardiometabolic risk profile could predict the risk for GDM as early as seven years before pregnancy. Obesity appears to be the single greatest risk factor. The combination of obesity with mild hyperglycemia was associated with the greatest overall risk. The study concluded that the pregravid cardiometabolic risk profile might help clinicians to identify high-risk women for primary prevention and early management of GDM [84].

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    29 . The HAPO study found
    A) the effects of maternal hyperglycemia cannot be reduced by treatment.
    B) a definitive cut-off point for maternal hyperglycemia and pregnancy outcomes.
    C) adverse events occurred at maternal glucose levels below those diagnostic for diabetes.
    D) a strong correlation between maternal glycemia at 12 to 18 weeks'' gestation
    C) At 24 to 28 weeks'' gestation

    GESTATIONAL DIABETES

    In pregnant women not known to have diabetes, the ADA recommends screening at 24 to 28 weeks''s insulin sensitivity, resulting in a decreased need for injections. Even so, continued research is necessary to determine the effects of calorie restriction during pregnancy on the future health of the child [16].

    reverses diabetes type 2 hba1c (🔴 mellitus nature journal) | reverses diabetes type 2 hypoglycemiahow to reverses diabetes type 2 for Although evidence-based guidelines for the optimal management of maternal obesity during pregnancy are lacking, the ACOG published a practice bulletin on obesity during pregnancy in 2015. The bulletin addresses clinical management questions about appropriate interventions before and during pregnancy, recommendations for weight gain, potential alterations to antepartum and intrapartum care, labor and delivery considerations, and the most effective postpartum care and strategies [117]. Additionally, experts recommend that pregnant women avoid excessive gestational weight gain, exercise moderately, and eat a healthy diet. Women should only attempt weight loss during pregnancy under the supervision of a qualified healthcare provider [16,25,113].

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    34 . When taken during pregnancy, metformin
    A) helps obese mothers to lose weight.
    B) may help decrease the risk for macrosomia.
    C) does not cross the placenta in significant amounts.
    D) has been proven to impact the offspring''s effect on the offspring during the growth years and later in life. Metformin may slightly increase the risk of prematurity [25].

    The Metformin in Gestational diabetes (MiG) trial was an important study that assessed the efficacy and safety of metformin in pregnancy. It included 751 women with GDM at 22 to 33 weeks''s diet before pregnancy appears to influence her metabolism during pregnancy, which may have important associations with a child''s pancreas, leading to hypoglycemia in the early postpartum period. Macrosomic and preterm infants are at the greatest risk for hypoglycemia.

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    39 . Which of the following statements regarding breastfeeding and diabetes is TRUE?
    A) Mothers with diabetes should not breastfeed.
    B) Only mothers with good glycemic control should breastfeed.
    C) Breastfeeding offers health benefits to both mother and child.
    D) The insulin requirements for nursing mothers are about 25% higher during lactation

    OBSTETRICAL AND POSTPARTUM MANAGEMENT OF PREGNANCY COMPLICATED BY DIABETES

    Breastfeeding offers many health benefits to women, including those with diabetes. Furthermore, it offers immediate and future benefits to both mother and child. Healthcare providers who work with patients with diabetes should advocate for breastfeeding and support institutional policies that facilitate breastfeeding.

    Lactation increases the caloric needs of the mother [141]. The initial energy demands of breastfeeding exceed the prepregnancy demand by approximately 650 calories per day. This decreases by about 100 calories in the second half of the first year of breastfeeding. The ADA recommends that breastfeeding mothers with diabetes consume at least 1,800 calories per day to meet the requirements for lactation while allowing for gradual weight loss [16]. Stored fat meets some of this need, providing about 150 calories per day. Therefore, an increase of about 500 calories per day over the prepregnancy allowance may be needed [16].

    In addition, the insulin requirements for nursing mothers are about 25% lower during lactation. In GDM, breastfeeding may be associated with lower rates of postpartum diabetes and lower fasting glucose levels [13,141]. In fact, lactation results in more favorable cardiometabolic profile among postpartum women in general, including women with GDM. This may protect against metabolic syndrome later in life [141].

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    40 . Which of the following is the most appropriate first-line treatment for depression during pregnancy?
    A) Antidepressant medication
    B) Encouraging the patient to seek social support
    C) Assisting the patient to achieve improved glycemic control
    D) Referral to a mental health professional for psychotherapy

    OBSTETRICAL AND POSTPARTUM MANAGEMENT OF PREGNANCY COMPLICATED BY DIABETES

    As noted, the hormonal fluctuations of pregnancy can increase the risk for depression, and severe depression is associated with poor glycemic control and ultimately poor pregnancy outcomes. Psychotherapy is the first line of treatment for depression during pregnancy. Referral to a mental health professional is appropriate. The safety of antidepressant medications during pregnancy is questionable, as some have been linked to congenital anomalies and infantile withdrawal syndrome. In the most severe cases, the benefits of using antidepressant medication may outweigh the risks, as fetal exposure to untreated major depressive disorder is significant. Balancing the risks to the fetus exposed to severe maternal depression and to the medications to treat depression is necessary [10].

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