2009 student’s worksheets - xtec. · pdf filestudent’s worksheets maria...

STUDENT’S WORKSHEETS

MARIA ASUNCIÓN ALONSO MONFERRER IES LES VINYES 1

2009

1.1.1 Activity: Warm-up

In groups, read the cards, discuss with your partners and classify the cards according to the groups below. Glue the cards on a poster which will be displayed on the wall.

A. Diabetes mellitus.

B. Diabetes mellitus type I

C. Diabetes mellitus type II

D. Gestational Diabetes

In general, patients of type ? Diabetes are carrying extra weight and, if they lose even a modest amount of weight, their blood sugars may come back down to normal.

Endocrine pancreas works properly, while cell insulin receptors are irreversibly damaged

The body's ability to make insulin fails pretty quickly and blood sugars rise rapidly

The symptoms come on relatively quickly. Patients may just get a history of frequent urination, increased thirst, blurred vision, tiredness for a couple of weeks.

Hyperglycemia. They need to be on insulin from the start.

It last few months 85% of people with diabetes suffer from type?

The patients take pills to get the blood sugar under control.

It is a condition typically seen in adults, those who are overweight, strong family history of this disease.

It is primarily a disease of children before adulthood.

Patients, who have milder elevations of blood sugar, may have very mild symptoms that only become more prominent later in life.

The immune system is triggered to begin attacking cells in the body that make insulin.

They have diabetes because their body stops making insulin

You do have insulin circulating. But it is not used efficiently and it is not reversible.

It is a disease of elevated sugar in the bloodstream, sugar called glucose

Patients could use small devices. They have a small catheter that goes under the skin and can stay there for up to 7 days. They give updates every five minutes. So it will show a trend.

Many people are on insulin pumps so they don't have to give themselves the shots

The fasting blood glucose levels are over 130 mg/dL

The cause is unknown, but it is thought that some hormones increase insulin resistance



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1.1.2 Activity: Previous Knowledge. Diabetes mellitus

You are going to watch an interactive power-point. Be prepared to participate in the activity.

� What is Diabetes mellitus?

� Types of Diabetes mellitus

� Intermediate states of hyperglycemia

� Symptoms and complications

� Treatment



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1.2.1 Activity: Poster Checks

Now, let’s review the posters displayed on the wall that you created in the “Warm-up” activity.

� Notice how the poster has changed according to the knowledge you have acquired. Write down how the poster structure has changed. You will have to hand out your report.

� Be ready to describe your poster in plenary



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1.2.2 Activity: Preparing for video interview

You’ve got gapped transcript about Diabetes mellitus, which should be filled in after having watched a recorded interview.

� Read the gapped transcript about Diabetes “video interview”.

� In groups of three, try to fill in the missing information.

The video will be on the screen the next session. (1.3.1 Activity)

Gapped transcript: Maryland Health Today

Ellen Beth Levitt: Welcome to Maryland Health Today. I'm Ellen Beth Levitt.

More than 20 million people in the United States have diabetes. But with

advances in understanding and treatments, there are many new options to help

them successfully manage the disease, and we'll learn about them on the show

today. My guest is Dr. Tom Donner, a diabetes expert and director of the Joslin

Diabetes Center at the University of Maryland Medical Center. Dr. Donner is

also an associate professor of medicine at the University of Maryland School of

Medicine. Welcome to the show.

Thomas W. Donner, M.D.: Thanks for inviting me.

Ellen Beth Levitt: First of all, could you explain what diabetes is?

Thomas W. Donner, M.D.: ………………………………………………….

………………………………………………………………………..

Ellen Beth Levitt: I guess there are different types, right?

Thomas W. Donner, M.D.: That's right. There are two main types of diabetes

Type 1. ………………………………………………………………………………………………………………………………………………………………………………………… .………………………………………………………………………………….



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Type 2 ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

Ellen Beth Levitt: Could you tell us more about the role of insulin? Our bodies produce insulin and then what is its role.

Thomas W. Donner, M.D.: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

Ellen Beth Levitt: Is this sugar that comes from what we eat or is it a natural sugar that the body produces?

Thomas W. Donner, M.D.: …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

Ellen Beth Levitt: Why is it so important to regulate sugar?

Thomas W. Donner, M.D.: High levels that are high for a long time can cause problems.

Ellen Beth Levitt: What kind of problems?

Thomas W. Donner, M.D.: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Ellen Beth Levitt: It also contributes to heart disease and stroke.

Thomas W. Donner, M.D.: Diabetes is risk factor of heart disease and stroke, upwards of two to four fold increased risk of those complications.

Ellen Beth Levitt: If you have too much sugar in the blood, does it do damage the organs?



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Thomas W. Donner, M.D.: That's right. It's a complicated process. But sugars will tend to hook on to proteins. They're the building blocks of all tissues in the body. It causes them to become less flexible and changes their function. So blood vessels get affected by high blood sugar. Blood ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

Ellen Beth Levitt: And it's because you don't have enough insulin produced by your body has stopped producing or the insulin's not working.

Thomas W. Donner, M.D.: That's exactly right.

Ellen Beth Levitt: So, what is hypoglycemia?

Thomas W. Donner, M.D.: When we talk about elevations in blood sugar, it's hyperglycemia. Hypoglycemia would be a low blood sugar reaction.

Ellen Beth Levitt: What would be the symptoms?

Thomas W. Donner, M.D.: Hyperglycemia, a number of symptoms ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

Ellen Beth Levitt: Are there any symptoms of diabetes then?

Thomas W. Donner, M.D.: Right. Unfortunately, as we talked about earlier, diabetes can have no symptoms at all. Patients may not really notice any symptoms at all. That's a problem because they can develop complications.

Ellen Beth Levitt: So there are about 20 million people that have diabetes that we know have diabetes, but there could be more that haven't been diagnosed.

Thomas W. Donner, M.D.: That's right. Then, there's a condition called Pre-diabetes. ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..



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Ellen Beth Levitt: Why do they have the highest rates?

Thomas W. Donner, M.D.: If you put a graph like this of the United States and showed obesity rates, they would be similarly high in those states. Those states have the highest obesity rates. Plus, states like Florida, there's an older population. And diabetes is also a disease that increases in frequency as people get older.

Ellen Beth Levitt: How does Maryland stack up?

Thomas W. Donner, M.D.: Maryland is about in the middle. We're about in the middle of the U.S. population.

Ellen Beth Levitt: Why do you think the rate is going up so dramatically?

Thomas W. Donner, M.D.: I think most of us believe that the main cause is that we as a population are becoming heavier and less physically active. As we become more advanced technologically, we don't have to do as much physically. We work at our desks for much of the day. Even the children are spending more time in front of the television playing video games. So inactivity is a major contributor to the development of diabetes.

Ellen Beth Levitt: Do we know why there is that connection?

Thomas W. Donner, M.D.: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

Ellen Beth Levitt: You mentioned symptoms earlier, do these symptoms come on suddenly or is it a gradual process?

Thomas W. Donner, M.D.: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

Ellen Beth Levitt: The type one diabetes, is that really strike in childhood?

Thomas W. Donner, M.D.: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….. So, we're sometimes challenged



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to figure out what type they have, but there are now blood test that we can now do that can measure the immune system that attacks cells in the body that make insulin. We can measure those antibodies and determine whether they have type one or two.

Ellen Beth Levitt: Is that what is believed to be the cause of type one? That your body produces antibodies against the normal process?

Thomas W. Donner, M.D.: Yes. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Ellen Beth Levitt: You were talking earlier about complications that can arise from untreated diabetes. And I know that you were part and the University of Maryland was part of a large landmark study in the 90s that showed that serious complications can be prevented with good control of sugar or glucose.

Thomas W. Donner, M.D.: That's right. You're referring to a study called the DCCT, or Diabetes Control and Complications Trial. This actually started in the mid-1980s. At that time, physicians were happy if the patients weren't having terrible symptoms from high blood sugar, not having low blood sugar reactions. That was okay to have a blood sugar in 180-200 range. That was the standard of care. Whereas, we knew the complications were probably caused by high blood sugar. So a study was done, and in those patients who were more aggressively treated after six years had a dramatically lower rate of complications in the eyes, kidneys and the nerves.

Ellen Beth Levitt: What do people need to do? How often should they check their blood sugar and are there some things they can do that are relatively simple in terms of life style modifications?

Thomas W. Donner, M.D.: When you talk about type one and type two, the treatments are very different. In patients with type one, …………………………………………………………………………………….

I'm going to talk first about type two diabetes, because that's …………. % of people. Initially, education in terms of lifestyle changes that can be made especially through diet and exercise is the cornerstone of treatment in those patients. In general, patients of type two diabetes are carrying extra weight and if they lose even a modest amount of weight, their blood sugars may come back down to normal.



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Ellen Beth Levitt: That's pretty good. What are some of the other things that they can do?

Thomas W. Donner, M.D.: Also encourage increased exercise. It can be a challenge. Even modest exercise, we're talking about …………minutes of exercise each day.

Ellen Beth Levitt: Even fast walking or gardening.

Thomas W. Donner, M.D.: Exactly. But maybe not gardening. That is some physical activity, but more like walking, jogging, biking.

Ellen Beth Levitt: Swimming maybe.

Thomas W. Donner, M.D.: Swimming is an excellent exercise. The effects of exercise not only help blood sugar while you're exercising, but hours afterward, the body is more sensitive to insulin. It's not more active for several days. 20 or 30 minutes a day has been shown to dramatically reduce the rate of developing diabetes in people.

Ellen Beth Levitt: What does someone have to do every day?

Thomas W. Donner, M.D.: We'll talk about type one patients. We have them check their blood sugar…………………... For a number of reasons. If a physician has recommended them to do diet and exercise, they can see what the effects are. So it's very rewarding when patients exercise one day and the next day they see that their blood sugar is down. Also, if they've eaten a large meal one night, they'll see their level very high the next morning. So, ……………………..is important. Again, adhering to a diet prescribed by the nutritionist or doctor and exercise are the cornerstones.

Ellen Beth Levitt: Is it important to keep blood pressure and cholesterol level in check?

Thomas W. Donner, M.D.: Absolutely. So, the way we prevent complications of diabetes are through good blood sugar control and through tight control of both the blood pressure and cholesterol.

Ellen Beth Levitt: You brought some tools with you to show us what people with diabetes need to use. So, if you could show us.

Thomas W. Donner, M.D.: Many people may not be aware that we have small devices now that can measure the glucose. Here I have another one.



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These devices are easy to use. I have a glucose test trip that you insert at the top. After sticking the test strip in, then—

Ellen Beth Levitt: You would have a little drop of blood on the strip.

Thomas W. Donner, M.D.: That's right…

……………………………………………………………………………………………

……………………………………………………………………………………………

…………………………………………………………………. The patient puts the

blood up to the strip, within five seconds; you'll get a blood sugar reading.

Ellen Beth Levitt: You have to learn what these numbers mean.

Thomas W. Donner, M.D.: That's right.

Ellen Beth Levitt: It's a lot of education.

Thomas W. Donner, M.D.: Our goal is to keep the levels in as close to normal range without causing any complications. We instruct patients on what those levels are. If a patient is on insulin, the blood sugar, we have them do at least ………..test a day. And the reason is because if their levels are on the high side, they can use a little extra insulin to get their blood sugar back to a normal range.

Ellen Beth Levitt: Great. We have to take a break.

January 7, 2009.



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1.3.1 Activity: A video interview You will watch a medical interview twice. Without writing anything down on the first viewing.

� Try to complete the gapped transcript (document from 1.2.2 Activity), and following that exchange information in groups of three.

� Be prepared to explain your answers in plenary.



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1.3.2 Activity: Criteria for evaluating oral presentations In groups of three decide and write down which items should be selected to assess a presentation. Order the items according to their importance .

But,

First, let’s watch a power point regarding “Formal presentations”. Then, you will have reliable advice to select the items Be prepared to discuss in plenary to choose the top criteria

PRODUCING A FORMAL PRESENTATION



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1.4.1 Activity: Local Radio. Medical talks. In groups of three you are going to produce a local radio program about Diabetes mellitus. You’ll have a medical document as a content reference. � Each of you will take a role. The teacher will distribute each role among

groups of three, –two doctors being interviewed by a skilled journalist-.

� You have 15`minutes to prepare the interview, and 7’ to perform it.

� Feel free to add more information about Diabetes mellitus

� Finally, you’ll have the criteria for evaluating oral presentations. (1.3.2 Activity). Each group will be analyzed by the others. Prepare to explain your analysis.



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http://www.labtestsonline.org/understanding/conditions/diabetes.html A ©2001 - 2009 by American Association for Clinical Chemistry Diabetes mellitus is the name given to a group of conditions linked by the patient’s inability to produce and/or utilize insulin and that lead to high blood glucose (sugar) levels. It is not to be confused with diabetes insipidus, a more rare condition that is associated with symptoms similar to those of diabetes mellitus but that has a different cause. Although the two share the same term “diabetes” (which means increased urine production), the term diabetes, when used by itself, is often used to refer to diabetes mellitus and will be used that way in this article. http://www.setrust.hscni.net/dlt%20services/Diabetes.html The South Eastern Health and Social Care Trust Diabetes Mellitus is a condition in which the amount of glucose (sugar) in the blood is too high, because the body cannot use it properly. Glucose needs the hormone Insulin to fuel it round the body to allow glucose to enter individual cells and to convert it to energy. When there is a shortage of Insulin, or if the available insulin does not function correctly, glucose will accumulate and Diabetes will develop. There is no such thing as Mild Diabetes – Diabetes needs to be taken seriously to prevent complications developing. Diabetes is a progressive condition and the treatment needed to control it properly will change with time. Remember Diabetes is a serious condition; it is not curable but treatable!

http://www.who.int/diabetesactiononline/diabetes/basics/en/index1.html

World Health Organization C The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs. (WHO 1999)

DOCUMENTS

B



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http://www.diabetes.org.uk/

Diabetes mellitus is a condition where the amount of glucose in the blood is too high because the body cannot use it properly. Glucose comes from the digestion of carbohydrate containing food and drinks and is also produced by the liver. Carbohydrate comes from many different sources including starchy foods such as bread, potatoes and chapattis, fruit, dairy products, sugar and other sweet foods.

Insulin is vital for life. It is a hormone produced by the pancreas and helps the glucose to enter the cells where it is used as fuel for energy so we can work, play and generally live our lives.

http://www.labtestsonline.org/understanding/conditions/diabetes.html ©2001 - 2009 by American Association for Clinical Chemistry Type 1 diabetes, which used to be called insulin dependent or juvenile diabetes, makes up about 10% of the diabetes cases in the United States. Most cases of type 1 diabetes are diagnosed in those under the age of 30. Symptoms often develop abruptly and the diagnosis is often made in an emergency room setting. The patient may be seriously ill, even comatose, with very high glucose levels and high levels of ketones (ketoacidosis). Type 1 diabetics make very little or no insulin. Any insulin-producing beta cells they do have at the time of diagnosis are usually completely destroyed within 5 to 10 years, leaving them entirely reliant on insulin injections to live.

http://www.labtestsonline.org/understanding/conditions/diabetes.html ©2001 - 2009 by American Association for Clinical Chemistry Those with Type 2 diabetes, which used to be known as non-insulin dependent diabetes or adult onset diabetes, do make their own insulin but it is either not in a sufficient amount to meet their needs or their body has become resistant to its effects. At the time of diagnosis, those with type 2 diabetes will frequently have both high glucose levels and high insulin levels, but they may not have any symptoms. About 90% of diabetes cases in the United States are type 2. It generally occurs later in life, in those who are obese, sedentary, and over 45 years of age.

A

D

A



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http://www.labtestsonline.org/understanding/conditions/diabetes.html ©2001 - 2009 by American Association for Clinical Chemistry Gestational diabetes is a form of hyperglycemia seen in some pregnant women, usually late in their pregnancy. The cause is unknown, but it is thought that some hormones from the placenta increase insulin resistance in the mother, causing elevated blood glucose levels. Most women are screened for gestational diabetes between their 24th and 28th week of pregnancy. If gestational diabetes is found and not addressed, the baby is likely to be larger than normal, be born with low glucose levels, and be born prematurely. The hyperglycemia associated with gestational diabetes usually goes away after the baby's birth, but both the women diagnosed with gestational diabetes and their babies are at an increased risk of eventually developing type 2 diabetes. A woman who has gestational diabetes with one pregnancy will frequently experience it with subsequent pregnancies. http://www.setrust.hscni.net/dlt%20services/Diabetes.html The South Eastern Health and Social Care Trust Type 1 Diabetes develops if the body is unable to produce any Insulin. This type of Diabetes usually occurs before the age of 40 years but can occur at any age and usually develops fairly rapidly. It is treated by insulin injections and diet. Insulin is vital for survival. It stops blood glucose from rising too high. People with Type 1 Diabetes usually feel unwell before starting insulin treatment. Symptoms include:

Frequency and passing large quantities of urine Severe thirst and dry mouth Dehydration Tiredness Weight Loss

A

B



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http://www.setrust.hscni.net/dlt%20services/Diabetes.html The South Eastern Health and Social Care Trust Type 2 Diabetes develops when the body is still producing some insulin but in inadequate amounts and/or when the insulin that is produced is not able to work properly. This type usually appears in people over the age of forty years, has a gradual onset and may be found accidental. It is treated by healthy eating and depending on the stage you are at, tablets and sometimes insulin injections. Risk Factors for developing Type 2 Diabetes

Age >40 years Overweight Physical inactivity Family History History of Gestational Diabetes (in pregnancy) or having given birth to a baby

weighing over 4kgs Ethnic group, Asian, African or Afro-Caribbean origin. People with Hypertension, Ischaemic Heart Disease, Cerebral, Vascular Disease and

Peripheral Disease.


World Health Organization C Type 1 Diabetes (T1B ) Description

Formerly known as Insulin-Dependent Diabetes Mellitus (IDDM).

Characterized by hyperglycemia due to an absolute deficiency of the insulin hormone produced by the pancreas.

Patients require lifelong insulin injections for survival.

Usually develops in children and adolescents (although can occur later in life).

May present with severe symptoms such as coma or ketoacidosis.

Patients are usually not obese with this type of diabetes, but obesity is not incompatible with the diagnosis.

Patients are at increased risk of developing microvascular and macrovascular complications. Etiology

Usually (but not always) caused by autoimmune destruction of the beta cells of the pancreas, with the presence of certain antibodies in blood.

A complex disease caused by mutations in more than one gene, as well as by environmental factors.

B



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http://www.who.int/diabetesactiononline/diabetes/basics/en/index1.html World Health Organization Type 2 diabetes T2D Description

Formerly named non-insulin-dependent diabetes mellitus (NIDDM).

Characterized by hyperglycemia due to a defect in insulin secretion usually with a contribution from insulin resistance.

Patients usually do not require lifelong insulin but can control blood glucose with diet and exercise alone, or in combination with oral medications, or with the addition of insulin.

Usually (but not always) develops in adulthood (and is on the rise in children and adolescents).

Is related to obesity, decreased physical activity and unhealthy diets.

As in T1D, patients are at a higher risk of microvascular and macrovascular complications. Etiology

Associated with obesity, decreased physical activity and unhealthy diets (and involves insulin resistance in nearly all cases).

Occurs more frequently in individuals with hypertension, dyslipidemia (abnormal cholesterol profile), and central obesity, and is a component of "metabolic syndrome". Often runs in families but is a complex disease caused by mutations in more than one gene, as well as by environmental factors.


World Health Organization C Gestational diabetes (GDM) Description

Characterized by hyperglycemia of varying severity diagnosed during pregnancy (without previously known diabetes) and usually (but not always) resolving within 6 weeks of delivery.

Risks to the pregnancy itself include congenital malformations, increased birth weight and an elevated risk of perinatal mortality.

Increased risk to woman of developing diabetes (T2D) later in life. Etiology

The mechanism is not completely well understood but hormones of pregnancy appear to interfere with insulin action.

C



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http://www.diabetes.org.uk/ Type 1 Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually appears before the age of 40. Type 1 diabetes is the least common of the two main types and accounts for between 5 and 15 per cent of all people with diabetes. You cannot prevent Type 1 diabetes.

http://www.diabetes.org.uk/ D Type 2 Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). In most cases this is linked with being overweight. This type of diabetes usually appears in people over the age of 40, though in South Asian and African-Caribbean people often appears after the age of 25. However, recently, more children are being diagnosed with the condition, some as young as seven. Type 2 diabetes is the most common of the two main types and accounts for between 85 and 95 per cent of all people with diabetes. There are currently over 2.6 million people with diabetes in the UK and there are more than half a million people with diabetes who have the condition and don’t know it.

http://www.diabetes.org.uk/ D Gestational diabetes mellitus (GDM) is a type of diabetes that arises during pregnancy (usually during the second or third trimester). In some women, GDM occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy.

D



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2.1.1 Activity The importance of pancreas in metabolism.

You will watch an interactive power-point about the endocrine pancreas.

Be prepared to participate.



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2.2.1 Activity. Preparing for a video. The pancreas

Let’s see how much you remember about the pancreas.

� You have a gapped transcript. Read carefully. � Try to fill the gaps with your partner.

We’ll watch the video later on.

The pancreas is shown here with the foreground highly magnified to reveal its inner anatomy. ………………… percent of pancreatic tissue is composed of acinar glands, which secrete an alkaline digestive juice into the duodenum via the pancreatic duct to help digest food. The endocrine areas of the pancreas,

known as ………………………………, are composed of two major types of cell. The alpha cells secrete the hormone …………………., and the beta cells secrete

……………….. into the bloodstream. These hormones work in opposition to control the blood glucose level. Insulin promotes the ………………………. and …………………… of glucose in the tissues, particularly ……………………….. and ………….., and reduces glucose production

……………………….. Glucagon has an anti-insulin effect in the liver, ……………………………………... The anatomy of the pancreas also includes: the

ampulla of the common bile duct: ……………………………, which carries digestive juice containing enzymes to the duodenum; the ……………, the exocrine

portions of the pancreas which secrete digestive juice into the pancreas; the splenic arteries which conduct oxygenated blood into the pancreas; and the mesenteric veins, which carry deoxygenated blood containing insulin and

glucagon away from the pancreas.



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2.2.2 Activity. A video recorder

� You’ll watch the video “the pancreas” twice. The first time you watch,

you do not need to write anything down.

� Then exchange information in groups of three.

� Following that, the video is played again. � Fill the gapped transcript and be prepared to explain your answers in

plenary



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2.3.1 Overview of metabolism

On the blackboard an interactive power-point about metabolism

Be prepared to participate.



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2.4.1 Identifying metabolic pathways

Let’s see if you can identify the metabolic pathways that would be modified in

case of Diabetes mellitus.

� There is an interactive web site linked to metabolic pathways projected

on the interactive blackboard

� You have a drawing that describes why blood glucose levels are raised in cases of Diabetes mellitus Fig.1

Pathways



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Fig.1 Increase of blood glucose levels in case of Diabetes mellitus

Be prepared to identify the metabolic pathways that would be modified in liver,

muscle and other organs or tissues in case of Diabetes mellitus.



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2.4.2 Activating GLUT 4

You are going to explain in plenary the mechanisms that allow glucose to be up

taken by the cells. Look at the drawing and read the questionnaire

� Fill the questionnaire and hand it out. � Discus in groups of three. � Be prepared to explain the answers.

QUESTIONARE

1. What are glucose transporters (GLUT 4)? 2. How are they important? 3. Where are GLUT4 found? 4. How does insulin act on GLUT4? 5. Are all cells insulin-sensitive?

Defend your answers.



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2.5.1 A video recorder: Gestational Diabetes You’ll watch a video about gestational Diabetes. � First, read the questioner below. � Start writing the answers the second time the video plays Hand out the report.

1. How many women will develop GDM? 2. Describe where is produced and which are the functions of insulin. 3. How is store the energy in our body? 4. What happens to the cells in case of gestational Diabetes? 5. When GDM is usually detected? 6. Is there any association between GDM and the placenta hormones?

Why? 7. What could happen to babies that were born to mothers with

gestational Diabetes? 8. What should women do in case of suffering from GDM?



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3.1.1 Blood testing in Gestational Diabetes The different tests that are used in the laboratory are shown in this interactive power point. Be prepared to participate

One of the major concerns about diabetes in pregnancy is

the harmful effect that high blood glucose levels can

have on the developing baby.

Screening in

Gestational Diabetes mellitus



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3.1.2 Activity: Organigram for screening gestational Diabetes You have got twenty-one cards linked with testing gestational Diabetes mellitus. Try to associate them and make an organigram that shows the different tests and their possible results when a screening for gestational Diabetes is performed.



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3.2.1 Activity: Clinical report

In order to diagnose gestational diabetes the obstetrician will refer the patients Ms McClifton and Ms McRobert to the laboratory, where you work, to be tested following the OGTT.

The patients will be given the test after an overnight fast (no eating!) of 8 or 10 hours. In the laboratory a blood sample will be taken. After the first blood sample, the patient will drink 100 g of glucose (sugar) in a drink within 5 minutes. Blood will be taken and tested at 1, 2, and 3 hours block of time to see how the patient processes sugar.

� Use the following information to graph two patients’ glucose (sugar) tolerance tests.

� Write a report � Answer the questions below.

CASE A OGTT: 100 g glucose drink (glucose load).

1. Your partner is going to tell you Ms Robert’s blood glucose level results.

Fill the gaps.

2. Draw a graph of OGTT for each patient.

3. Discuss with your partner the diagnosis. And answer the questions

4. Write a report

Time of Sample Collection Blood Glucose Level Ms. McClifton

Blood Glucose Level Ms McRobert

Fasting (prior to glucose load)

90 mg/dL (5.3mmol/L)

1 hour after glucose load 150 mg/dL (10.0mmol/L)

2 hours after glucose load 145 mg/dL (8.6mmol/L)




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CASE B OGTT: 100g glucose drink (glucose load).

1. Your partner is going to tell you McClifton’s blood glucose level results.

Fill the gaps.

2. Draw the graph of OGTT for each patient.

3. Discuss with your partner the diagnosis. And answer the questions

4. Write a report.

Time of Sample Collection Target Level Ms McRobert

Target Level Ms. McClifton

Fasting (prior to glucose load)

95 mg/dL (5.3mmol/L)

1 hour after glucose load 190 mg/dL (10.0mmol/L)


3 hours after glucose load

129mg/dL (7.8mmol/L)

•••

QUESTIONS:

1. Which patient has gestational diabetes?

2. Explain the patients’ reaction, during the test, according to the graph you have drawn.



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3.2.2 Activity. Preparing for a video: Screening GDM

You will watch a video about screening gestational Diabetes.

Read the questionnaire and try to find out some of the answers.

DR. Siobhan Dolan, MD, MPH.

MONTEFIORE MEDICAL CENTER

1. When does gestational Diabetes occur?

2. When is the first blood glucose test done in pregnancy?

a.

b. Routinely at

3. Approximately, which is the common rate of gestational Diabetes?

4. Is there any relationship between women suffering from Gestational

Diabetes and women suffering from Diabetes II, later on, after pregnancy?

5. Ms Kelli (the patient) is ………………….. month(S) pregnant and she is going

to have a ………………………………………. test.

6. Describe the characteristics of this test?



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7. What’s happened if the result of this test is abnormal?

DR. Siobhan Dolan , MD, MPH.

MONTEFIORE MEDICAL CENTER

8. Another test should be done if the previous is abnormal.

Describe the following test; what is this test used for?

9. Which are the ways to manage gestational Diabetes?

a.

b.

c.

10. Which are the healthiest measures to be followed during a pregnancy?



2009

3.3.1 A video: Screening gestational Diabetes You’ll watch a video about gestational Diabetes twice . Do not write anything down the first time you watch. Exchange information and write a report (document, activity 3.2.2).



2009

3.3.2 Activity: Screening gestational Diabetes through time You will have an approach about the research made in gestational Diabetes; just follow the teacher’s instructions.

A

John B. O’Sullivan: A Pioneer in the Study of Gestational Diabetes

The increased obstetrical risk associated with diabetes first recognized in pregnancy, i.e., gestational diabetes, was first described in the postwar period by Dr. J. P. Hoet in a paper written in French and translated into English by Dr. F.D.W. Lukens for publication in Diabetes in 1954. Not long after that the National Institutes of Health developed a program in the epidemiology of chronic disease, and a field center was established in Boston, Massachusetts, under Hugh Wilkerson. Dr. John B. O’Sullivan, having grown up in Ireland and graduated from the Royal College of Physicians and Surgeons in 1951, found his way to America and joined this program in the mid-late 1950s.

At the time ( 1951s) there was a great controversy about how to diagnose gestational diabetes. Using oral glucose tolerance test (OGTT) criteria for nonpregnant subjects, the incidence of diabetes was as much as one-third of the entire pregnancy population. To address this question, O’Sullivan performed 100-g OGTTs in 752 mainly second- and third-trimester pregnant women. For assessing the upper limit of glycemic normality in pregnancy.



2009

B


O’Sullivan and Mahan determined whether insulin therapy could ameliorate the condition. In this work, they found that insulin could reduce infant macrosomia incidence, a leading indicator of the diabetic diathesis in pregnancy. The follow-up studies conducted by O’Sullivan’s group at the Boston City Hospital in the 1960s allowed for very-long-term follow-up of the early pregnancy cohort, showing that ∼50% of the women diagnosed with gestational diabetes would become intolerant to glucose by nonpregnancy-defined criteria in subsequent years, reaching an asymptote at ∼10 years postpartum.

C


Although he had other careers as the director of employee health nationwide at Liberty Mutual Insurance Company; as advisor to the National Institutes of Health diabetes and disease prevention programs, including the Lipid Research Clinics Program; and as a clinician at the Boston City Hospital Diabetes Clinic, and also published in the area of arthritis epidemiology, Dr. O’Sullivan’s greatest love was the research of early diabetes as manifested in pregnancy and in the nonpregnant state and its subsequent effects on health. The criteria of O’Sullivan and Mahan brought to American epidemiology sound observational and statistical science to establish definitions that have stood the test of time.

The O’Sullivan criteria serve as a point of departure for all subsequent research in the field. Those of us who worked with Dr. O’Sullivan will always remember the man and his pioneering, independent, and uncompromising science.

Dr. O’Sullivan died at home in Wellesley, MA, in August 2001, attended by his wife, Ann, his four children, and his five grandchildren. He was 75 years of age.



2009

D


Dr. John B. O’Sullivan, having grown up in Ireland and graduated from the Royal College of Physicians and Surgeons in 1951, found his way to America and joined the program in the epidemiology of chronic disease in Boston Massachusetts in the mid-late 1950s.

The O’Sullivan criteria for screening gestational diabetes became established across the country by the mid-1980s.

Presently the field of gestational diabetes remains in great need of clinical trials evaluating specific approaches to therapy, comparing, for instance, exercise and nutrition therapy. But, the intellectual clarity and mathematical and epidemiological discipline shown in the path-breaking work of O’Sullivan and Mahan still serves as a guide for investigators who work in the field.

Those of us fortunate enough to have participated in the Western Diabetes and Pregnancy Study Group meeting in Seattle in 1993 heard Dr. O’Sullivan’s review of his work. His good humor, common sense, and intellectual discipline were seen at this meeting, interrupted by visits to Kells, the local Pike Place Market Irish pub, for an Irish song or two.

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