GESTATIONAL
DIABETES
OUTLINES:
Definition
Types (type 1-type 2- gestational diabetes)
Cause and risk factor
Pathophysiology
Sings and symptoms of hypoglycemia &hyperglycemia
Diagnosis test (FBS-2postprandial-GCT-OGTT)
Maternal & fetal effect of DM
Therapeutic management (insulin and its types)
Nursing management (Ante partum- intra partum -postpartum)
OBJECTIVE LEARNING:
By the end in this presentation all students will be able to provide a
comprehensive nursing management for Gestational Diabetes (GD).
We will be able to:
Identify the GDM.
Understand the pathophysiology
Describe Metabolic changes in pregnancy.
Describe Maternal, fetal and neonatal effects of diabetes.
Understand body mass index.
Describe How to diagnosed patient.
INTRODUCTION
Gestational Diabetes:
This diagnosis is given when a woman, who has never had diabetes before,
gets diabetes or has high blood sugar, when she is pregnant.
It is one of the most common health problems for pregnant women.
DEFINITION:
GESTATIONAL DIABETES:
is a temporary type of diabetes and is one of the most common
health problems for the pregnant women. glucose intolerance is
an early stage of the condition
TYPE 1 DIABETES:
Insulin dependent Diabetes: is an
autoimmune condition in which the body
attacks insulin-producing cells in the
pancreas, making it impossible for them
to produce insulin. Managed with insulin
therapy and lifestyle changes.
TYPE 2 DIABETES:
Noninsulin-dependent Diabetes: is
categorized by a build- up of glucose
(sugar) in the bloodstream, caused by the
body's inability to use insulin properly .
The most common treatment is diet,
exercise and oral medication, but some
cases may also require insulin.
GESTATIONAL DIABETES:
is a variation of diabetes that some women develop during pregnancy
,most often around week 24 After the baby is born most
women's blood suStress -related Diabetes:
STRESS-RELATED DIABETES:
Any age Hyperglycemia seen during periods of stress
such as surgery or hospitalization.
CAUSES OF GESTATIONAL
DIABETES:
The exact cause of gestational diabetes is unknown, but it may
be due to hormones your placenta [Link] hormones
help your baby grow, but they can also stop insulin from doing
its [Link] your body isn’t sensitive to insulin, the sugar in your
bloodstream stays put and isn’t move out of your blood into
your cells like it should be. The sugar is then unable to convert
into energy in the cells. This is called insulin resistance. This
causes the blood sugar levels to increase.
RISK FACTORS:
Family or Personal health history if a close family
member, such as a parent or sibling, has type 2
diabetes. You're also more likely to develop
gestational diabetes if you had it during a previous
pregnancy, if you delivered a baby who weighed more
than 9 pounds (4.1 kilograms) or if you had an
unexplained stillbirth.
RISK FACTORS FOR GESTATIONAL
DIABETES INCLUDE:
Age greater than 25 Women older than age 25 are more likely to develop
gestational diabetes.
Excess weight You're more likely to develop gestational diabetes if you're
significantly overweight with a body mass index (BMI) of 30 or higher.
Nonwhite race For reasons that aren't clear, women who are black,
Hispanic, American Indian or Asian are at higher risk to develop gestational
diabetes.
PATHOPHYSIOLOGY:
One main aspect of the underlying pathology is insulin resistance . placenta
produce growth hormone , " placenta lactogen , progesterone and estrogen .
These hormones promote glucose intake by the fetus by causing insulin
resistance in the mother . To compensate for the peripheral IR during
pregnancy ,insulin secretion increase from a women's pancreas . The
development of GDM occurs when a women's pancreas does not secrete
enough insulin to keep up with the metabolic stress of the IR .
In the presence of insulin resistance, this uptake of blood glucose is
prevented and the blood sugar level remains high . The body then
compensates by producing more insulin to overcome the resistance and in
gestational diabetes, the insulin production can be up to 1.5 or 2 times that
seen in a normal pregnancy. This causes hyperglycemia (or high levels of
sugar in the blood), which can damage the nerves, blood vessels and organs
in your Body.
CONT...
Gestational diabetes typically does not cause any noticeable signs or
symptoms. This is why screening tests are so important.
✓ higher birth weight of the baby premature birth
✓ low blood sugar levels in the baby at birth
✓ an increase in the pregnant woman's blood pressure
✓ a higher risk of the woman developing preeclampsia during
pregnancy.
DIAGNOSIS:
All pregnant women at risk for gestational diabetes should be screened by
glucose challenge test GCT between 24-28 weeks Women with fasting
glucose > 126mg/dl or a non-fasting of >200mg/dlis diagnostic for
GDM and no added testing is needed.
Glucose Challenge Test ( GCT ) :
✓ 50 gram oral glucose with blood level 1 hour later.
✓ Does NOT require fasting state.
✓ Normal finding is <140 mg/dl.
✓ If >140, need to do a 3 hour glucose tolerance test.
CONT…
3-hour oral glucose tolerance test (OGTT):
It is the gold standard for diagnosing diabetes
Draw a fasting glucose level
Give 100 gram oral glucose with glucose levels drawn after 1, 2 and 3 hours.
Normal levels should be in the following ranges:
fasting: <95 1hr : <180 2 hr:<155 3 hr:<140
Two or more abnormal values = GDM
WHAT IS GLUCOSE
TOLERANCE TEST:
Though no longer routinely used for diagnosing diabetes. The oral glucose
tolerance test (OGTT) was the gold standardfor making the diagnosis of
type 2 diabetes.
It is still commonly used during pregnancy for diagnosing gestational
diabetes. With an oral glucose tolerance test, the person fasts overnight (at
least 8 hours, but not more than 12 hours).
The next morning, the fasting plasma glucose is tested. After this test, the
person receives a dose of oral glucose (the dose depends upon the length
of the test). Usually, the glucose is in a sweet-tasting liquid that the person
drinks. Blood samples are taken up to four times at different time points
after consumption of the sugar to measure the blood glucose.
HOW ARE THE RESULTS OF THE
GLUCOSE TOLERANCE TEST
EVALUATED:
Glucose tolerance tests may lead to one of the
following diagnoses:
a) Normal response: A person is said to have a normal
response when the two hour glucose level is less than 140
mg/dl, and all values between 0 and 2 hours are less than
200 mg/dl.
MATERNAL & FETAL EFFECT
OF DM:
Increased maternal risk for:
Abortion
Pregnancy-induced hypertension
Polyhydramnios
Urinary tract infections
Diabetic retinopathy
Diabetic ketoacidosis DKA
Labor dystocia
Cesarean birth
INCREASED FETAL AND NEONATAL RISK
FOR:
Congenital anomalies.
Perinatal death.
Macrosomia.
Preterm birth.
Birth injury.
Neonatal hypoglycemia.
Polycythemia.
Hyperbilirubinemia.
Hypocalcemia.
Respiratory distress syndrome (RDS).
THERAPEUTIC MANAGEMENT:
Test of blood sugar before and after meals:
Manage of condition by eating healthy and exercising regularly . The types of food that are
usually part of a gestational diabetes diet plan include:
lean proteins.
healthful fats.
whole grains.
low-fat dairy products.
nonstarchy vegetables.
fruits in moderation
Exercise can help the body regulate insulin sensitivity , while a balanced diet can help
prevent spikes and dips in blood sugar levels .Blood sugar levels can increase as pregnancy
progresses, so even if they are well controlled at first, May need to take medicine later in
pregnancy.
CONT…
Tablets:
Metformin is taken as a tablet up to 3 times a day, usually with or after
meals.
Insulin injections:
Insulin may be recommended if:
cannot take metformin or it causes side effects.
blood sugar levels aren't controlled with metformin.
Have very high blood sugar.
Baby is very large or you have too much fluid in yor womb.
Types of insulin Examples
Rapid - acting lispro
Short - acting humulin R
Intermediate acting humulin N
Longe acting Lantus { glargine }
NURSING MANAGEMENT:
The care of pregnant woman with diabetes mellitus focuses on helping her
to maintain normal blood glucose level and optimumfetal condition.
Nursing considerations should be followed in dealing with diabetic woman:
[Link] effective communication to promote
active participation in plan of care
[Link] normal pregnancy care
NURSING ASSESSMENT:
Take dmonitoring blood glucose level and administering insulinetailed
history about onset, type, presence of diabetes complications such as
retinopathy or nephropathy before pregnancy and management of pre-
existing diabetes.
Determine if the woman have necessary skills and procedures such as.
Assess woman's knowledge ofthe effect of diabetes on pregnancy and
pregnancy on diabetes.
Assess how well the woman understands her diet plan through asking
about the number of meals and snakes she eat, composition of her diet
and distribution of daily caloric intake.
NURSING INTERVENTION:
Teaching self-care skills.
Teaching dietary management.
Recognizing and correcting hypoglycemia and hyperglycemia.
Explaining procedures, tests and plan of care.
Teaching self-care skills include self monitoring of blood glucose and insulin
administration. Demonstration and re- demonstration are effective ways to
teach and evaluate psychomotor skills.
SELF MONITORING OF
BLOOD GLUCOSE:
Teach the woman that accurate management of diabetes during pregnancy
depends on accurate recorded glucose values.
One common test regimen of glucose requires obtaining fasting and 2 hours
postprandial levels. Another include six times per day fasting, 1-2 hours after
breakfast, before and after lunch, before dinner and at bedtime.
In addition, the woman should perform glucose test whenever experiencing
hypoglycemia or hyperglycemia signs and symptoms.
The woman should record all test results to a log for review by health care
provider.
The side of fingertip is less sensitive than the pad.
Teach woman to disinfect the finger before test to prevent infection
The first drop of blood is wiped awayand second is used to place in meter's strip.
Teach her that meters have memory option to provide retrieval of glucose readings
Teach her common sites of insulin injection
CONT…
Instruct woman to take her meal immediately after injection especially
with short-acting insulin.
Learn woman the accurate technique of insulininjection.
Daily Fetal Movement Count DFMC.
Teach woman how to count fetal movement and notify any change in usual
pattern of it.
The woman should lie on her side, eat sugary food or juice
FMC should be 3 counts/hour or 10 counts/12 hour
SUMMARY:
All pregnant women at risk for gestational diabetes
should be screened by glucose challenge test GCT
between 24-28 weeks.
GDM is a problem that affects a significant number of
women during pregnancy.
GDM can have lasting health impacts on both the
mother and the fetus.
THANK YOU
