1 / 23

Gestational Diabetes Mellitus

Gestational Diabetes Mellitus. Amy Hansen Concordia College. Objectives. Be able to describe gestational diabetes Identify who is at risk for gestational diabetes Describe the diagnosis of gestational diabetes Identify management options for gestational diabetes. Definition.

Download Presentation

Gestational Diabetes Mellitus

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Gestational Diabetes Mellitus Amy Hansen Concordia College

  2. Objectives • Be able to describe gestational diabetes • Identify who is at risk for gestational diabetes • Describe the diagnosis of gestational diabetes • Identify management options for gestational diabetes

  3. Definition • “Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.” American Diabetes Association. (2002). Gestational diabetes mellitus. (Position statement). Diabetes Care, 25: S94-96.

  4. Significance of GDM • Insulin resistance occurs to some degree in all pregnancies • Affects 7% of all pregnancies • 200,000 cases each year • Women with pre-existing diabetes are not considered to have GDM • 90% of women with GDM have normal glucose levels after delivery

  5. Symptoms of GDM • Glycosuria • Elevated blood glucose levels • Usually appears between 24-28 weeks gestation • Degree of hyperglycemia is not as severe as in other types of diabetes

  6. Risk Factors for GDM • Over age 25 • Obesity before pregnancy • Non-white • First-degree family member with diabetes • History of abnormal glucose tolerance • History of poor obstetric outcome

  7. Who Should Be Tested? • Assess client’s risk at first visit • Women of high risk should be screened as soon as possible • Should be retested at 24-28 weeks gestation • Women of average risk should be tested at 24-28 weeks gestation • Women of low risk require no testing? • Must not have any risk factors

  8. Testing for GDM • Fasting plasma glucose level >126 mg/dL or casual plasma glucose level >200 mg/dL on two or more occasions • Oral Glucose Tolerance Test (OGTT)

  9. 100 g glucose load Fasting >95 mg/dL 1 hour >180 mg/dL 2 hours >155 mg/dL 3 hours >140 mg/dL 75 g glucose load Fasting >95 mg/dL 1 hour >180 mg/dL 2 hours >155 mg/dL Oral Glucose Tolerance Test The 100 g glucose load is considered most accurate!

  10. Maternal Immediate Risks • Preeclampsia • High blood pressure • Proteinuria • Edema of hands and face • Risk of placenta detaching from uterus • Develops between 20th week of gestation and 1st week after delivery • Pregnancy-Induced Hypertension • Increased chance of cesarean delivery

  11. Fetal Immediate Risks • Macrosomia • Birth injuries • Hypoglycemia • Jaundice • Polycythemia • Hypocalcemia

  12. Long Term Risks • Mothers have increased risk of developing Type 2 diabetes later in life • Offspring have increased risk of obesity, glucose intolerance and diabetes

  13. Medical Nutrition Therapy • Very little research • Individualization • Goals • Adequate calories and nutrition for pregnancy • Minimize hyperglycemia • Prevent ketosis from undereating

  14. Medical Nutrition Therapy • Limit CHO to 40% of kcals • Low CHO, high protein breakfasts • Increased cortisol and growth hormone contribute to morning glucose intolerance • Encourage foods with low a glycemic index • Small, frequent meals & snacks • Use exchange system or CHO counting

  15. Medical Nutrition Therapy • Obese women (BMI >30) may benefit from a 30-33% kcal reduction • If GDM cannot be controlled by diet alone, drug therapy should be used

  16. Self Monitoring • Daily testing schedule – 4x/day • Blood glucose goals • Fasting: <95 mg/dL • 1 hour postprandial: <140 mg/dL • 2 hours postprandial: <120 mg/dL • Record glucose levels in a logbook

  17. Dietetic Intervention • MNT/Education should occur within 1 week of diagnosis • Perform nutritional assessment and establish goals • Subsequent visits: assess food & glucose records, weight changes, compliance, etc. • Postpartum: monitor glucose levels, test 6-12 weeks after delivery

  18. Drug Therapy • Insulin • Insulin pump or multiple doses of isophane (NPH) insulin to meet basal need • Rapid acting insulin before meals to prevent peaks of hyperglycemia • Use human insulin to reduce risk of developing antibodies

  19. Drug Therapy • Glyburide • Second-generation sulfonylurea • Increases insulin secretion & decreases release of hepatic glucose into the blood • Low levels cross the placenta • Study by Langer, et al – Glyburide is as effective as human insulin • Other sufonylureas are contraindicated during pregnancy

  20. Roles of the Dietitian • Assess client risk for GDM • Educate the patient about GDM • Work with patient to create an individualized diet plan

  21. Ethical Issues • Selective vs. universal screening • Recognize individuality • Autonomy vs. beneficence

  22. References • American Diabetes Association. (2001). Diabetes pills and gestational diabetes. [Electronic version] Diabetes Forecast 54(5) 106. Retrieved October 14, 2002 from Health Reference Center-Academic on-line database. • American Diabetes Association. (2002). Gestational diabetes mellitus. (Position statement). [Electronic version]. Diabetes Care 25(1) S94-96. Retrieved October 14, 2002 from Health Reference Center-Academic on-line database. • Berkow, R. (Ed). (1997). The Merck Manual of Medical Information (Home Edition). Whitehouse Station, NJ: Merck Research Laboratories. • Jovanovie, L. & Pettitt, D. (2001). Gestational diabetes mellitus. JAMA 286(20) 2516-18. • Kenshole, A. (2002). Pro & Con: Should screening for gestational diabetes be targeted rather than universal? [Electronic version] OB GYN News 35(18) 4. Retrieved October 14, 2002 from Health Reference Center-Academic on-line database. • Kjos, S. & Buchanan, T. (1999). Gestational diabetes mellitus. The New England Journal of Medicine 341(23) 1749-55.

  23. References • Langer, O., Conway, D., Berkus, M., Xenakis, E., & Gonzales, O. (2000). A comparison of glyburide and insulin in women with gestational diabetes mellitus. The New England Journal of Medicine 343(16) 1134-38. • Mahan, L.K., & Escott-Stump, S. (Ed). (2000). Krause’s Food, Nutrition & Diet Therapy (10th Edition). Philadelphia: W.B. Saunders Co. • Reader, D. & Sipe, M. (2001). Key components of care for women with gestational diabetes (Nutrition FYI). [Electronic version] Diabetes Spectrum 14(4) 188-91. Retrieved October 14, 2002 from Health Reference Center-Academic on-line database. • Walling, A. (2002). ACOG update on gestational diabetes mellitus. [Electronic version] American Family Physician 65(5) 964. Retrieved October 14, 2002 from Health Reference Center-Academic on-line database.

More Related