Presentation On: Kgmu College of Nursing

KGMU COLLEGE OF NURSING
PRESENTATION ON


PRESENTED BY:-
Deeksha
M.Sc.(N) 1st yr
INTRODUCTION
This diagnosis is given when a woman, who has never had diabetes before,
gets diabetes or has high blood sugar, when she is pregnant. Its medical name
is gestational diabetes mellitus or GDM. It is one of the most common health
problems for pregnant women. The word “gestational” actually refers to
“during pregnancy.”
DEFINITION
DIABETES MELLITUS:-
A metabolic condition characterized by chronic hyperglycemia as a result of
defective insulin secretion, insulin action or both.
GESTATIONAL DIABETES:-
• Defined as carbohydrate intolerance of variable severity with onset or first
recognition during pregnancy. • The entity usually presents late in the second or
during the third trimester.
INCIDENCE
:Gestational diabetes affects 3–9% of pregnancies, affecting 1% of those under

the age of 20 and 13% of those over the age of 44.
RISK FACTORS
1. Strong familial history of diabetes

2. obesity
3. Previous gestational diabetes
4. Have given birth to large infants (4 kg or more)
5. Previous polyhydramnios.
6. Over the age of 35 yrs
7. Ethnic group (East Asian, pacific island ancestry)
CLASSIFICATION:
OVERT DIABETES:
 A patient with symptoms of diabetes mellitus eg;
 Polyuria
 Polydipsia
 Polyphagia
 And random plasma glucose level of 200 mg/dl or more is considered overt
diabetes.
 Criteria for overt diabetes:
 FPG>126 MG/DL
 PP>200MG/DL
 Hb1Ac>6.5 gm%
WHEN DOES GESTATIONAL DIABETES
DEVELOP?
GDM develops when a stage is reached, when the pancreas despite the
increased insulin production cannot counter the insulin resistance caused by
the pregnancy hormones.
GDM usually occurs in women with poor pancreatic reserve and insulin
resistance such as those with polycystic ovary syndrome or a family history
of diabetes. It usually appears after 24 weeks of pregnancy.
CLINICAL FEATURES:-
SYMPTOMS:-
 Weight loss during early
 weight gain or Excessive weight gain during pregnancy 2nd and third trimester of
pregnancy
 Polyuria (frequent urination)
 Polydipsia (increased thirst)
 Polyphagia(increased hunger)
 Fatigue , Weakness
 Tingling or numbness in hands or feet

SIGNS :-
Polyhydramnios
Fundal height more than period of gestation
Signs of dehydration
Vision impairment
 Kusummal breathing
WHY DIDN’T I HAVE DIABETES
BEFORE?
During pregnancy, many physiological changes take place. Changes in

metabolism can be seen. Insulin may not be as effective in moving sugar into
the cells during pregnancy.
 Therefore, the cells can’t get the sugar they need for energy. Increased
sugar levels in the blood can lead to many problems.
SCREENING:-
while some advocate screening routinely to all pregnant mothers, others reserve it only
for the potential candidates. Screening strategy for detection of GDM are:
 Low risk: absence of any risk factors as mentioned in factors – then blood glucose
testing is not routinely required.
 Average risk: some risk factors- perform screening test.
 High risk: blood glucose test as soon as feasible.
DIPSI: ( diabetes in pregnancy study group in India)

recommends 1 step procedure with 75 g oral glucose without regard to the time of the
last meal . A venous plasma glucose value at 2- hour more than 140 mg/dl is diagnosed
GDM.
OGTT: ORAL GLUCOSE TOLERANCE TEST
( WHO, FOGSI, DIPSI)
75 grams 2 hour OGTT ( WHO, FOGSI, DIPSI)
2 hour blood pregnant Non pregnant

sugar values
mg/dl
< 120 Normal normal
120-139 GGI Normal
140-199 GDM IGT
>200 Diabetes Diabetes

Different cut offs adopted in 75 g OGTT
Plasma glucose WHO IADPSG, ADA
Fasting >125mg/dl >92mg/dl

>6.9 mmol/L > 5.1 mmol/L
1 hour - >180 mg/dl

> 10 mmol/L
2hour >140mg/dl >153mg/dl

> 7.8 mmol/L >8.5mmol/L
DIAGNOSTIC EVALUATION
History collection:
EXAMINATIONS-
Physical ﬁndings:
Blood pressure, heart rate, weight (measured every day while the patient is
hospitalized)
Height of uterine fundus measured once per week
Pelvic examination: check for indications of premature birth; vaginal culture
INVESTIGATIONS
Blood and urine testing

 Self-monitoring of blood glucose :- Self-monitoring of blood glucose
(SMBG)
 As a rule, blood glucose is measured 7 times per day.
 Blood glucose testing times: before each meal, 2 hours after each meal (2
hours after the start of the meal), and before going to sleep at night.
 HbA1c, peripheral blood in general: measured
 ketone bodies , Anti-insulin antibody, Urine protein, quantitative
measurement of urinary glucose: twice per month
MANAGEMENT
NON-PHARMACOLOGICAL TREATMENT
 Diet therapy: 25-30 kcal/kg/day
 During pregnancy, as pregnant women patients need to consume adequate
energy, protein, and minerals
 Either low-carbohydrate, low-fat calorie-restricted, may be effective in the
short-term diet for a pregnant woman with diabetes includes:
 at least 175 g/day of carbohydrate, 28 g/day of fiber and 1.1 g of protein per
kg/day
 Medical Nutrition Therapy
 According to the ADA nutrition practice guidelines there are three clinical
goals for treatment
 To achieve and maintain normoglycemia

 To consume adequate energy to promote appropriate gestational weight gain
and avoid maternal ketosis
 To consume food-providing nutrients necessary for maternal and fetal health
Health care team includes an obstetrician, registered dietitian who is also a
certified diabetes educator, a nurse educator, and an endocrinologist
 Primary approach is to normalize blood glucose levels through diet and
exercise
 Exercise:
 Patients GDM should be referred to an effective ongoing support program
targeting weight loss of 7% of body weight and increasing physical activity to at
least 150 min per week of moderate activity such as walking.
 PHARMACOLOGICAL MANAGEMENT:
guidelines recommend insulin as the optimal approach
DOC: INSULIN
 Insulin therapy is required for the treatment of T1DM during pregnancy
OHA: oral hypoglycemic drug/agent:

 Glimpride
 Metformin( most common prefer)
 Glienclaninde
NURSING MANAGEMENT
Pre-conception management
 Aim to maintain HbA1c < (6.1%) to reduce the risk of congenital
malformations
 advise women with HbA1c > (10%) to avoid pregnancy.
 Reinforce self-monitoring of blood glucose.
 Offer HbA1c testing monthly
 retinal assessment at the first pre-conception appointment and then
annually if no retinopathy is found.
 Intrapartum management
 preterm, steroids are given to the woman to improve fetal lung maturation and
additional insulin may be required.
 If the fetus is macrosomic, the woman should be informed of the risks and
benefits of vaginal birth, induction of labour and caesarean section.
 Blood glucose levels should be monitored hourly through labour and birth
 Care of the baby at birth
 A pediatrician should be present at the birth if the woman is receiving insulin.
 Observe for signs of respiratory distress, hypoglycemia, hypothermia, cardiac
decompensation and neonatal encephalopathy
 A baby should be admitted to a neonatal intensive care unit (NICU) only if a
significant complication is apparent.
 The woman should hold her baby after the birth and prior to any transfer to the
NICU.
 Blood glucose testing of the baby should be carried out after birth and at intervals
according to local protocols
 The baby should feed within 30 minutes of birth and then every 2–3 hours .
 Postnatal care of the woman with
 Type 1 diabetes:
 insulin should be reduced immediately after birth and blood glucose levels
monitored.
 observed for signs of hypoglycemia.
 As placental hormone levels fall, the insulin sensitivity improves, such that the
insulin infusion rate is likely to need reducing in the early postnatal period.
 GDM: follow up
 A fasting blood glucose test should be undertaken at 6 weeks
 The woman should be advised of the risk of developing diabetes in future
pregnancies and the need for pre-pregnancy screening.
 Informed of the importance of using contraception to prevent pregnancies
 A healthy lifestyle with regular exercise, smoking cessation and maintaining a
BMI within normal limits should also be emphasized to the woman.A follow-up
appointment at 6 weeks with the diabetes team
COMPLICATION:
 Large baby fetal ( fetal macrosomia)

 ployhydromnios- PROM ,chorio-amnitis
 Puerperal sepsis
 Pre term labour- PIH IUGFD
 Fetal complication:
 Hypoglycemia
 Polycythemia
 Hyperbilirubinemia- increase chance of jaundice
SUMMARY: -
CONCLUSION
ASSIGNMENT
 Write down the nursing management for Diabetes mellitus in

pregnancy.
EVALUATION
Who is screened for Gestational Diabetes ?
 Only women under 25 years old
 Only women with risk factors
 All pregnant women
 Only women who have had GD before
Which of the following is NOT a risk factor for Gestational Diabetes?
 Previous pregnancy loss
 Hypothyroidism
 Chronic hypertension
 Twin pregnancy
 Complete the following statement: First and foremost management of
Gestational Diabetes should be through..
 Healthy diet plan and exercise
 Weekly sonogram
 Once daily blood sugar monitor
 Prescribed medication
 4 .Which of the following is the BEST way Gestational Diabetes can be
prevented ?
 Weight loss during 1st trimester
 Taking insulin
 In vitro fertilization
 Practicing healthy lifestyle before getting pregnant.
 5. Complete the statement: After delivery, the baby of a full term well
managed Gestational Diabetes pregnancy..
 Monitored in the NICU
 Monitored for signs of hypoglycemia for at least 12 hrs
 Vital signs monitored
 Formula fed .
BIBLIOGRAPHY
 Dutta’s DC.Textbook of obstetrics.Jaypee brothers of medical

publisher.9th edition.445-485.
 Jacob anamma.a comprehensive textbook of midwives.Jaypee
brothers publisher.3 edition.
 https://www.healthline.com

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KGMU COLLEGE OF NURSING

:Gestational diabetes affects 3–9% of pregnancies, affecting 1% of those under

1. Strong familial history of diabetes

During pregnancy, many physiological changes take place. Changes in

DIPSI: ( diabetes in pregnancy study group in India)

75 grams 2 hour OGTT ( WHO, FOGSI, DIPSI)

2 hour blood pregnant Non pregnant

120-139 GGI Normal

140-199 GDM IGT

>200 Diabetes Diabetes

Plasma glucose WHO IADPSG, ADA

Fasting >125mg/dl >92mg/dl

1 hour - >180 mg/dl

2hour >140mg/dl >153mg/dl

Blood and urine testing

 To achieve and maintain normoglycemia

OHA: oral hypoglycemic drug/agent:

 Large baby fetal ( fetal macrosomia)

 Write down the nursing management for Diabetes mellitus in

 Dutta’s DC.Textbook of obstetrics.Jaypee brothers of medical

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