Background Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications. Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease.
ORA was referred to a diabetes educator when she developed diabetes at ORA is a year-old primigravida and is She was referred to the diabetes educator from the antenatal clinic because her oral glucose tolerance test showed her BG was elevated at 8.
Women who develop gestational diabetes are at increased risk of developing type 2 diabetes. If diet and exercise do not control blood glucose, insulin will be required. Evidence suggests that the use of insulin in treating high blood glucose levels in GDM reduces serious perinatal morbidity Crowther et al.
However, once the diagnosis of GDM is made, the pregnancy will be managed at a more intensive level of care. The care is usually transferred from the general practitioner to a multidisciplinary team that consists of an obstetrician, endocrinologist, diabetes educator and dietitian.
Experts face the dilemma of managing GDM on a regular basis in diabetes centres. The potential need for insulin should be addressed promptly to improve fetal and maternal outcomes, and reduce maternal anxiety about the blood glucose levels and the impact they could have on the developing fetus, and the fear of the prospect of giving insulin injections.
The key educational issues for Mrs.
Understand the importance of home blood glucose monitoring in gestational diabetes. Decide when to start insulin in gestational diabetes mellitus. Enable self-management of injections.
Prepare the woman for delivery and possibility of diabetes in the future. The diabetes educator arranged for Mrs. ORA to be reviewed by the diabetes team. At the initial consultation it was important to reassure her and gain her trust. ORA was taught to perform HBGM using a loan hospital blood glucose meter and was given dietary advice by the dietitian.
Exercise within the limitations of advancing pregnancy was also encouraged. On review 1 week later, despite following the dietary advice and walking 20 minutes a day, Mrs. The results in Table The Australian Diabetes in Pregnancy Society suggest that insulin should be considered if BGLs exceed the targets on two or more occasions in a 1- to 2-week period, particularly in the presence of macrosomia as determined by ultrasound.
The insulin regimen should be tailored to address the times when hyperglycemia occurs. The table shows Mrs. ORA has hyperglycemia before breakfast and 2 hours after meals.
She was prescribed a basal bolus regimen of a short-acting analogue with meals, and intermediate acting insulin at bedtime. While there are no adequate well controlled studies in pregnant women, the shorter-acting insulin analogues, for example Humalog and NovoRapid, and the longer-acting insulin analogues, such as Lantus and Levemir, are preferred by some endocrinologists.
This option is one that would be preferred if the benefits of improved glycemic control or well-being of the mother decreased hypoglycemia, especially nocturnal events and anxiety outweigh any possible risk of harm to the developing fetus. Time of introducing insulin is crucial to prevent fetal macrosomia.
Often, only around 10—12 weeks remain before delivery, leaving only a small window of opportunity to correct the blood glucose levels. Regular review and dose titration is necessary to achieve targets without causing hypoglycemia.
Further research is needed to assess the long-term risks of fetal exposure to OHAs because of their possible teratogenic effect. Some endocrinologists do use metformin to reduce insulin resistance Simmons et al. Currently there are insufficient data to support using metformin in lieu of insulin in GDM.Introduction.
This chapter discusses pregnancy in both pre-existing diabetes (type 1 and type 2 diabetes diagnosed prior to pregnancy), overt diabetes diagnosed early in pregnancy and gestational diabetes (GDM or glucose intolerance first recognized in .
Classification. Gestational diabetes is formally defined as "any degree of glucose intolerance with onset or first recognition during pregnancy". This definition acknowledges the possibility that a woman may have previously undiagnosed diabetes mellitus, or may have developed diabetes coincidentally with pregnancy.
GESTATIONAL DIABETES CASE STUDY ] The REAL cause of Diabetes (Recommended),Gestational Diabetes Case Study A well-planned and balanced diabetic diet for type 2 together with a healthy quantity physical activity can aid in treating diabetes.
Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.
If left untreated, diabetes can cause many complications. Acute complications can .
Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Apr 11, · Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy.
[1, 2] A study by Stuebe et al found this condition to be associated with persistent metabolic dysfunction in women at 3 years after delivery, separate from.