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Gestational Diabetes

Gestational Diabetes Mellitus (GDM) is a type of diabetes that occurs during the 2nd to 3rd trimester of pregnancy and typically resolves after childbirth, though it increases the risk of developing Type 2 diabetes later. It is characterized by insulin resistance, leading to elevated blood glucose levels, and is diagnosed through glucose tolerance tests. Management includes dietary changes, exercise, and monitoring blood glucose levels, with potential insulin or medication use, while also addressing associated risks and complications for both mother and baby.

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2 views25 pages

Gestational Diabetes

Gestational Diabetes Mellitus (GDM) is a type of diabetes that occurs during the 2nd to 3rd trimester of pregnancy and typically resolves after childbirth, though it increases the risk of developing Type 2 diabetes later. It is characterized by insulin resistance, leading to elevated blood glucose levels, and is diagnosed through glucose tolerance tests. Management includes dietary changes, exercise, and monitoring blood glucose levels, with potential insulin or medication use, while also addressing associated risks and complications for both mother and baby.

Uploaded by

Daisy Jane
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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By: Gracy Espino

What is Gestational Diabetes


Mellitus (GDM)?

- a form of diabetes that occurs during


the 2nd to 3rd trimester of pregnancy.

• It tends to disappear after pregnancy.


However, many women will go on to
develop Type 2 diabetes later on.
Why does a woman develop
Diabetes during her
Pathophysiology of
Gestational Diabetes
3 Key players
What is insulin?

It’s a hormone secreted by the


pancreas (specifically by the
beta cells in the pancreas)
that influence cells to take
glucose from the blood into the
cell so it can be used as energy.
What is insulin?

It’s a hormone secreted by the


pancreas (specifically by the
beta cells in the pancreas)
that influence cells to take
glucose from the blood into the
cell so it can be used as energy.
There are various types of
diabetes.
Type 1 Diabetes: this is autoimmune and occurs
because the cells that produce insulin (beta cells in
the pancreas) are destroyed and produce little to
no insulin.

Type 2 Diabetes: it’s an insulin resistance issue


meaning
the cells are not receptive to insulin’s influence.
There are various types of
diabetes.
Gestational Diabetes:
• similar to Type 2 diabetes because
of insulin resistance.
• It tends to occur during pregnancy
(2nd to 3rd trimester) and goes
away after birth.
*However according to the CDC.gov:
“About 50% of women with
gestational diabetes go on to develop
type 2 diabetes”.
High insulin sensitivity
• means the cells are receptive to insulin, so
glucose easily transports into the cell.
• This is beneficial during early pregnancy
because it helps support the growth of adipose
tissue (which helps mom and baby throughout
the pregnancy).
• However, because there is the shifting of more
glucose into the cell, this can cause mom some
blood glucose shifts (like hypoglycemia).
Low insulin sensitivity (insulin resistance)
• means cells are not receptive to insulin so
glucose does NOT easily get transported into
the cell but stays in the blood.
• This occurs during the 2nd or 3rd trimester and
the extra glucose in mom’s blood will go to the
growing baby who will use it for energy.
• Hormones listed above cause this low insulin
sensitivity.
Four cardinal
signs/symptoms of GDM
1. Polyuria – frequent urination
2. Polydipsia – excessive thirst
3. Polyphagia – excessive
hunger
4. Sugar in urine
Nursing Interventions &
“Sugar Babe”
Treatment

S- Screening: 1-hour oral glucose tolerance test


at 24-28 weeks

• fasting not required for this test


• drink 50 grams of a glucose solution
• 1 hour later have blood drawn
• Glucose of >140 mg/dL abnormal result
Will have to have the 3-hour oral glucose
tolerance
test to diagnose gestational diabetes
Nursing Interventions &
Treatment
3-hour oral glucose tolerance test (administer if 1 hr
ogtt abnormal)
•Patient comes back to the office on another day to
have performed
•Fasting required
•Blood drawn at the following times: fasting (then will drink
100-gram glucose solution), 1, 2, and 3 hours
•Two or more abnormal results…diagnosed with
gestational diabetes
• Fasting >95 mg/dL
• 1 hour >180 mg/dL
• 2 hour >155 mg/dL
• 3 hour >140 mg/dL
U - Use diet and exercise to manage (some
may need insulin or oral diabetic
medications like Metformin or Glyburide)

G - Glucose monitoring: pregnant mom will


monitor her blood glucose on a daily basis

<95 mg/dL fasting (greater than 70 mg/dL)


<140 mg/dL 1 hour after meal
A - Assess urine for glucose during prenatal visits
(glucose starts to leak into the urine) and assess
for burning during urination (could indicate
infection)
R - Risk Factors for Momma:
•Maternal age over 25
•Overweight or obese…BMI >25 or >30
•Macrosomia (fetal) previous baby was large… >9
lbs
•Multiple pregnancies
•A history (previous gestational diabetes diagnosis
or family history of diabetes mellitus)
B - Blood glucose swings during and after labor:
monitor blood glucose levels during and after
labor
•Try to maintain euglycemia: this could help
decrease the risk of baby experiencing
hypoglycemia at birth
•During labor, IV regular insulin or glucose may be
given to some patients to keep their glucose level
within normal range
•After labor watch for hypoglycemia in both mom
(sweating, cold, clammy, confused) and baby
(may need glucose solution after birth)
A - Adverse effects of gestational diabetes:
preeclampsia (htn and protein in urine), UTI,
vaginal infections, risk for c-section due to large
baby, respiratory distress in baby, preterm labor,
hypoglycemia after birth
B - Blood glucose monitoring postpartum: 6-12
weeks postpartum with 2-hour oral glucose
tolerance test
E - Educate about importance of regular testing
for diabetes due to risk of type 2 diabetes
•Every 1-3 years…even if it goes away after birth
because remember 50% will go on to develop
Complications:
•cardiovascular affects to mom (her
vessels can become damaged from
the high glucose levels in the blood
leading to: high blood
pressure/preeclampsia)
•UTIs/yeast infections: remember
bacteria and yeast thrive on glucose
•Type 2 diabetes after birth
•Preterm labor
Complications:
•Increased risk of C-section due to a
large baby for gestational age, which
is hard to deliver vaginally
•Baby can have breathing difficulties
(hyperglycemia can affect lung
maturity…surfactant) and
hypoglycemia at birth

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