DM Flashcards
An endocrine
disorder in which the
pancreas cannot
produce adequate
insulin to regulate
body glucose levels.
Diabetes Mellitus
1.) Affects __% to __% of all pregnancies
2.) The most frequently seen medical condition in
pregnancy
1.) 3 to 5%
2.) Diabetes Mellitus
4 Cardinal Signs of DM:
- Polyuria (w/ glycosuria) – due to increase glomerular filtration of glucose
- Polydipsia
- Polyphagia
- Weight loss
Classifications of Diabetes Mellitus
*Type 1 or IDDM
*Type 2 or NIDDM
*Gestational Diabetes
*Impaired glucose homeostasis
Characterized by the destruction of the beta cells in the pancreas that usually leads to
absolute insulin deficiency
a. Immune mediated DM results from auto immune destruction of the beta cells
b. Idiopathic type 1 refers to forms that have no known cause
Type 1
Usually arises because of insulin resistance combined with a relative deficiency in the
production of insulin
Type 2
A condition of abnormally glucose metabolism that arises during pregnancy Possible signal of an increased risk of type 2 diabetes later in life
Gestational Diabetes
A case between “normal” and “diabetes” in what the body is no longer using and/or secreting insulin properly
a. Impaired fasting glucose- a state when fasting plasma glucose is at least 110 but under 126mg/dl
b. Impaired glucose tolerance – a state when insulin of the oral glucose tolerance test are at least 140 but under 200mg/dl in 1-hour sample
Impaired glucose homeostasis
- A condition of abnormal
glucose metabolism that arises
during pregnancy - Usually at the midpoint of
pregnancy when insulin
resistance becomes noticeable
Gestational Diabetes Mellitus
Risk Factors for GDM
- Obesity
- Age over 25 years
- History of large babies (10 lbs or more)
- History of unexplained fetal or perinatal loss
- History of congenital anomalies in previous pregnancies
- History of polycystic ovary syndrome
- Family history of diabetes
- Increase insulin release
- Significant hypoglycemia may occur
First Trimester
- placental hormones rise sharply
- Insulin resistance happens
- Insulin requirements double or quadruple by the end of pregnancy
Second and Third Trimester
- Decrease in insulin requirements after passage of
placenta - Non breastfeeding mothers- insulin- CHO balance returns
in approximately 7 to 10 days - Breastfeeding mothers- insulin requirements remain low
At Birth
Maternal Risks and Complications
- Miscarriage
- Pre-eclampsia/ Eclampsia
- Cesarean birth
*Hydramnios
*Infections (monilial vaginitis/UTI) - Ketoacidosis
Fetal and Neonatal Risks and Complications
*Congenital malformations
*Macrosomia
*Birth injuries
*Respiratory Distress Syndrome
*Polycythemia
What do we take during Physical Examination
*Baseline ECG should be obtained
*Evaluation for retinopathy
*Weight and BP monitoring
*Fundal height should be measured
- Recommended between 24 and 28 weeks gestation
- The woman should ingest 50g of oral glucose solution.
*One hour later a blood sample is taken.
Glucose Challenge Test (GCT)
Glucose Challenge Test (GCT):
*If the result is ____ mg/dl or greater, a 3-hour oral glucose tolerance test is recommended.
- Some practitioners use a lower cutoff of ___ or ___ mg/dl to identify more women at risk.
1.) 140mg/dl
2.) 130 or 135mg/dl
- The woman must fast from midnight on the day of the test.
- The woman should ingest 100g of oral glucose solution.
- Plasma glucose levels are then determined at 1, 2, and 3 hours.
*Oral Glucose Tolerance Test (OGTT)
the diagnosed if the fasting blood
glucose level is abnormal or if two or more of the following values occur on the OGTT:
*Fasting > 95 mg/dl
*1 hr. > 180 mg/dl
*2 hrs. > 155 mg/dl
*3 hrs. > 140 mg/dl
Gestational diabetes
Monitoring a Woman with Diabetes:
- A woman should use a home test kit to determine if she is pregnant at the earliest possible time
- The measurement of glycosylated hemoglobin is used to detect the degree of hyperglycemia present.
*HbA1c is measured.
*Ophthalmic examination
S/Sx of Maternal Hypoglycemia
- Shakiness (Tremors)
- Sweating
- Pallor; cold, clammy skin
- Disorientation; irritability
- Headache
- Hunger
- Blurred vision
S/Sx of Maternal Hyperglycemia
- Depressed reflexes
- Drowsiness, headache
- Rapid, deep respirations, acetone breath
- Polyuria
- Dry mouth, polydipsia
- Flushed, hot skin
- Fatigue
Antepartal Nursing managment
MAJOR GOALS:
- To maintain physiologic equilibrium of insulin
availability and glucose utilization during
pregnancy - To ensure an optimally healthy mother and
newborn
5 Antepartal Nursing Management:
1.) Dietary Regulation (Simple sugars should be eliminated)
- Exercise
- Blood Glucose Monitoring
- Insulin administration
- Evaluation of Fetal Status
* Serum AFP screening
* Ultrasound
* BPP
* NST
* Contraction test
* Amniocentesis
Labor management
- hourly monitoring of glucose levels
- 5% dextrose solution, normal saline