diabetes mellitus and pregnancy

8/12/2019 diabetes mellitus and pregnancy

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DIABETES MELLITUS

An endocrine disorder of carbohydrate metabolism,

resulting from inadequate production or use of Insulin.

Overview


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DIABETES MELLITUS

4 Cardinal Signs of DM:

1. Polyuria (with glycosuria)2. Polydipsia

3. Polyphagia

4. Weight loss

Overview


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Early Pregnancy:

Insulin release accelerates

Significant hypoglycemia may occur

Increase in fat stores

Late Pregnancy:

Placental hormones rise sharply

Insulin resistance happens

Insulin insufficency occurs

May have episodes of hyperglycemia

Switch from CHO metabolism to gluconeogenesis

Effects of Pregnancy on

Fuel Metabolism


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DM may be difficult to control because insulinrequirements are changeable.

1. During the first trimester, the need for insulin

frequently decreases.2. N/V may cause dietary fluctuations

3. Insulin requirements increase

4. Increased energy needs during labor5. Decrease in insulin requirement occurs after the

passage of the placenta

Influence of PregnancyOn Diabetes


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The pregnancy of a woman who has diabetes

carries higher risk of complications

Influence of Diabeteson Pregnancy Outcome


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Type 1 or IDDM

Type 2 or NIDDM

Gestational Diabetes

Other specific types

Classifications of Diabetes Mellitus


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DIABETES MELLITUS

A condition of abnormal

glucose metabolism that

arises during pregnancy.

Possible signal of an

increased risk for type 2

diabetes later in life.

Gestational Diabetes Mellitus


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DIABETES MELLITUS

Overweight or obesity Chronic hypertension

Maternal age older than 25 years

Family history of diabetes

Previous birth of a large infant (> 4000g)

Previous birth of an infant with unexplainedcongenital anomalies

Previous unexplained fetal death

Gestational diabetes in previous pregnancy

Multifetal pregnancy

Fasting serum glucose > 140 mg/dl or random

serum glucose > 200 mg/dl

Risk Factors for GDM


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aternal RisksHydramniosPreeclampsia-eclampsia

EffectsFetal Neonatal RisksCongenital anomalies

LGARDS

Polycythemia

Hyperbilirubinemia


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DIABETES MELLITUS

History

How long has she had the disease?

How does she maintain normal bloodglucose?

Is she familiar with ways to monitor

blood glucose and administer insulin?

ssessment


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DIABETES MELLITUS

Physical Examination

Baseline ECG should be obtained

Evaluation for retinopathy

Weight and BP monitoring

Fundal height should be measured

ssessment


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DIABETES MELLITUS

SCREENING TESTS

Glucose Challenge Test (GCT)The woman should ingest 50g of oral glucose

solution.One hour later a blood sample is taken.

If the blood glucose concentration is 140mg/dl or greater, a 3-hour oral glucosetolerance test is recommended.

Some practitioners use a lower cutoff of 130or 135 mg/dl to identify more women at risk.

ssessment


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DIABETES MELLITUS

SCREENING TESTS

Oral Glucose Tolerance Test (OGTT)

The woman must fast from midnighton the day of the test.

The woman should ingest 100g of

oral glucose solution.

Plasma glucose levels are thendetermined at 1, 2, and 3 hours.

ssessment


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DIABETES MELLITUSssessment


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DIABETES MELLITUS

Oral Glucose Tolerance Test (OGTT) Gestational diabetes is 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

ssessment


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DIABETES MELLITUS

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

ssessment


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DIABETES MELLITUS

Risk for ineffective tissue perfusion related to

reduced vascular flow.

Imbalanced nutrition, less than body

requirements, related to inability to use glucose.

Risk for ineffective coping related to required

change in lifestyle.

Risk for infection related to impaired healing

accompanying condition.

Nursing Diagnoses


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DIABETES MELLITUS

Deficient fluid volume related to polyuria

accompanying disorder.

Deficient knowledge related to difficult and

complex health problem.

Health seeking behaviors related to voiced need

to learn home glucose monitoring.

Deficient knowledge related to therapeutic

regimen necessary during pregnancy.

Nursing Diagnoses


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DIABETES MELLITUS

Demonstrate competence in home glucose monitoringand administration of insulin before home managementis initiated.

Describe a plan for meeting dietary recommendationsthat fits family lifestyle and food preferences.

Identify signs and symptoms of hypoglycemia and

hyperglycemia and the management required for each.

Verbalize knowledge of fetal surveillance proceduresand keep scheduled appointments for testing.

Planning


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IMPLEMENT TION


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DIABETES MELLITUS

MAJOR GOALS:

1. To maintain physiologic equilibrium of insulin

availability and glucose utilization during

pregnancy

2. To ensure an optimally healthy mother and

newborn.

ntepartal Nursing Management


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1. Dietary Regulation

Simple sugars in concentrated sweets should be

eliminated

For obese women, a small percentage of CHO isrecommended

Calories should be divided among 3 meals and at

least 3 snacks



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2. Exercise

Exercise and active lifestyle can improve

cardiorespiratory fitness



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3. Blood Glucose Monitoring



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4. S/Sx of Maternal Hypo/Hyper glycemia

ntepartal Nursing ManagementSigns / Symptoms of

Maternal Hypoglycemia:

Signs / Symptoms of

Maternal Hyperglycemia:

-Shakiness (Tremors)

-Fatigue

- Sweating - Flushed, hot skin

- Pallor; cold, clammy skin - Dry mouth, polydipsia

- Disorientation; irritability - Polyuria

- Headache - Rapid, deep respirations,

acetone breath

- Hunger - Drowsiness, headache

-Blurred vision

-Depressed reflexes


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ntepartal Nursing Management5. Insulin administration


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DIABETES MELLITUS

5. Evaluation of Fetal Status

AFP screening

Ultrasound

BPP

NST Contraction test



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Maternal insulin requirements fall during

postpartal period.

Antihyperglycemics contraindicated during

breastfeeding.

Postpartum adjustment

Postpartal Nursing Management


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Increasing Effective Communication

Providing Opportunities for Control

Providing Normal Pregnancy Care

Other Nursing Considerations


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The woman and at least one support person candemonstrate competence in home glucose monitoring andadministration of insulin

The woman can describe a satisfactory plan for meetingher individual dietary requirements

The woman and at least one support person can list thesigns and symptoms of hypoglycemia and hyperglycemiaand describe the initial management of these conditions

The woman can verbalize knowledge of the reason for fetalsurveillance procedures and keeps appointments for tests.

Expected Outcomes


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Murray, S. & McKinney, E. (2006). Foundations of

maternal-newborn nursing (4th ed.). USA:

Saunders Elsevier.

Pilitteri, A. (2010), Maternal & child health nursing:

Care of the childbearing & childrearing family

(6th ed.). Philippines: Lippincott Williams &

Wilkins.

REFERENCES

diabetes mellitus and pregnancy

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