GESTATIONAL DIABETES
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Feb 28, 2009
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About This Presentation
EASY TO FOLLOW POWERPOINT PRESENTATION ON GDM USEFUL FOR HEALTH CARE PROVIDERS AND ALL WOMEN OF REPRODUCTIVE AGE GROUP
Slide Content
GESTATIONAL GESTATIONAL
DIABETESDIABETES
DR.RISHIKESAN K.VDR.RISHIKESAN K.V
VENNIYIL MEDICAL CENTREVENNIYIL MEDICAL CENTRE
DIABETESDIABETES
DR.RISHIKESAN K.VDR.RISHIKESAN K.V
VENNIYIL MEDICAL CENTREVENNIYIL MEDICAL CENTRE
55 of 42 of 42 gdmgdm
Gestational DiabetesGestational Diabetes
This diagnosis is given when a woman, who This diagnosis is given when a woman, who
has never had diabetes before, gets has never had diabetes before, gets
diabetes or has high blood sugar, when she diabetes or has high blood sugar, when she
is pregnant. is pregnant.
Its medical name is Its medical name is gestational diabetes gestational diabetes
mellitusmellitus or GDM. or GDM.
It is one of the most common health It is one of the most common health
problems for pregnant women.problems for pregnant women.
The word “gestational” actually refers to The word “gestational” actually refers to
“during pregnancy.”“during pregnancy.”
Gestational DiabetesGestational Diabetes
This diagnosis is given when a woman, who This diagnosis is given when a woman, who
has never had diabetes before, gets has never had diabetes before, gets
diabetes or has high blood sugar, when she diabetes or has high blood sugar, when she
is pregnant. is pregnant.
Its medical name is Its medical name is gestational diabetes gestational diabetes
mellitusmellitus or GDM. or GDM.
It is one of the most common health It is one of the most common health
problems for pregnant women.problems for pregnant women.
The word “gestational” actually refers to The word “gestational” actually refers to
“during pregnancy.”“during pregnancy.”
kvrkvr gdmgdm
Gestational DiabetesGestational Diabetes
It occurs in about 5% of It occurs in about 5% of
all pregnancies. all pregnancies.
If not treated, If not treated,
gestational diabetes gestational diabetes
can cause health can cause health
problems for the problems for the
mother and the fetus.mother and the fetus.
Gestational DiabetesGestational Diabetes
It occurs in about 5% of It occurs in about 5% of
all pregnancies. all pregnancies.
If not treated, If not treated,
gestational diabetes gestational diabetes
can cause health can cause health
problems for the problems for the
mother and the fetus.mother and the fetus.
Glucose MetabolismGlucose Metabolism
Normal pregnancy Normal pregnancy : Diabetogenic state: Diabetogenic state
*increase in pc BG*increase in pc BG
*insulin resistance*insulin resistance
Early Pregnancy : Early Pregnancy :
Anabolic stateAnabolic state
*increase in maternal fat store*increase in maternal fat storeqsqs
*decreased FFA concentration*decreased FFA concentration
*decrease in insulin requirements*decrease in insulin requirements
Normal pregnancy Normal pregnancy : Diabetogenic state: Diabetogenic state
*increase in pc BG*increase in pc BG
*insulin resistance*insulin resistance
Early Pregnancy : Early Pregnancy :
Anabolic stateAnabolic state
*increase in maternal fat store*increase in maternal fat storeqsqs
*decreased FFA concentration*decreased FFA concentration
*decrease in insulin requirements*decrease in insulin requirements
CHO MetabolismCHO Metabolism
Effects of Pregnancy Effects of Pregnancy
**Mild fasting hypoglycemia;Mild fasting hypoglycemia;
*Post prandial hyperglycemia *Post prandial hyperglycemia
Due to increase in plasma volume in early Due to increase in plasma volume in early
gestation and increase in fetal glucose gestation and increase in fetal glucose
utilization.utilization.
As pregnancy advances As pregnancy advances -Progressive -Progressive
increase in tissue resistance to insulinincrease in tissue resistance to insulin
–Increase insulin secretion to maintain Increase insulin secretion to maintain
euglycemiaeuglycemia
–Suppressed glucagon responseSuppressed glucagon response
–Inc. prolactin, cortisolInc. prolactin, cortisol
–HPL has GH like effectsHPL has GH like effects
Effects of Pregnancy Effects of Pregnancy
**Mild fasting hypoglycemia;Mild fasting hypoglycemia;
*Post prandial hyperglycemia *Post prandial hyperglycemia
Due to increase in plasma volume in early Due to increase in plasma volume in early
gestation and increase in fetal glucose gestation and increase in fetal glucose
utilization.utilization.
As pregnancy advances As pregnancy advances -Progressive -Progressive
increase in tissue resistance to insulinincrease in tissue resistance to insulin
–Increase insulin secretion to maintain Increase insulin secretion to maintain
euglycemiaeuglycemia
–Suppressed glucagon responseSuppressed glucagon response
–Inc. prolactin, cortisolInc. prolactin, cortisol
–HPL has GH like effectsHPL has GH like effects
CHO MetabolismCHO Metabolism
Gestational DiabetesGestational Diabetes
Risk FactorsRisk Factors
maternal age >25maternal age >25
Family historyFamily history
glucosuriaglucosuria
prior macrosomiaprior macrosomia
previous unexplained stillbirthprevious unexplained stillbirth
ethnic group: Hispanic, Black, ethnic group: Hispanic, Black,
AsiansAsians
Risk FactorsRisk Factors
maternal age >25maternal age >25
Family historyFamily history
glucosuriaglucosuria
prior macrosomiaprior macrosomia
previous unexplained stillbirthprevious unexplained stillbirth
ethnic group: Hispanic, Black, ethnic group: Hispanic, Black,
AsiansAsians
gdmgdm
Insulin from the Insulin from the
pancreaspancreas
Vad happens to the carbohydrates from the Vad happens to the carbohydrates from the
food? food?
- -- -
- -- -
- -
Fat/muscle cellFat/muscle cell
Stored sugar in the Stored sugar in the
liver (glycogen)liver (glycogen)
Carbohydrates Carbohydrates
from foodfrom food
Insulin from the Insulin from the
pancreaspancreas
Vad happens to the carbohydrates from the Vad happens to the carbohydrates from the
food? food?
- -- -
- -- -
- -
Fat/muscle cellFat/muscle cell
Stored sugar in the Stored sugar in the
liver (glycogen)liver (glycogen)
Carbohydrates Carbohydrates
from foodfrom food
gdmgdm 1717
Why didn’t I have diabetes before?Why didn’t I have diabetes before?
During pregnancy, many During pregnancy, many
physiological changes take place. physiological changes take place.
Changes in metabolism can be Changes in metabolism can be
seen. Insulin may not be as seen. Insulin may not be as
effective in moving sugar into the effective in moving sugar into the
cells during pregnancy. cells during pregnancy.
Therefore, the cells can’t get the Therefore, the cells can’t get the
sugar they need for energy. sugar they need for energy.
Increased sugar levels in the Increased sugar levels in the
blood can lead to many blood can lead to many
problems.problems.
Why didn’t I have diabetes before?Why didn’t I have diabetes before?
During pregnancy, many During pregnancy, many
physiological changes take place. physiological changes take place.
Changes in metabolism can be Changes in metabolism can be
seen. Insulin may not be as seen. Insulin may not be as
effective in moving sugar into the effective in moving sugar into the
cells during pregnancy. cells during pregnancy.
Therefore, the cells can’t get the Therefore, the cells can’t get the
sugar they need for energy. sugar they need for energy.
Increased sugar levels in the Increased sugar levels in the
blood can lead to many blood can lead to many
problems.problems.
2020 gdmgdm
Why isn’t insulin doing its job?Why isn’t insulin doing its job?
The placenta is a system of vessels that The placenta is a system of vessels that
passes nutrients, blood, and water from passes nutrients, blood, and water from
mother to fetus.mother to fetus.
The placenta makes certain hormones The placenta makes certain hormones
that may prevent insulin from working the that may prevent insulin from working the
way that it should.way that it should.
When this condition happens, it is referred When this condition happens, it is referred
to as to as insulin resistanceinsulin resistance..
In order to keep metabolism normal during pregnancy, In order to keep metabolism normal during pregnancy, the the
body has to make three times more insulin than normal body has to make three times more insulin than normal to to
offset the hormones made by the placenta.offset the hormones made by the placenta.
Placenta
Why isn’t insulin doing its job?Why isn’t insulin doing its job?
The placenta is a system of vessels that The placenta is a system of vessels that
passes nutrients, blood, and water from passes nutrients, blood, and water from
mother to fetus.mother to fetus.
The placenta makes certain hormones The placenta makes certain hormones
that may prevent insulin from working the that may prevent insulin from working the
way that it should.way that it should.
When this condition happens, it is referred When this condition happens, it is referred
to as to as insulin resistanceinsulin resistance..
In order to keep metabolism normal during pregnancy, In order to keep metabolism normal during pregnancy, the the
body has to make three times more insulin than normal body has to make three times more insulin than normal to to
offset the hormones made by the placenta.offset the hormones made by the placenta.
Placenta
2121 gdmgdm
Why isn’t insulin doing its job?Why isn’t insulin doing its job?
For most women, the body’s extra For most women, the body’s extra
insulin is enough to keep their blood insulin is enough to keep their blood
sugar levels in the healthy range.sugar levels in the healthy range.
But, for about 5% of pregnant women, But, for about 5% of pregnant women,
even the extra insulin is not enough to even the extra insulin is not enough to
keep blood sugar levels normal.keep blood sugar levels normal.
These women end up with high blood These women end up with high blood
sugar or gestational diabetes at around sugar or gestational diabetes at around
the 20the 20
thth
to 24 to 24
thth
week of pregnancy. week of pregnancy.
Why isn’t insulin doing its job?Why isn’t insulin doing its job?
For most women, the body’s extra For most women, the body’s extra
insulin is enough to keep their blood insulin is enough to keep their blood
sugar levels in the healthy range.sugar levels in the healthy range.
But, for about 5% of pregnant women, But, for about 5% of pregnant women,
even the extra insulin is not enough to even the extra insulin is not enough to
keep blood sugar levels normal.keep blood sugar levels normal.
These women end up with high blood These women end up with high blood
sugar or gestational diabetes at around sugar or gestational diabetes at around
the 20the 20
thth
to 24 to 24
thth
week of pregnancy. week of pregnancy.
Gestational DiabetesGestational Diabetes
ScreeningScreening
–24-28 weeks routine24-28 weeks routine
–no need to fastno need to fast
–screen at 1st prenatal visit if hx of screen at 1st prenatal visit if hx of
previous GDMprevious GDM
–screen earlier (12-24 weeks ) if screen earlier (12-24 weeks ) if
risk factorsrisk factors
ScreeningScreening
–24-28 weeks routine24-28 weeks routine
–no need to fastno need to fast
–screen at 1st prenatal visit if hx of screen at 1st prenatal visit if hx of
previous GDMprevious GDM
–screen earlier (12-24 weeks ) if screen earlier (12-24 weeks ) if
risk factorsrisk factors
MATERNAL RISKMATERNAL RISK
Birth traumaBirth trauma
Preterm LaborPreterm Labor
PIHPIH
Operative deliveryOperative delivery
50% lifetime risk in developing Type 50% lifetime risk in developing Type
II DMII DM
Recurrence risk of GDM is 30-50%Recurrence risk of GDM is 30-50%
Gestational DiabetesGestational Diabetes
Birth traumaBirth trauma
Preterm LaborPreterm Labor
PIHPIH
Operative deliveryOperative delivery
50% lifetime risk in developing Type 50% lifetime risk in developing Type
II DMII DM
Recurrence risk of GDM is 30-50%Recurrence risk of GDM is 30-50%
Gestational DiabetesGestational Diabetes
Will GDM hurt my baby?Will GDM hurt my baby?
Most women with gestational diabetes give birthMost women with gestational diabetes give birth
to healthy babies; this is especially true forto healthy babies; this is especially true for
women who have kept their blood sugar underwomen who have kept their blood sugar under
control, maintained a healthy diet, engaged incontrol, maintained a healthy diet, engaged in
regular, moderate physical activity, and regular, moderate physical activity, and
had a healthy weight throughout thehad a healthy weight throughout the
pregnancy.In some cases, however, pregnancy.In some cases, however,
the condition can affect the pregnancy.the condition can affect the pregnancy.
Most women with gestational diabetes give birthMost women with gestational diabetes give birth
to healthy babies; this is especially true forto healthy babies; this is especially true for
women who have kept their blood sugar underwomen who have kept their blood sugar under
control, maintained a healthy diet, engaged incontrol, maintained a healthy diet, engaged in
regular, moderate physical activity, and regular, moderate physical activity, and
had a healthy weight throughout thehad a healthy weight throughout the
pregnancy.In some cases, however, pregnancy.In some cases, however,
the condition can affect the pregnancy.the condition can affect the pregnancy.
GDM GDM Associated ConditionsAssociated Conditions
MacrosomiaMacrosomia
In this condition, the baby’s body is larger than normal. In this condition, the baby’s body is larger than normal.
Large-bodied babies may be injured during natural delivery Large-bodied babies may be injured during natural delivery
through the vagina, so the baby may need to be delivered through the vagina, so the baby may need to be delivered
through cesarean section. through cesarean section.
HypoglycemiaHypoglycemia
In this condition, the baby’s blood glucose is too low. In this condition, the baby’s blood glucose is too low.
Breastfeeding may need to be started right away to get Breastfeeding may need to be started right away to get
more glucose into the baby’s system. If breastfeeding is more glucose into the baby’s system. If breastfeeding is
not possible, then the baby may need to get glucose put not possible, then the baby may need to get glucose put
directly into the blood through a thin, plastic tube in his or directly into the blood through a thin, plastic tube in his or
her arm.her arm.
JaundiceJaundice
In this condition ,the baby’s skin turns yellowish. The white In this condition ,the baby’s skin turns yellowish. The white
parts of the eye may also change color slightly. If treated, parts of the eye may also change color slightly. If treated,
this is not a serious problem.this is not a serious problem.
MacrosomiaMacrosomia
In this condition, the baby’s body is larger than normal. In this condition, the baby’s body is larger than normal.
Large-bodied babies may be injured during natural delivery Large-bodied babies may be injured during natural delivery
through the vagina, so the baby may need to be delivered through the vagina, so the baby may need to be delivered
through cesarean section. through cesarean section.
HypoglycemiaHypoglycemia
In this condition, the baby’s blood glucose is too low. In this condition, the baby’s blood glucose is too low.
Breastfeeding may need to be started right away to get Breastfeeding may need to be started right away to get
more glucose into the baby’s system. If breastfeeding is more glucose into the baby’s system. If breastfeeding is
not possible, then the baby may need to get glucose put not possible, then the baby may need to get glucose put
directly into the blood through a thin, plastic tube in his or directly into the blood through a thin, plastic tube in his or
her arm.her arm.
JaundiceJaundice
In this condition ,the baby’s skin turns yellowish. The white In this condition ,the baby’s skin turns yellowish. The white
parts of the eye may also change color slightly. If treated, parts of the eye may also change color slightly. If treated,
this is not a serious problem.this is not a serious problem.
GDM GDM ASSOCIATED CONDITIONS….ASSOCIATED CONDITIONS….
Respiratory Distress Syndrome (RDS)Respiratory Distress Syndrome (RDS)
In this condition, the baby has trouble breathing. In this condition, the baby has trouble breathing.
The baby may need oxygen or other help The baby may need oxygen or other help
breathing if he or she has this condition.breathing if he or she has this condition.
Low Calcium and Magnesium Levels in Baby’s Low Calcium and Magnesium Levels in Baby’s
BloodBlood
In this condition, spasms in the hands and feet, or In this condition, spasms in the hands and feet, or
twitching and cramping of muscles can occur. twitching and cramping of muscles can occur.
The condition can be treated through The condition can be treated through
supplementation with magnesium and calcium supplementation with magnesium and calcium
supplements.supplements.
Keep in mind that just because you have GDM it does not
mean that these problems will occur
Respiratory Distress Syndrome (RDS)Respiratory Distress Syndrome (RDS)
In this condition, the baby has trouble breathing. In this condition, the baby has trouble breathing.
The baby may need oxygen or other help The baby may need oxygen or other help
breathing if he or she has this condition.breathing if he or she has this condition.
Low Calcium and Magnesium Levels in Baby’s Low Calcium and Magnesium Levels in Baby’s
BloodBlood
In this condition, spasms in the hands and feet, or In this condition, spasms in the hands and feet, or
twitching and cramping of muscles can occur. twitching and cramping of muscles can occur.
The condition can be treated through The condition can be treated through
supplementation with magnesium and calcium supplementation with magnesium and calcium
supplements.supplements.
Keep in mind that just because you have GDM it does not
mean that these problems will occur
Could GDM hurt my baby in other ways?Could GDM hurt my baby in other ways?
Gestational diabetes usually does Gestational diabetes usually does notnot cause birth cause birth
defects or deformities.defects or deformities.
Most developmental or physical defects happened Most developmental or physical defects happened
during the first trimester of pregnancy, between the during the first trimester of pregnancy, between the
11
stst
and 8 and 8
thth
week, and gestational diabetes typically week, and gestational diabetes typically
develops around the 24develops around the 24
thth
week of pregnancy. week of pregnancy.
Gestational diabetes usually does Gestational diabetes usually does notnot cause birth cause birth
defects or deformities.defects or deformities.
Most developmental or physical defects happened Most developmental or physical defects happened
during the first trimester of pregnancy, between the during the first trimester of pregnancy, between the
11
stst
and 8 and 8
thth
week, and gestational diabetes typically week, and gestational diabetes typically
develops around the 24develops around the 24
thth
week of pregnancy. week of pregnancy.
Women with gestational
diabetes typically have normal
blood sugar levels during the
first trimester, allowing
the body and body
Systems of the fetus
to develop normally.
diabetes typically have normal
blood sugar levels during the
first trimester, allowing
the body and body
Systems of the fetus
to develop normally.
The fact that you have gestational
diabetes will not cause diabetes
in your baby.
However, your child will be
at a higher risk for developing
type 2 diabetes in adulthood
and may get it at a younger
age (younger than 30).
diabetes will not cause diabetes
in your baby.
However, your child will be
at a higher risk for developing
type 2 diabetes in adulthood
and may get it at a younger
age (younger than 30).
As your child grows, taking steps such as:
eating a healthy diet, maintaining a healthy
weight, and getting regular, moderate
physical activity can help to reduce his or
her risk.
Macrosomic, or large-bodied babies are at
higher risk for childhood and adult obesity.
eating a healthy diet, maintaining a healthy
weight, and getting regular, moderate
physical activity can help to reduce his or
her risk.
Macrosomic, or large-bodied babies are at
higher risk for childhood and adult obesity.
Magnetic Resonance Image
of Pregnancy Complicated by Diabetes
Normoglycmia Hyperglycmia
Jovanovic L et al. Am J Perinatol. 1993;10:432-437
of Pregnancy Complicated by Diabetes
Normoglycmia Hyperglycmia
Jovanovic L et al. Am J Perinatol. 1993;10:432-437
Macrosomia
Gestational Diabetes
Fetal RisksFetal Risks
no increaseno increase in congenital anomalies in congenital anomalies
increased risk of stillbirth if fasting+ increased risk of stillbirth if fasting+
pc hyperglycemiapc hyperglycemia
macrosomiamacrosomia
birth trauma-shoulderbirth trauma-shoulder
dystocia and related dystocia and related
complications complications
Gestational DiabetesGestational Diabetes
no increaseno increase in congenital anomalies in congenital anomalies
increased risk of stillbirth if fasting+ increased risk of stillbirth if fasting+
pc hyperglycemiapc hyperglycemia
macrosomiamacrosomia
birth trauma-shoulderbirth trauma-shoulder
dystocia and related dystocia and related
complications complications
Gestational DiabetesGestational Diabetes
5252 gdm gdm PBRC 2006PBRC 2006
A Treatment Plan for GDMA Treatment Plan for GDM
May include these items:May include these items:
Knowing your blood sugar (glucose) level and keeping it Knowing your blood sugar (glucose) level and keeping it
under controlunder control
Eating a healthy diet, as outlined by your health care Eating a healthy diet, as outlined by your health care
providerprovider
Getting regular, moderate physical activityGetting regular, moderate physical activity
Maintaining a healthy weight gainMaintaining a healthy weight gain
Keeping daily records of your diet, physical activity, and Keeping daily records of your diet, physical activity, and
glucose levelsglucose levels
Taking insulin and/or other medications as prescribedTaking insulin and/or other medications as prescribed
A Treatment Plan for GDMA Treatment Plan for GDM
May include these items:May include these items:
Knowing your blood sugar (glucose) level and keeping it Knowing your blood sugar (glucose) level and keeping it
under controlunder control
Eating a healthy diet, as outlined by your health care Eating a healthy diet, as outlined by your health care
providerprovider
Getting regular, moderate physical activityGetting regular, moderate physical activity
Maintaining a healthy weight gainMaintaining a healthy weight gain
Keeping daily records of your diet, physical activity, and Keeping daily records of your diet, physical activity, and
glucose levelsglucose levels
Taking insulin and/or other medications as prescribedTaking insulin and/or other medications as prescribed
5555 gdmgdm
Know your blood sugar level Know your blood sugar level
& keep it under control: & keep it under control: OverviewOverview
There are two parts:There are two parts:
–Knowing your blood sugar levelKnowing your blood sugar level
Test to see how much glucose is in your bloodTest to see how much glucose is in your blood
–Keeping your blood sugar level under controlKeeping your blood sugar level under control
Keep the amount within a healthy range at all timesKeep the amount within a healthy range at all times
This is important to do because your blood sugar level change This is important to do because your blood sugar level change
throughout the day based on what foods you eat, when you throughout the day based on what foods you eat, when you
eat them, and how much you eat. Your level of physical eat them, and how much you eat. Your level of physical
activity and when you do physical activity also influences blood activity and when you do physical activity also influences blood
sugar levels.sugar levels.
Know your blood sugar level Know your blood sugar level
& keep it under control: & keep it under control: OverviewOverview
There are two parts:There are two parts:
–Knowing your blood sugar levelKnowing your blood sugar level
Test to see how much glucose is in your bloodTest to see how much glucose is in your blood
–Keeping your blood sugar level under controlKeeping your blood sugar level under control
Keep the amount within a healthy range at all timesKeep the amount within a healthy range at all times
This is important to do because your blood sugar level change This is important to do because your blood sugar level change
throughout the day based on what foods you eat, when you throughout the day based on what foods you eat, when you
eat them, and how much you eat. Your level of physical eat them, and how much you eat. Your level of physical
activity and when you do physical activity also influences blood activity and when you do physical activity also influences blood
sugar levels.sugar levels.
Management Management
Goal is to optimize BG Goal is to optimize BG
levels to minimize risk levels to minimize risk
of adverse perinatal of adverse perinatal
outcomesoutcomes
Diet Diet
ExerciseExercise
Insulin therapyInsulin therapy
Gestational DiabetesGestational Diabetes
Goal is to optimize BG Goal is to optimize BG
levels to minimize risk levels to minimize risk
of adverse perinatal of adverse perinatal
outcomesoutcomes
Diet Diet
ExerciseExercise
Insulin therapyInsulin therapy
Gestational DiabetesGestational Diabetes
5757 of 42 of 42PBRC 2006PBRC 2006
Know your blood sugar level Know your blood sugar level
& keep it under control & keep it under control
Although your glucose Although your glucose
levels change during the levels change during the
day, there is a healthy day, there is a healthy
range that is normal. If range that is normal. If
your glucose level is your glucose level is
outside of the healthy outside of the healthy
target range, speak with target range, speak with
your health care your health care
provider.provider.
Time of
Blood Sugar
Test
Healthy Target Levels
(in mg/dl)
Fasting
glucose level
No higher than 95
One hour
after eating
No higher than
140
Two hours
after eating
No higher than
120
Know your blood sugar level Know your blood sugar level
& keep it under control & keep it under control
Although your glucose Although your glucose
levels change during the levels change during the
day, there is a healthy day, there is a healthy
range that is normal. If range that is normal. If
your glucose level is your glucose level is
outside of the healthy outside of the healthy
target range, speak with target range, speak with
your health care your health care
provider.provider.
Time of
Blood Sugar
Test
Healthy Target Levels
(in mg/dl)
Fasting
glucose level
No higher than 95
One hour
after eating
No higher than
140
Two hours
after eating
No higher than
120
5858 gdmgdm
Know your blood sugar level Know your blood sugar level
& keep it under control & keep it under control
Knowing your glucose Knowing your glucose
levels at specific times of levels at specific times of
the day may become the day may become
very important if insulin very important if insulin
therapy becomes therapy becomes
necessary.necessary.
Insulin resistance can Insulin resistance can
increase as a pregnancy increase as a pregnancy
progresses indicating a progresses indicating a
need for additional need for additional
insulin to control glucose insulin to control glucose
levelslevels. .
Measuring your
blood sugar will
give you
information about…
For example
The amount of food
you can eat
Can you have that extra ½
bagel for breakfast?
Foods that affect
your glucose level
Does your body process
different foods differently?
Times when your
glucose level is high
or low
You might have high blood
sugar in the morning after
breakfast; other women
may have high blood sugar
after dinner.
Times that
physical activity is
more likely to keep
your glucose level
in target
Does walking for 20
minutes after breakfast or
dinner help to keep your
glucose level within the
healthy range?
Know your blood sugar level Know your blood sugar level
& keep it under control & keep it under control
Knowing your glucose Knowing your glucose
levels at specific times of levels at specific times of
the day may become the day may become
very important if insulin very important if insulin
therapy becomes therapy becomes
necessary.necessary.
Insulin resistance can Insulin resistance can
increase as a pregnancy increase as a pregnancy
progresses indicating a progresses indicating a
need for additional need for additional
insulin to control glucose insulin to control glucose
levelslevels. .
Measuring your
blood sugar will
give you
information about…
For example
The amount of food
you can eat
Can you have that extra ½
bagel for breakfast?
Foods that affect
your glucose level
Does your body process
different foods differently?
Times when your
glucose level is high
or low
You might have high blood
sugar in the morning after
breakfast; other women
may have high blood sugar
after dinner.
Times that
physical activity is
more likely to keep
your glucose level
in target
Does walking for 20
minutes after breakfast or
dinner help to keep your
glucose level within the
healthy range?
5959
gdmgdm
Know your blood sugar level Know your blood sugar level
& keep it under control & keep it under control
You may have to test four times a day:You may have to test four times a day:
In the morning before eating breakfast, In the morning before eating breakfast,
referred to as the referred to as the FastingFasting glucose level glucose level
1 or 2 hours 1 or 2 hours after breakfastafter breakfast
1 or 2 hours 1 or 2 hours after lunchafter lunch
1 or 2 hours 1 or 2 hours after dinnerafter dinner
You may also have to test your glucose level You may also have to test your glucose level
before you go to bed at night. This is referred to as before you go to bed at night. This is referred to as
your your nighttime nighttime oror nocturnal nocturnal glucose test. glucose test.
gdmgdm
Know your blood sugar level Know your blood sugar level
& keep it under control & keep it under control
You may have to test four times a day:You may have to test four times a day:
In the morning before eating breakfast, In the morning before eating breakfast,
referred to as the referred to as the FastingFasting glucose level glucose level
1 or 2 hours 1 or 2 hours after breakfastafter breakfast
1 or 2 hours 1 or 2 hours after lunchafter lunch
1 or 2 hours 1 or 2 hours after dinnerafter dinner
You may also have to test your glucose level You may also have to test your glucose level
before you go to bed at night. This is referred to as before you go to bed at night. This is referred to as
your your nighttime nighttime oror nocturnal nocturnal glucose test. glucose test.
Management : DietManagement : Diet
patients without fasting patients without fasting
hyperglycemiahyperglycemia
average 8000-9000 kj/day.average 8000-9000 kj/day.
BMI >27 25 kcal/kg/IBW /dBMI >27 25 kcal/kg/IBW /d
BMI 20-26 30 ; BMI 20-26 30 ;
BMI <20 38 ; BMI <20 38 ;
Gestational DiabetesGestational Diabetes
patients without fasting patients without fasting
hyperglycemiahyperglycemia
average 8000-9000 kj/day.average 8000-9000 kj/day.
BMI >27 25 kcal/kg/IBW /dBMI >27 25 kcal/kg/IBW /d
BMI 20-26 30 ; BMI 20-26 30 ;
BMI <20 38 ; BMI <20 38 ;
Gestational DiabetesGestational Diabetes
6363 gdmgdm
Eating a healthy dietEating a healthy diet
OverviewOverview
A healthy diet is one that includes A healthy diet is one that includes
a balance of foods from all a balance of foods from all
the food groups, giving the the food groups, giving the
nutrients, vitamins, and minerals nutrients, vitamins, and minerals
necessary for a healthy necessary for a healthy
pregnancy. pregnancy.
For women with gestational For women with gestational
diabetes, a healthy diet can help to diabetes, a healthy diet can help to
keep blood sugar levels in the keep blood sugar levels in the
healthy target range.healthy target range.
Carbohydrates are often the Carbohydrates are often the
center of a healthy diet for a center of a healthy diet for a
woman with gestational diabetes.woman with gestational diabetes.
Eating a healthy dietEating a healthy diet
OverviewOverview
A healthy diet is one that includes A healthy diet is one that includes
a balance of foods from all a balance of foods from all
the food groups, giving the the food groups, giving the
nutrients, vitamins, and minerals nutrients, vitamins, and minerals
necessary for a healthy necessary for a healthy
pregnancy. pregnancy.
For women with gestational For women with gestational
diabetes, a healthy diet can help to diabetes, a healthy diet can help to
keep blood sugar levels in the keep blood sugar levels in the
healthy target range.healthy target range.
Carbohydrates are often the Carbohydrates are often the
center of a healthy diet for a center of a healthy diet for a
woman with gestational diabetes.woman with gestational diabetes.
6262 of 42 of 42 gdmgdm
Eating a healthy dietEating a healthy diet
CarbohydratesCarbohydratesCarbohydrates are nutrients which come Carbohydrates are nutrients which come
from foods like grain products, fruits, and from foods like grain products, fruits, and
vegetables. vegetables.
During digestion, the body is able to break During digestion, the body is able to break
down most carbohydrates into simple down most carbohydrates into simple
sugars, like glucose.sugars, like glucose.
Eating carbohydrates affects blood sugar Eating carbohydrates affects blood sugar
levels. Eating a large amount of levels. Eating a large amount of
carbohydrates at a meal will have a larger carbohydrates at a meal will have a larger
effect on blood glucose levels than eating a effect on blood glucose levels than eating a
small amount of carbohydrates.small amount of carbohydrates.
It is important to balance between eating It is important to balance between eating
enough carbohydrates to receive the enough carbohydrates to receive the
necessary amounts of energy and resultant necessary amounts of energy and resultant
glucose, and not consuming too much to glucose, and not consuming too much to
where blood sugar levels are out of where blood sugar levels are out of
controlcontrol..
Eating a healthy dietEating a healthy diet
CarbohydratesCarbohydratesCarbohydrates are nutrients which come Carbohydrates are nutrients which come
from foods like grain products, fruits, and from foods like grain products, fruits, and
vegetables. vegetables.
During digestion, the body is able to break During digestion, the body is able to break
down most carbohydrates into simple down most carbohydrates into simple
sugars, like glucose.sugars, like glucose.
Eating carbohydrates affects blood sugar Eating carbohydrates affects blood sugar
levels. Eating a large amount of levels. Eating a large amount of
carbohydrates at a meal will have a larger carbohydrates at a meal will have a larger
effect on blood glucose levels than eating a effect on blood glucose levels than eating a
small amount of carbohydrates.small amount of carbohydrates.
It is important to balance between eating It is important to balance between eating
enough carbohydrates to receive the enough carbohydrates to receive the
necessary amounts of energy and resultant necessary amounts of energy and resultant
glucose, and not consuming too much to glucose, and not consuming too much to
where blood sugar levels are out of where blood sugar levels are out of
controlcontrol..
6363 of 42 of 42PBRC 2006PBRC 2006
Eating a healthy dietEating a healthy diet
Meal PlansMeal Plans
CHO
counting
With this meal plan, the number of grams of
carbohydrates that is eaten at each meal or
snack is counted to make sure that they are
within a certain range. A meal plan may be very
specific, allowing a specified amount at each
meal or snack, or it may be more general, with a
daily carbohydrate total.
The
exchange
system
The exchange system groups each food
consumed into one of the following food groups:
bread/starches, fruits, vegetables, proteins, milk,
and fats. Each food within a group has very
similar amounts of carbohydrate, fat, protein and
calories, but the amounts of vitamins and
minerals may vary. In this plan, the number of
items from a food group that is eaten at each
meal is counted. There is a designated amount
for each group every day.
Eating a healthy dietEating a healthy diet
Meal PlansMeal Plans
CHO
counting
With this meal plan, the number of grams of
carbohydrates that is eaten at each meal or
snack is counted to make sure that they are
within a certain range. A meal plan may be very
specific, allowing a specified amount at each
meal or snack, or it may be more general, with a
daily carbohydrate total.
The
exchange
system
The exchange system groups each food
consumed into one of the following food groups:
bread/starches, fruits, vegetables, proteins, milk,
and fats. Each food within a group has very
similar amounts of carbohydrate, fat, protein and
calories, but the amounts of vitamins and
minerals may vary. In this plan, the number of
items from a food group that is eaten at each
meal is counted. There is a designated amount
for each group every day.
6464 of 42 of 42PBRC 2006PBRC 2006
Eating a healthy dietEating a healthy diet
to keep blood sugar in check:to keep blood sugar in check:
Eat meals and snacks on
a regular schedule
throughout
the day
Researchers recommend that women with gestational diabetes
should eat at least three small-to-medium sized meals and two
to four snacks every day.
Eat smaller amounts
of
carbohydrates at
each meal
It is preferable to eat several small meals every day rather than
one large meal. Carbohydrates will increase blood glucose
level directly, therefore, eating a small amount of
carbohydrates all through the day will help keep blood sugar
from rising too high.
Add a nighttime
snack to your meal
plan
A snack of one or two servings of carbohydrates before
bedtime will keep blood sugar at a healthy level during sleep.
Some healthy examples could include: a piece of fruit, a
handful of pretzels, or crackers.
Eating a healthy dietEating a healthy diet
to keep blood sugar in check:to keep blood sugar in check:
Eat meals and snacks on
a regular schedule
throughout
the day
Researchers recommend that women with gestational diabetes
should eat at least three small-to-medium sized meals and two
to four snacks every day.
Eat smaller amounts
of
carbohydrates at
each meal
It is preferable to eat several small meals every day rather than
one large meal. Carbohydrates will increase blood glucose
level directly, therefore, eating a small amount of
carbohydrates all through the day will help keep blood sugar
from rising too high.
Add a nighttime
snack to your meal
plan
A snack of one or two servings of carbohydrates before
bedtime will keep blood sugar at a healthy level during sleep.
Some healthy examples could include: a piece of fruit, a
handful of pretzels, or crackers.
Diet : general principlesDiet : general principles
55% CHO / 25% Protein / 55% CHO / 25% Protein /
20% fat20% fat
Normal weight gain 10-12 kgNormal weight gain 10-12 kg
Avoid ketosisAvoid ketosis
Liberal exercise program to Liberal exercise program to
optimize BG controloptimize BG control
Gestational DiabetesGestational Diabetes
55% CHO / 25% Protein / 55% CHO / 25% Protein /
20% fat20% fat
Normal weight gain 10-12 kgNormal weight gain 10-12 kg
Avoid ketosisAvoid ketosis
Liberal exercise program to Liberal exercise program to
optimize BG controloptimize BG control
Gestational DiabetesGestational Diabetes
6666 PBRC 2006PBRC 2006
Role of physical activityRole of physical activity
Women with gestational diabetes often Women with gestational diabetes often
need regular, moderate physical activity need regular, moderate physical activity
to help control their blood sugar levels to help control their blood sugar levels
by allowing insulin to work better.by allowing insulin to work better.
Examples include:Examples include:
– WalkingWalking
– Prenatal aerobics classesPrenatal aerobics classes
– SwimmingSwimming
However, a consultation and approval However, a consultation and approval
by a health care provider is needed by a health care provider is needed
before beginning any physical activity before beginning any physical activity
during pregnancy.during pregnancy.
Caution Keep in mind that
it may take 2 to
4 weeks before
physical activity
has an effect on
blood sugar
levels.
Role of physical activityRole of physical activity
Women with gestational diabetes often Women with gestational diabetes often
need regular, moderate physical activity need regular, moderate physical activity
to help control their blood sugar levels to help control their blood sugar levels
by allowing insulin to work better.by allowing insulin to work better.
Examples include:Examples include:
– WalkingWalking
– Prenatal aerobics classesPrenatal aerobics classes
– SwimmingSwimming
However, a consultation and approval However, a consultation and approval
by a health care provider is needed by a health care provider is needed
before beginning any physical activity before beginning any physical activity
during pregnancy.during pregnancy.
Caution Keep in mind that
it may take 2 to
4 weeks before
physical activity
has an effect on
blood sugar
levels.
If persistent hyperglycemiaIf persistent hyperglycemia
after one week of dietafter one week of diet
control proceed to insulincontrol proceed to insulin
6-14 weeks 6-14 weeks 0.5u/kg/d 0.5u/kg/d
14-26 weeks14-26 weeks 0.7u/kg/d 0.7u/kg/d
26-36 weeks 0.9u/kg/d26-36 weeks 0.9u/kg/d
36-40weeks 36-40weeks 1 u /kg/d 1 u /kg/d
Gestational DiabetesGestational Diabetes
INSULININSULIN
after one week of dietafter one week of diet
control proceed to insulincontrol proceed to insulin
6-14 weeks 6-14 weeks 0.5u/kg/d 0.5u/kg/d
14-26 weeks14-26 weeks 0.7u/kg/d 0.7u/kg/d
26-36 weeks 0.9u/kg/d26-36 weeks 0.9u/kg/d
36-40weeks 36-40weeks 1 u /kg/d 1 u /kg/d
Gestational DiabetesGestational Diabetes
INSULININSULIN
If fasting hyperglycemia start with If fasting hyperglycemia start with NPHNPHhs hs
initial dose initial dose 6-8 U 6-8 U
if only pc hyperglycemia use if only pc hyperglycemia use HHumalogumalog
2-4u ac the specific meal 2-4u ac the specific meal
adjust adjust 2u/time2u/time ; 1 formula /time ; 1 formula /time
BG target BG target ac <5.3 (90mg.)ac <5.3 (90mg.)
2 h pc <6.7 ( 120 mg)2 h pc <6.7 ( 120 mg)
Gestational DiabetesGestational Diabetes
INSULININSULIN
initial dose initial dose 6-8 U 6-8 U
if only pc hyperglycemia use if only pc hyperglycemia use HHumalogumalog
2-4u ac the specific meal 2-4u ac the specific meal
adjust adjust 2u/time2u/time ; 1 formula /time ; 1 formula /time
BG target BG target ac <5.3 (90mg.)ac <5.3 (90mg.)
2 h pc <6.7 ( 120 mg)2 h pc <6.7 ( 120 mg)
Gestational DiabetesGestational Diabetes
INSULININSULIN
6969 gdmgdm
Role of moderate physical activityRole of moderate physical activity
Researchers are uncertain about the Researchers are uncertain about the
exact amount of physical activity required exact amount of physical activity required
to control blood sugar during gestational to control blood sugar during gestational
diabetes.diabetes.
The amount that is usually recommended The amount that is usually recommended
is based on how active an individual was is based on how active an individual was
before the pregnancy and whether or not before the pregnancy and whether or not
there are any other health concerns.there are any other health concerns.
For some women with GDM, regular For some women with GDM, regular
physical activity can include walking, physical activity can include walking,
swimming, or light running; whereas, for swimming, or light running; whereas, for
other women only slow walking may be other women only slow walking may be
recommended. recommended.
A health care provider can offer advice on A health care provider can offer advice on
appropriate activities, and their duration appropriate activities, and their duration
and frequency to assure a healthy and frequency to assure a healthy
pregnancy. pregnancy.
Role of moderate physical activityRole of moderate physical activity
Researchers are uncertain about the Researchers are uncertain about the
exact amount of physical activity required exact amount of physical activity required
to control blood sugar during gestational to control blood sugar during gestational
diabetes.diabetes.
The amount that is usually recommended The amount that is usually recommended
is based on how active an individual was is based on how active an individual was
before the pregnancy and whether or not before the pregnancy and whether or not
there are any other health concerns.there are any other health concerns.
For some women with GDM, regular For some women with GDM, regular
physical activity can include walking, physical activity can include walking,
swimming, or light running; whereas, for swimming, or light running; whereas, for
other women only slow walking may be other women only slow walking may be
recommended. recommended.
A health care provider can offer advice on A health care provider can offer advice on
appropriate activities, and their duration appropriate activities, and their duration
and frequency to assure a healthy and frequency to assure a healthy
pregnancy. pregnancy.
7070 gdmgdm
Role of moderate physical activityRole of moderate physical activity
General Guidelines For Physical ActivityGeneral Guidelines For Physical Activity
Do Don’t
Participate in moderate and
regular physical activity
unless prohibited by a health care
provider
Get too tired while working out
or doing physical activity
Choose activities like swimming,
that don’t require a
lot of standing
or balance
Do any activity while lying on your back
when you are in your 2
nd
or 3
rd
trimester of pregnancy
Wear loose, light clothing that won’t
cause excessive sweating or increased
body temperature
Perform activities in very hot weather
Drink a lot of water before,
during, and after your activity
Perform activities that may bump or
hurt your belly, or that may cause you
to lose your balance
Eat a healthy diet and gain the
right amount of
weight
Fast (skip meals) or do physical activity
when you are hungry
Watch your level of exertion
(Can you talk easily?)
Over-exert yourself
Role of moderate physical activityRole of moderate physical activity
General Guidelines For Physical ActivityGeneral Guidelines For Physical Activity
Do Don’t
Participate in moderate and
regular physical activity
unless prohibited by a health care
provider
Get too tired while working out
or doing physical activity
Choose activities like swimming,
that don’t require a
lot of standing
or balance
Do any activity while lying on your back
when you are in your 2
nd
or 3
rd
trimester of pregnancy
Wear loose, light clothing that won’t
cause excessive sweating or increased
body temperature
Perform activities in very hot weather
Drink a lot of water before,
during, and after your activity
Perform activities that may bump or
hurt your belly, or that may cause you
to lose your balance
Eat a healthy diet and gain the
right amount of
weight
Fast (skip meals) or do physical activity
when you are hungry
Watch your level of exertion
(Can you talk easily?)
Over-exert yourself
7272 gdmgdm
Maintain a healthy weightMaintain a healthy weight
OverviewOverview
Healthy weight gain can refer to Healthy weight gain can refer to
your your overall weight gainoverall weight gain or your or your
weekly rate of weight gainweekly rate of weight gain..
Some health care providers Some health care providers
focus only on overall gain or focus only on overall gain or
only on weekly gain, but some only on weekly gain, but some
keep track of both types of keep track of both types of
weight gain.weight gain.
Maintain a healthy weightMaintain a healthy weight
OverviewOverview
Healthy weight gain can refer to Healthy weight gain can refer to
your your overall weight gainoverall weight gain or your or your
weekly rate of weight gainweekly rate of weight gain..
Some health care providers Some health care providers
focus only on overall gain or focus only on overall gain or
only on weekly gain, but some only on weekly gain, but some
keep track of both types of keep track of both types of
weight gain.weight gain.
7373 gdmgdm
Maintain a healthy weightMaintain a healthy weight
Weekly Rate Of Weight GainWeekly Rate Of Weight Gain
Time Frame Expected Weight Gain
In the first trimester of
pregnancy
(the first 3 months)
Three to six pounds for the
entire three
months
During the second and third
trimester
(the last 6 months)
Between ½ and 1 pound each
week
If you gained too much weight
early in the pregnancy
Limit weight gain to ¾ of a
pound each week (3 pounds each
month) to help get your blood
sugar level under control
A weight gain of two pounds or more each
week is
considered high.
Maintain a healthy weightMaintain a healthy weight
Weekly Rate Of Weight GainWeekly Rate Of Weight Gain
Time Frame Expected Weight Gain
In the first trimester of
pregnancy
(the first 3 months)
Three to six pounds for the
entire three
months
During the second and third
trimester
(the last 6 months)
Between ½ and 1 pound each
week
If you gained too much weight
early in the pregnancy
Limit weight gain to ¾ of a
pound each week (3 pounds each
month) to help get your blood
sugar level under control
A weight gain of two pounds or more each
week is
considered high.
7474 gdmgdm
Maintain a healthy weightMaintain a healthy weight
Things to Keep in MindThings to Keep in Mind
A weekly rate of weight gain may go up and A weekly rate of weight gain may go up and
down throughout the pregnancy.down throughout the pregnancy.
A physician can assess whether weight gain is A physician can assess whether weight gain is
appropriate or not.appropriate or not.
A A weight lossweight loss can be can be dangerousdangerous during any part during any part
of the pregnancy, therefore any weight loss of the pregnancy, therefore any weight loss
needs to be reported to a health care provider needs to be reported to a health care provider
right away.right away.
If weight gain slows or stop, and does not If weight gain slows or stop, and does not
increase again after one-to-two weeks, it should increase again after one-to-two weeks, it should
be reported to a health care provider be reported to a health care provider
immediately. Adjustments in your treatment plan immediately. Adjustments in your treatment plan
may be necessary.may be necessary.
Maintain a healthy weightMaintain a healthy weight
Things to Keep in MindThings to Keep in Mind
A weekly rate of weight gain may go up and A weekly rate of weight gain may go up and
down throughout the pregnancy.down throughout the pregnancy.
A physician can assess whether weight gain is A physician can assess whether weight gain is
appropriate or not.appropriate or not.
A A weight lossweight loss can be can be dangerousdangerous during any part during any part
of the pregnancy, therefore any weight loss of the pregnancy, therefore any weight loss
needs to be reported to a health care provider needs to be reported to a health care provider
right away.right away.
If weight gain slows or stop, and does not If weight gain slows or stop, and does not
increase again after one-to-two weeks, it should increase again after one-to-two weeks, it should
be reported to a health care provider be reported to a health care provider
immediately. Adjustments in your treatment plan immediately. Adjustments in your treatment plan
may be necessary.may be necessary.
Maintain a healthy weightMaintain a healthy weight
Additional tipsAdditional tips
Try to get more light or moderate physical activity, if Try to get more light or moderate physical activity, if
your health care provider says that it is safe.your health care provider says that it is safe.
Use the Use the Nutrition FactsNutrition Facts labels on food packages to labels on food packages to
make lower-calorie food choices that fit into a make lower-calorie food choices that fit into a
healthy meal plan.healthy meal plan.
Eat fewer fried foods and “fast” foodsEat fewer fried foods and “fast” foods..
Eat healthy foods that fit into your meal plan, such as Eat healthy foods that fit into your meal plan, such as
salads with low-fat dressings and broiled or grilled salads with low-fat dressings and broiled or grilled
chicken.chicken.
Use less butter and margarine on food, or don’t use Use less butter and margarine on food, or don’t use
them at allthem at all..
Additional tipsAdditional tips
Try to get more light or moderate physical activity, if Try to get more light or moderate physical activity, if
your health care provider says that it is safe.your health care provider says that it is safe.
Use the Use the Nutrition FactsNutrition Facts labels on food packages to labels on food packages to
make lower-calorie food choices that fit into a make lower-calorie food choices that fit into a
healthy meal plan.healthy meal plan.
Eat fewer fried foods and “fast” foodsEat fewer fried foods and “fast” foods..
Eat healthy foods that fit into your meal plan, such as Eat healthy foods that fit into your meal plan, such as
salads with low-fat dressings and broiled or grilled salads with low-fat dressings and broiled or grilled
chicken.chicken.
Use less butter and margarine on food, or don’t use Use less butter and margarine on food, or don’t use
them at allthem at all..
Additional tipsAdditional tips
Use spices and herbs (such as curry, garlic, Use spices and herbs (such as curry, garlic,
and parsley) and low-fat or lower calorie and parsley) and low-fat or lower calorie
sauces to flavor rice and pasta.sauces to flavor rice and pasta.
Eat smaller meals and have low-calorie snacks more Eat smaller meals and have low-calorie snacks more
often, to ensure that your body has a constant often, to ensure that your body has a constant
glucose supply, and to prevent yourself from getting glucose supply, and to prevent yourself from getting
very hungry.very hungry.
Avoid skipping meals or cutting back too much on Avoid skipping meals or cutting back too much on
breakfast or lunch. Eating less food or skipping meals breakfast or lunch. Eating less food or skipping meals
could make you overly hungry at the next meal, could make you overly hungry at the next meal,
causing you to overeat.causing you to overeat.
Use spices and herbs (such as curry, garlic, Use spices and herbs (such as curry, garlic,
and parsley) and low-fat or lower calorie and parsley) and low-fat or lower calorie
sauces to flavor rice and pasta.sauces to flavor rice and pasta.
Eat smaller meals and have low-calorie snacks more Eat smaller meals and have low-calorie snacks more
often, to ensure that your body has a constant often, to ensure that your body has a constant
glucose supply, and to prevent yourself from getting glucose supply, and to prevent yourself from getting
very hungry.very hungry.
Avoid skipping meals or cutting back too much on Avoid skipping meals or cutting back too much on
breakfast or lunch. Eating less food or skipping meals breakfast or lunch. Eating less food or skipping meals
could make you overly hungry at the next meal, could make you overly hungry at the next meal,
causing you to overeat.causing you to overeat.
7777 of 42 of 42
GDMGDM
Keep daily records of your diet, physicalKeep daily records of your diet, physical
activity, and glucose levelsactivity, and glucose levels
Keeping records refers to writing down your blood sugar numbers, Keeping records refers to writing down your blood sugar numbers,
physical activities, and everything that you eat and drink in a physical activities, and everything that you eat and drink in a
daily record bookdaily record book..
Recording everything that you eat and drink really means Recording everything that you eat and drink really means
everything everything that you eat and drink. This refers to bites, nibbles, that you eat and drink. This refers to bites, nibbles,
snacks, second helpings and all liquids.snacks, second helpings and all liquids.
It’s easy to forget or underestimate how much snacking you really It’s easy to forget or underestimate how much snacking you really
do.do.
GDMGDM
Keep daily records of your diet, physicalKeep daily records of your diet, physical
activity, and glucose levelsactivity, and glucose levels
Keeping records refers to writing down your blood sugar numbers, Keeping records refers to writing down your blood sugar numbers,
physical activities, and everything that you eat and drink in a physical activities, and everything that you eat and drink in a
daily record bookdaily record book..
Recording everything that you eat and drink really means Recording everything that you eat and drink really means
everything everything that you eat and drink. This refers to bites, nibbles, that you eat and drink. This refers to bites, nibbles,
snacks, second helpings and all liquids.snacks, second helpings and all liquids.
It’s easy to forget or underestimate how much snacking you really It’s easy to forget or underestimate how much snacking you really
do.do.
7878
GDMGDM
Keep daily records of your diet, Keep daily records of your diet,
physical activity, and glucose physical activity, and glucose
levelslevels
Keep track of the followingKeep track of the following
Blood sugar levelBlood sugar level
FoodFood
Physical wellnessPhysical wellness
Physical activityPhysical activity
Weight gainWeight gain
GDMGDM
Keep daily records of your diet, Keep daily records of your diet,
physical activity, and glucose physical activity, and glucose
levelslevels
Keep track of the followingKeep track of the following
Blood sugar levelBlood sugar level
FoodFood
Physical wellnessPhysical wellness
Physical activityPhysical activity
Weight gainWeight gain
7979
gdmgdm
Keep daily records of your diet, physical Keep daily records of your diet, physical
activity, and glucose levelsactivity, and glucose levels
It’s a good idea to follow a schedule for It’s a good idea to follow a schedule for
writing in the record book.writing in the record book.
This lets you get used to writing in it and This lets you get used to writing in it and
helps you to remember to do it.helps you to remember to do it.
Daily records help to keep track of how well your Daily records help to keep track of how well your
treatment plan is working and what, if anything, treatment plan is working and what, if anything,
should be changed.should be changed.
The information also reveals whether or not The information also reveals whether or not
you will need insulin, and if so, how much you will need insulin, and if so, how much
will be needed.will be needed.
gdmgdm
Keep daily records of your diet, physical Keep daily records of your diet, physical
activity, and glucose levelsactivity, and glucose levels
It’s a good idea to follow a schedule for It’s a good idea to follow a schedule for
writing in the record book.writing in the record book.
This lets you get used to writing in it and This lets you get used to writing in it and
helps you to remember to do it.helps you to remember to do it.
Daily records help to keep track of how well your Daily records help to keep track of how well your
treatment plan is working and what, if anything, treatment plan is working and what, if anything,
should be changed.should be changed.
The information also reveals whether or not The information also reveals whether or not
you will need insulin, and if so, how much you will need insulin, and if so, how much
will be needed.will be needed.
8080
gdmgdm
Take insulin and/or Take insulin and/or
other medications as prescribedother medications as prescribed
Even if you do everything your health Even if you do everything your health
care provider recommends to manage care provider recommends to manage
your gestational diabetes, you may still your gestational diabetes, you may still
need to take insulin during your need to take insulin during your
pregnancy to keep it under control.pregnancy to keep it under control.
The only way to get extra insulin into The only way to get extra insulin into
your body is to inject it under your skin your body is to inject it under your skin
with a needle.with a needle.
gdmgdm
Take insulin and/or Take insulin and/or
other medications as prescribedother medications as prescribed
Even if you do everything your health Even if you do everything your health
care provider recommends to manage care provider recommends to manage
your gestational diabetes, you may still your gestational diabetes, you may still
need to take insulin during your need to take insulin during your
pregnancy to keep it under control.pregnancy to keep it under control.
The only way to get extra insulin into The only way to get extra insulin into
your body is to inject it under your skin your body is to inject it under your skin
with a needle.with a needle.
8282 gdmgdm
Take insulin and/or Take insulin and/or
other medications as prescribedother medications as prescribed
You may have to include small amounts of insulin in You may have to include small amounts of insulin in
your treatment plan if:your treatment plan if:
Your blood sugar level is too high.Your blood sugar level is too high.
You blood sugar level is frequently too highYou blood sugar level is frequently too high
Your blood sugar level remains high, and you are not Your blood sugar level remains high, and you are not
gaining much weight even with proper eating habit.gaining much weight even with proper eating habit.
You cannot safely add physical activity to your You cannot safely add physical activity to your
treatment plantreatment plan
Take insulin and/or Take insulin and/or
other medications as prescribedother medications as prescribed
You may have to include small amounts of insulin in You may have to include small amounts of insulin in
your treatment plan if:your treatment plan if:
Your blood sugar level is too high.Your blood sugar level is too high.
You blood sugar level is frequently too highYou blood sugar level is frequently too high
Your blood sugar level remains high, and you are not Your blood sugar level remains high, and you are not
gaining much weight even with proper eating habit.gaining much weight even with proper eating habit.
You cannot safely add physical activity to your You cannot safely add physical activity to your
treatment plantreatment plan
Take insulin and/or Take insulin and/or
other medications as other medications as
prescribedprescribed
Things to know about insulin:
1.If you need to take insulin, it
does not mean that you didn’t
try hard enough or that you
failed at taking care of yourself.
3.Taking insulin does not mean
that you have Type 1 diabetes.
other medications as other medications as
prescribedprescribed
Things to know about insulin:
1.If you need to take insulin, it
does not mean that you didn’t
try hard enough or that you
failed at taking care of yourself.
3.Taking insulin does not mean
that you have Type 1 diabetes.
Things to know about insulinThings to know about insulin
3. An increase in the amount or dosage of 3. An increase in the amount or dosage of
insulin needed does not mean that your insulin needed does not mean that your
pregnancy is in danger.pregnancy is in danger.
4. You may need more insulin if you are 4. You may need more insulin if you are
under high amounts of stress or if you are under high amounts of stress or if you are
sick because your blood sugar level gets sick because your blood sugar level gets
higher on its own in these cases.higher on its own in these cases.
3. An increase in the amount or dosage of 3. An increase in the amount or dosage of
insulin needed does not mean that your insulin needed does not mean that your
pregnancy is in danger.pregnancy is in danger.
4. You may need more insulin if you are 4. You may need more insulin if you are
under high amounts of stress or if you are under high amounts of stress or if you are
sick because your blood sugar level gets sick because your blood sugar level gets
higher on its own in these cases.higher on its own in these cases.
Neonatal Malformations Are Not Related Neonatal Malformations Are Not Related
to Type of Insulinto Type of Insulin
0
2
4
6
8
10
12
14
16
GDM Preexisting diabetes
Regular human insulin
Insulin lispro
Congenital
malformation
rate (%)
Bhattacharyya A et al. Q J Med. 2001;94:255-260
7.9%
6.6%
15.8%
3.8%
N=213 N=97
P=0.79
P=0.16
to Type of Insulinto Type of Insulin
0
2
4
6
8
10
12
14
16
GDM Preexisting diabetes
Regular human insulin
Insulin lispro
Congenital
malformation
rate (%)
Bhattacharyya A et al. Q J Med. 2001;94:255-260
7.9%
6.6%
15.8%
3.8%
N=213 N=97
P=0.79
P=0.16
Malformations Are Related to Malformations Are Related to
Glucose Not Type of InsulinGlucose Not Type of Insulin
Wyatt JW, Frias JL, Hoyme HE, Jovanovic L, et al. Congenital anomaly
rate in offspring of pre-gestational diabetic women treated with insulin
lispro during pregnancy. Diabetic Medicine 21:2001-2007, 2004.
Glucose Not Type of InsulinGlucose Not Type of Insulin
Wyatt JW, Frias JL, Hoyme HE, Jovanovic L, et al. Congenital anomaly
rate in offspring of pre-gestational diabetic women treated with insulin
lispro during pregnancy. Diabetic Medicine 21:2001-2007, 2004.
Take insulin and/or Take insulin and/or
other medications as other medications as
prescribedprescribed
Special instructions for women taking insulin are to:Special instructions for women taking insulin are to:
Follow a regular eating scheduleFollow a regular eating schedule
The timing of insulin shots and of eatingThe timing of insulin shots and of eating
meals needs to be correct. Yourmeals needs to be correct. Your
healthcare provider can tell you whenhealthcare provider can tell you when
to do both. It is very important not toto do both. It is very important not to
skip or delay meals and snacks when skip or delay meals and snacks when
taking insulin because this can affect your glucose taking insulin because this can affect your glucose
insulin balance.insulin balance.
other medications as other medications as
prescribedprescribed
Special instructions for women taking insulin are to:Special instructions for women taking insulin are to:
Follow a regular eating scheduleFollow a regular eating schedule
The timing of insulin shots and of eatingThe timing of insulin shots and of eating
meals needs to be correct. Yourmeals needs to be correct. Your
healthcare provider can tell you whenhealthcare provider can tell you when
to do both. It is very important not toto do both. It is very important not to
skip or delay meals and snacks when skip or delay meals and snacks when
taking insulin because this can affect your glucose taking insulin because this can affect your glucose
insulin balance.insulin balance.
Know the symptoms of hypoglycemia
If your blood sugar level drops below
60 at any time, you have
hypoglycemia. This can be very
dangerous. Hypoglycemia is already
common in all women with gestational
diabetes, but for women taking insulin
for this condition, they are at greater
risk.
If your blood sugar level drops below
60 at any time, you have
hypoglycemia. This can be very
dangerous. Hypoglycemia is already
common in all women with gestational
diabetes, but for women taking insulin
for this condition, they are at greater
risk.
Before any physical activity is begun,
you should test your blood sugar. If it
is low, do not begin the activity. Eat
something and test again to make
sure it is higher before beginning
you should test your blood sugar. If it
is low, do not begin the activity. Eat
something and test again to make
sure it is higher before beginning
Why does low blood sugar
occur?
Too much exercise
Skipping meals or snacks
Delaying meals or snacks
Not eating enough
Too much insulin
occur?
Too much exercise
Skipping meals or snacks
Delaying meals or snacks
Not eating enough
Too much insulin
How might I feel if I have How might I feel if I have
low blood sugar?low blood sugar?
Very hungryVery hungry
Very tiredVery tired
Shaky or tremblingShaky or trembling
Sweating or clamminessSweating or clamminess
NervousNervous
ConfusedConfused
Like you’re going to pass out or faintLike you’re going to pass out or faint
Blurred visionBlurred vision
* Report any abnormal
blood sugar level to your
health care provider right
away, in case a change
in your treatment plan is
needed.
low blood sugar?low blood sugar?
Very hungryVery hungry
Very tiredVery tired
Shaky or tremblingShaky or trembling
Sweating or clamminessSweating or clamminess
NervousNervous
ConfusedConfused
Like you’re going to pass out or faintLike you’re going to pass out or faint
Blurred visionBlurred vision
* Report any abnormal
blood sugar level to your
health care provider right
away, in case a change
in your treatment plan is
needed.
Hypoglycemia Hypoglycemia
Prevention StrategiesPrevention Strategies
ConsistentMonitoring
ConsistentMonitoring
Before All Meals & Snacks
Pre/Post Exercise
Bedtime
3 a.m. (occasionally)
Prevention StrategiesPrevention Strategies
ConsistentMonitoring
ConsistentMonitoring
Before All Meals & Snacks
Pre/Post Exercise
Bedtime
3 a.m. (occasionally)
9393 gdmgdm
Things to keep in mind about deliveryThings to keep in mind about delivery
Blood Sugar
and Insulin
Balance
Keeping blood sugar levels under control during labor and delivery is vital
for both you and your baby’s health. If you did not have to take insulin
during the pregnancy, then you won’t need it during labor or delivery;
however, if you did have to take insulin during pregnancy, then you may
receive an insulin shot when labor begins or during labor.
Early
Delivery
Gestational diabetes puts women at higher risk for a condition known as
preeclampsia late in pregnancy. Preeclampsia is a condition associated
with sudden blood pressure increases, which can be quite serious.
Unfortunately, the only cure to preeclampsia is delivery of the baby, but
delivery may not be the best option for your health or for the health of
your baby. Your health care provider will keep you under close watch if
this condition develops, determining whether early delivery is safe and
needed.
Cesarean
Delivery
This is a type of delivery used to deliver the baby, as opposed to natural
delivery through the vagina. Cesarean delivery is also referred to as a
cesarean section, or “C” section. Simply having gestational diabetes is
not reason alone to have a C section, but your health care provider
may have other reasons for choosing this option, such as changes in your
health or your baby’s health during delivery.
Things to keep in mind about deliveryThings to keep in mind about delivery
Blood Sugar
and Insulin
Balance
Keeping blood sugar levels under control during labor and delivery is vital
for both you and your baby’s health. If you did not have to take insulin
during the pregnancy, then you won’t need it during labor or delivery;
however, if you did have to take insulin during pregnancy, then you may
receive an insulin shot when labor begins or during labor.
Early
Delivery
Gestational diabetes puts women at higher risk for a condition known as
preeclampsia late in pregnancy. Preeclampsia is a condition associated
with sudden blood pressure increases, which can be quite serious.
Unfortunately, the only cure to preeclampsia is delivery of the baby, but
delivery may not be the best option for your health or for the health of
your baby. Your health care provider will keep you under close watch if
this condition develops, determining whether early delivery is safe and
needed.
Cesarean
Delivery
This is a type of delivery used to deliver the baby, as opposed to natural
delivery through the vagina. Cesarean delivery is also referred to as a
cesarean section, or “C” section. Simply having gestational diabetes is
not reason alone to have a C section, but your health care provider
may have other reasons for choosing this option, such as changes in your
health or your baby’s health during delivery.
PostpartumPostpartum
often will not require insulinoften will not require insulin
if fasting hyperglycemia – if fasting hyperglycemia –
more likely to develop persistent Diabetesmore likely to develop persistent Diabetes
6 weeks post partum 75g OGTT6 weeks post partum 75g OGTT
yearly fasting BGyearly fasting BG
emphasize importance of maintaining N emphasize importance of maintaining N
weight, exerciseweight, exercise
Gestational DiabetesGestational Diabetes
often will not require insulinoften will not require insulin
if fasting hyperglycemia – if fasting hyperglycemia –
more likely to develop persistent Diabetesmore likely to develop persistent Diabetes
6 weeks post partum 75g OGTT6 weeks post partum 75g OGTT
yearly fasting BGyearly fasting BG
emphasize importance of maintaining N emphasize importance of maintaining N
weight, exerciseweight, exercise
Gestational DiabetesGestational Diabetes
Will I develop Type 2 diabetes in the Will I develop Type 2 diabetes in the
futurefuture? There are ? There are CERTAIN TRAITS CERTAIN TRAITS ::
You developed gestational diabetes before your You developed gestational diabetes before your
2424
thth
week of pregnancy. week of pregnancy.
Your blood sugar level during pregnancy was Your blood sugar level during pregnancy was
consistently on the high end of the healthy range.consistently on the high end of the healthy range.
Your blood sugar levels after the baby was born Your blood sugar levels after the baby was born
were higher-than-average, according to your health were higher-than-average, according to your health
care provider.care provider.
You are in the impaired glucose tolerance category.You are in the impaired glucose tolerance category.
You are obese, according to your health care You are obese, according to your health care
provider.provider.
futurefuture? There are ? There are CERTAIN TRAITS CERTAIN TRAITS ::
You developed gestational diabetes before your You developed gestational diabetes before your
2424
thth
week of pregnancy. week of pregnancy.
Your blood sugar level during pregnancy was Your blood sugar level during pregnancy was
consistently on the high end of the healthy range.consistently on the high end of the healthy range.
Your blood sugar levels after the baby was born Your blood sugar levels after the baby was born
were higher-than-average, according to your health were higher-than-average, according to your health
care provider.care provider.
You are in the impaired glucose tolerance category.You are in the impaired glucose tolerance category.
You are obese, according to your health care You are obese, according to your health care
provider.provider.
……....CERTAIN TRAITS CERTAIN TRAITS which increase which increase
the chancesthe chances
66.You have diabetes in your family..You have diabetes in your family.
77.You belong to a high-risk ethnic group (Hispanic, .You belong to a high-risk ethnic group (Hispanic,
African American, Native American, South or East African American, Native American, South or East
Asian, Pacific Islander, Indigenous Australian).Asian, Pacific Islander, Indigenous Australian).
88.You have had gestational diabetes with other .You have had gestational diabetes with other
pregnancies.pregnancies.
With one or more of these traits, you should talk
to your doctor about Type 2 diabetes.
the chancesthe chances
66.You have diabetes in your family..You have diabetes in your family.
77.You belong to a high-risk ethnic group (Hispanic, .You belong to a high-risk ethnic group (Hispanic,
African American, Native American, South or East African American, Native American, South or East
Asian, Pacific Islander, Indigenous Australian).Asian, Pacific Islander, Indigenous Australian).
88.You have had gestational diabetes with other .You have had gestational diabetes with other
pregnancies.pregnancies.
With one or more of these traits, you should talk
to your doctor about Type 2 diabetes.
Should I breastfeed having gestational Should I breastfeed having gestational
diabetes?diabetes?
Yes, women with gestational diabetes should Yes, women with gestational diabetes should
breastfeed their babies, if possible.breastfeed their babies, if possible.
Breastfeeding is not only beneficial to the baby, Breastfeeding is not only beneficial to the baby,
but it is also beneficial to the mother. but it is also beneficial to the mother.
Breastfeeding allows the body to use extra calories Breastfeeding allows the body to use extra calories
stored during pregnancy, allowing for weight loss.stored during pregnancy, allowing for weight loss.
A weight loss after having the baby not only A weight loss after having the baby not only
enhances overall health, but also helps to reduce enhances overall health, but also helps to reduce
the risk of developing type 2 diabetes later in life.the risk of developing type 2 diabetes later in life.
diabetes?diabetes?
Yes, women with gestational diabetes should Yes, women with gestational diabetes should
breastfeed their babies, if possible.breastfeed their babies, if possible.
Breastfeeding is not only beneficial to the baby, Breastfeeding is not only beneficial to the baby,
but it is also beneficial to the mother. but it is also beneficial to the mother.
Breastfeeding allows the body to use extra calories Breastfeeding allows the body to use extra calories
stored during pregnancy, allowing for weight loss.stored during pregnancy, allowing for weight loss.
A weight loss after having the baby not only A weight loss after having the baby not only
enhances overall health, but also helps to reduce enhances overall health, but also helps to reduce
the risk of developing type 2 diabetes later in life.the risk of developing type 2 diabetes later in life.
Breastfeeding
is also
believed to
help lower
fasting blood
glucose levels
in mothers.
is also
believed to
help lower
fasting blood
glucose levels
in mothers.
9999 gdmgdm
Will I have diabetes after Will I have diabetes after
having my baby?having my baby?
Shortly after the baby is born, the placentaShortly after the baby is born, the placenta
is “delivered.”is “delivered.”
Since the placenta is what was causing the insulin resistance, Since the placenta is what was causing the insulin resistance,
when it is gone, gestational diabetes usually resolves as well.when it is gone, gestational diabetes usually resolves as well.
But, just by having had gestational diabetes, you have a 40% But, just by having had gestational diabetes, you have a 40%
higher chance of developing type 2 diabetes later in life than higher chance of developing type 2 diabetes later in life than
women who did not have the condition during pregnancy.women who did not have the condition during pregnancy.
Keeping your weight within a healthy range and keeping up Keeping your weight within a healthy range and keeping up
regular, moderate physical activity after your baby is born can regular, moderate physical activity after your baby is born can
help lower your risk for developing type 2 diabetes.help lower your risk for developing type 2 diabetes.
Will I have diabetes after Will I have diabetes after
having my baby?having my baby?
Shortly after the baby is born, the placentaShortly after the baby is born, the placenta
is “delivered.”is “delivered.”
Since the placenta is what was causing the insulin resistance, Since the placenta is what was causing the insulin resistance,
when it is gone, gestational diabetes usually resolves as well.when it is gone, gestational diabetes usually resolves as well.
But, just by having had gestational diabetes, you have a 40% But, just by having had gestational diabetes, you have a 40%
higher chance of developing type 2 diabetes later in life than higher chance of developing type 2 diabetes later in life than
women who did not have the condition during pregnancy.women who did not have the condition during pregnancy.
Keeping your weight within a healthy range and keeping up Keeping your weight within a healthy range and keeping up
regular, moderate physical activity after your baby is born can regular, moderate physical activity after your baby is born can
help lower your risk for developing type 2 diabetes.help lower your risk for developing type 2 diabetes.
101101 gdmgdm
What should I do after delivery?What should I do after delivery?
Six weeks after your baby Six weeks after your baby
is born, you should have a is born, you should have a
blood test to find out blood test to find out
whether your blood sugar whether your blood sugar
level is back to normal. level is back to normal.
Based on the results you Based on the results you
will fall into one of the will fall into one of the
three categories:three categories:
If your category
is…
You should…
Normal
Get checked for
diabetes every 3
years
Impaired Glucose
Tolerance
Get checked for
diabetes every year
and talk with your
health care provider
to learn about ways
to lower your risk for
developing diabetes.
Diabetic
Work with your
health care provider
in setting up a
treatment plan for
your diabetes.
What should I do after delivery?What should I do after delivery?
Six weeks after your baby Six weeks after your baby
is born, you should have a is born, you should have a
blood test to find out blood test to find out
whether your blood sugar whether your blood sugar
level is back to normal. level is back to normal.
Based on the results you Based on the results you
will fall into one of the will fall into one of the
three categories:three categories:
If your category
is…
You should…
Normal
Get checked for
diabetes every 3
years
Impaired Glucose
Tolerance
Get checked for
diabetes every year
and talk with your
health care provider
to learn about ways
to lower your risk for
developing diabetes.
Diabetic
Work with your
health care provider
in setting up a
treatment plan for
your diabetes.
102102 gdmgdm
Importance of checking oftenImportance of checking often
Getting checked for diabetes is important Getting checked for diabetes is important
because Type 2 diabetes shows few because Type 2 diabetes shows few
symptoms.symptoms.
The only way to know for sure is to have The only way to know for sure is to have
a blood test that reveals a higher-than-a blood test that reveals a higher-than-
normal blood sugar level.normal blood sugar level.
If you notice any of these things, you If you notice any of these things, you
should tell your health care provider right should tell your health care provider right
away:away:
–Being very thirstyBeing very thirsty
–Urinating oftenUrinating often
–Feeling constantly or overly tiredFeeling constantly or overly tired
–Losing weight quickly and/or without Losing weight quickly and/or without
reasonreason
Importance of checking oftenImportance of checking often
Getting checked for diabetes is important Getting checked for diabetes is important
because Type 2 diabetes shows few because Type 2 diabetes shows few
symptoms.symptoms.
The only way to know for sure is to have The only way to know for sure is to have
a blood test that reveals a higher-than-a blood test that reveals a higher-than-
normal blood sugar level.normal blood sugar level.
If you notice any of these things, you If you notice any of these things, you
should tell your health care provider right should tell your health care provider right
away:away:
–Being very thirstyBeing very thirsty
–Urinating oftenUrinating often
–Feeling constantly or overly tiredFeeling constantly or overly tired
–Losing weight quickly and/or without Losing weight quickly and/or without
reasonreason
Gestational DiabetesGestational Diabetes
Intra partum managementIntra partum management
Check bloodCheck blood
Glucose hourly Glucose hourly
Maintain BG Maintain BG
4-6mmol/L 4-6mmol/L
( 70-110mg ( 70-110mg
/dl )/dl )
Intra partum managementIntra partum management
Check bloodCheck blood
Glucose hourly Glucose hourly
Maintain BG Maintain BG
4-6mmol/L 4-6mmol/L
( 70-110mg ( 70-110mg
/dl )/dl )
PostpartumPostpartum
often will not require insulinoften will not require insulin
if fasting hyperglycemia –if fasting hyperglycemia –
more likely to develop more likely to develop
persistent Diabetespersistent Diabetes
6 weeks post partum 75g 6 weeks post partum 75g
OGTTOGTT
yearly fasting BGyearly fasting BG
emphasize importance of maintaining emphasize importance of maintaining
Normal weight, exerciseNormal weight, exercise
Gestational DiabetesGestational Diabetes
often will not require insulinoften will not require insulin
if fasting hyperglycemia –if fasting hyperglycemia –
more likely to develop more likely to develop
persistent Diabetespersistent Diabetes
6 weeks post partum 75g 6 weeks post partum 75g
OGTTOGTT
yearly fasting BGyearly fasting BG
emphasize importance of maintaining emphasize importance of maintaining
Normal weight, exerciseNormal weight, exercise
Gestational DiabetesGestational Diabetes
Preexisting DiabetesPreexisting Diabetes
Preconception CounsellingPreconception Counselling
risk of NTD ~1-2%risk of NTD ~1-2%
Folic Acid 1-4 mg /dayFolic Acid 1-4 mg /day
BG 3.5-5.3 (65-95 mg/dL)prior to mealsBG 3.5-5.3 (65-95 mg/dL)prior to meals
switch to MDI regimen (insulin ac meals switch to MDI regimen (insulin ac meals
and HS)and HS)
keep track of cycles keep track of cycles
Preconception CounsellingPreconception Counselling
risk of NTD ~1-2%risk of NTD ~1-2%
Folic Acid 1-4 mg /dayFolic Acid 1-4 mg /day
BG 3.5-5.3 (65-95 mg/dL)prior to mealsBG 3.5-5.3 (65-95 mg/dL)prior to meals
switch to MDI regimen (insulin ac meals switch to MDI regimen (insulin ac meals
and HS)and HS)
keep track of cycles keep track of cycles
Normoglycemia prior to conception Normoglycemia prior to conception
Ideally Ideally HBA1C 6% or lessHBA1C 6% or less
Team approachTeam approach
Glucose monitoring qidGlucose monitoring qid
ACE contraindicated : should be D/C at ACE contraindicated : should be D/C at
conception or use Diltiazem insteadconception or use Diltiazem instead
Baseline HBA1C, 24h urine for protein Baseline HBA1C, 24h urine for protein
Creatinine Clearance , opthalmology Creatinine Clearance , opthalmology
reviewreview
Switch from OHA to insulinSwitch from OHA to insulin
Preexisting DiabetesPreexisting Diabetes
Ideally Ideally HBA1C 6% or lessHBA1C 6% or less
Team approachTeam approach
Glucose monitoring qidGlucose monitoring qid
ACE contraindicated : should be D/C at ACE contraindicated : should be D/C at
conception or use Diltiazem insteadconception or use Diltiazem instead
Baseline HBA1C, 24h urine for protein Baseline HBA1C, 24h urine for protein
Creatinine Clearance , opthalmology Creatinine Clearance , opthalmology
reviewreview
Switch from OHA to insulinSwitch from OHA to insulin
Preexisting DiabetesPreexisting Diabetes
Advice
Diet :Maintaining a healthy diet and
preventing or reducing overweight will
help you control your diabetes
Exercise :Regular exercise will help to
maintain an optimum weight and will
benefit all members of the family
Smoking :It is widely accepted that smoking
causes heart and lung disease. Most diabetic
complications are worsened by smoking
Weight control :There is a greater risk of
Developing diabetes and heart disease with
increasing waist circumference
Finnish Diabetes Study
This study was conducted to determine the
effects of a programme of changes in lifestyle in patients with ‘Pre’ diabe tes
Lifestyle changes included
•Weight reduction greater than 5% (if needed)
•Fat intake less than 30% of calorie intake
•Saturated fat less than 10% of calorie intake
•Fibre intake greater than 15grams/ 1000 calories
•Exercise greater than 4 hours per week (brisk walking)
Carrying out this programme resulted in less diabetes by 58%
Are you eating healthy foods?
How often do you exercise?
Do you smoke?
Do you know your target weight?
Blood Pressure
140 / 80
Very good control of blood pressure is required!
Raised blood pressure can increase all complications
of diabetes
It is important that it is checked regularly
Tablets maybe taken to control blood pressure
You mayneed to change what you eat and exercise more
UK Prospective Diabetes StudyUK Prospective Diabetes Study
Blood Pressure Control Study
Aggressive blood pressure
control reduces the risk of
most complications in
Diabetes
It’s as simple as that!
Remember your target is 140/80
Have you hit the bulls-eye?
Target :
Re tino pat hy pro gre ssion
-7 0%
-6 0%
-5 0%
-4 0%
-3 0%
-2 0%
-1 0%
0%
any di abe tes
rel ate d
endpo int s
Diabe te s
re lated
de at h
Hear t
fail ure
st roke Mi cro vasc ula r
dise ase
Lo ss o f
visio n
24 %
32%
56%
4 4%
37%
34%
47%
P=0.0 04
P=0.01 9
P=0.004
P=0.013
P=0.0 09
P=0.00 4
P=0.004
Re tino pat hy pro gre ssion
-7 0%
-6 0%
-5 0%
-4 0%
-3 0%
-2 0%
-1 0%
0%
any di abe tes
rel ate d
endpo int s
Diabe te s
re lated
de at h
Hear t
fail ure
st roke Mi cro vasc ula r
dise ase
Lo ss o f
visio n
24 %
32%
56%
4 4%
37%
34%
47%
P=0.0 04
P=0.01 9
P=0.004
P=0.013
P=0.0 09
P=0.00 4
P=0.004
Any diabetes
¨0
¨10
¨20
¨30
¨40
¨50
¨60
problem
Heart
Failure
Stroke
Cholesterol
This is the amount of fat in
blood
Some blood fats are necessary to
provide important energy sources
Too much fat can cause you to be
overweight, making it much more
difficult to control your diabetes
It can also cause heart problems
How m uch fat does your blood
contain?
The optim al targ et for blood
cholesterol lev el is
LESS THAN 5
1234560
0
20
40
60
80
100
R isk
re duc tio n
55%
Sim vastatin
Number of years on
Proportion without major
Heart problems (%)
1234560
0
20
40
60
80
100
R isk
re duc tio n
55%
Placebo
Number of years on simvastatin
Proportion without major
Heart problems (%)
SCANDINAVIAN SIMVASTATIN
SURVIVAL STUDY
This study showed that
long-term simvastatin
(cholesterol lowering drug)
therapy reduces chances
of dying and heart problems
in patients with diabetes
Do you know whatyour level is?
Are you on target?
FAT
BLOOD
SERUM
Diabetes Control
Blood glucose needs to be kept within
a controlled range
4–7
This can be helped by regular blood
glucose monitoring at home and keeping
an accurate written record. Bring it to clinic!
What is HbA1c%?
This value tells you the amount of glucose
sticking to your blood over the last 60 days
It reflects how well your diabetes has been controlled
The aim is to have a value of less than7.0%
What drugs help to control diabetes?
Metformin,Gliclazide,Glimepiride,
Pioglitazone,Rosiglitazone, Insulin and
many other drugs
UK Prospective Diabetes
Glucose Control Study
The UKPD study shows that goodThe UKPD study shows that good
glucose control can decrease the glucose control can decrease the
risks of:risks of:
Heart attack by 16%
Cataract by 24%
Kidney problems by 33%
-
-
-
-
-
-
-
-
-
-
Are you in control of your diabetes?
What is your HbA1c%?
0
1
2
3
4
5
6
7
8
9
10
HbA1c%
> 16 0 14 0 t o 15 013 0 -1 40 <13 0
< 6
6 t o 7
7 to 8
> 8
Blood Pressure
Risk of Diabetes Complications
Increasing
Eyes
How your eyes work
Your eye has a lens and an opening at the front,
which adjust to bring objects into focus on the
retina at the back of the eye.
The retina is made up of delicate tissue that is
sensitive to light rather like the film in a camera.
At the centreof the retina is the macula, which is
a small area about the size of a pinhead. It is vital
because it enables you to see fine detail.
When was the last time you had
your eyes checked?
Is Diabetes slowly stealing your vision?
•A person with diabetes can have eye disease and not even know it until
serious, irreversible vision loss has occurred
•The only way to diagnose early signs of diabetic eye disease isthrough a dilated
eye exam at least once a year
DIABETIC EYE DISEASE
Diabetic Eye Disease(Diabetic
retinopathy) is the commonest
cause of blindness under the age of 65
in the Western World
37% of diabetes patients have
retinopathy at diagnosis of diabetes
1500 new cases of blindness could be
prevented by yearly screening in UK
20 years after diagnosis 95% with Type
1 diabetes have retinopathy
20 years after diagnosis 60% of patients
with Type 2 diabetes have retinopathy
Laser treatment can save eye sight
getting worse in 90% of patients
Normal retina Diabetic Retinopathy
Macula Optic Disc Fatty Haemorrhage
Deposits
Feet
•During a lifetime, your feet may walk the equivalent of four
times around the world!
•To ensure that they continue their trip through life without
complaint, it pays to look after your feet!
It is important that you examine your feet regularly. You should
also feel inside all shoes for any seams or stitching which could
rub the foot and lead to problems.
It is important that you receive regular foot advice or treatment.
People suffering from diabetes can often experience loss of sensation
in their feet. Even the smallest injury can lead to infection, which if
not treated promptly, may lead to serious complications.
Foot Problems
15% of patients with diabetes will develop
foot ulcers due to nerve damage and reduced
blood flow
Foot ulcers come before 85% of amputations
in people with diabetes. Foot ulcers are the
commonest cause of amputation in the UK
Liverpool Diabetes Clinic: Foot Protection Programme
When patients with diabetes and foot deformities attended regular clinics with a
trained podiatrist and foot education, it was found that
At 2 years ulceration was reduced to 2.4% compared with 3.5%
Amputation was reduced by 3 times
When was the last time you had your feet checked?
GuardianDrugs
30
25
20
15
10
5
0
Any cardiovascularHeart Attack
problem
-14%
-29%
ASPIRIN
Diabetes UK recom m ends taking
aspirin to prevent against heart
problem s in all diabetes patients
(grea ter tha n 30 yrs ) with any of the
following:
Heart attack, angina, high blood
pressure, eye problem s, blood
vessel diseases and kidney
problem s
Also if: Indo -Asian, overweight, high
cholesterol, Heart Disease risk
greater than 15%, fam ily history,
history of heart disease, sm okers
ACE-inhibitors are drugs that have a special role in preventing diabetic com plications.
The HOPE study showed that one ace inhibitor, ‘Ram ipril’reduced:
The names of these drugs end in ‘PRIL’
Do you know if you are taking any of
the guardian drugs?
ACE INHIBITORS
% Decrease in Events
· Heart D isease
· Stroke
· K idney
· Eye disease
What are Guardian Drugs?
Guardian drugs are given to protect you from further diabetes
complications
Diabetes Care 4 U!
Welcome to Diabetes Care 4 U! Here you will find posters packed full
of information and innovative ideas to ensure you have great Diabetes
Care! Before you enter into the unique experience let us go overthe
problems of diabetes.
DIABETIC EYE DISEASE
Most common cause of
blindness in people of
working age
HEART and BLOOD VESSELS
2 to 4 fold increased risk of
heart disease and stroke
75% have hypertension
DIABETIC KIDNEY
DISEASE
20% of all new patients
needing renal dialysis
therapy have diabetes
FOOT PROBLEMS
15% of people with diabetes develop foot
ulcer; 5-15% of these need amputation
If you think any area of your care needs to be addressed please
make a note and discuss this with your Diabetes Care Team.
Enjoy the Posters!
Stroke
Eye
Disease
Heart Disease
High Blood Pressure
Kidney Disease
Remember with
good care all
complications
can be reduced
or even
prevented!
Pain or loss of the lower
legs due to impaired
blood flow
Peripheral Neuropathy
(nerve disease)
Diet :Maintaining a healthy diet and
preventing or reducing overweight will
help you control your diabetes
Exercise :Regular exercise will help to
maintain an optimum weight and will
benefit all members of the family
Smoking :It is widely accepted that smoking
causes heart and lung disease. Most diabetic
complications are worsened by smoking
Weight control :There is a greater risk of
Developing diabetes and heart disease with
increasing waist circumference
Finnish Diabetes Study
This study was conducted to determine the
effects of a programme of changes in lifestyle in patients with ‘Pre’ diabe tes
Lifestyle changes included
•Weight reduction greater than 5% (if needed)
•Fat intake less than 30% of calorie intake
•Saturated fat less than 10% of calorie intake
•Fibre intake greater than 15grams/ 1000 calories
•Exercise greater than 4 hours per week (brisk walking)
Carrying out this programme resulted in less diabetes by 58%
Are you eating healthy foods?
How often do you exercise?
Do you smoke?
Do you know your target weight?
Blood Pressure
140 / 80
Very good control of blood pressure is required!
Raised blood pressure can increase all complications
of diabetes
It is important that it is checked regularly
Tablets maybe taken to control blood pressure
You mayneed to change what you eat and exercise more
UK Prospective Diabetes StudyUK Prospective Diabetes Study
Blood Pressure Control Study
Aggressive blood pressure
control reduces the risk of
most complications in
Diabetes
It’s as simple as that!
Remember your target is 140/80
Have you hit the bulls-eye?
Target :
Re tino pat hy pro gre ssion
-7 0%
-6 0%
-5 0%
-4 0%
-3 0%
-2 0%
-1 0%
0%
any di abe tes
rel ate d
endpo int s
Diabe te s
re lated
de at h
Hear t
fail ure
st roke Mi cro vasc ula r
dise ase
Lo ss o f
visio n
24 %
32%
56%
4 4%
37%
34%
47%
P=0.0 04
P=0.01 9
P=0.004
P=0.013
P=0.0 09
P=0.00 4
P=0.004
Re tino pat hy pro gre ssion
-7 0%
-6 0%
-5 0%
-4 0%
-3 0%
-2 0%
-1 0%
0%
any di abe tes
rel ate d
endpo int s
Diabe te s
re lated
de at h
Hear t
fail ure
st roke Mi cro vasc ula r
dise ase
Lo ss o f
visio n
24 %
32%
56%
4 4%
37%
34%
47%
P=0.0 04
P=0.01 9
P=0.004
P=0.013
P=0.0 09
P=0.00 4
P=0.004
Any diabetes
¨0
¨10
¨20
¨30
¨40
¨50
¨60
problem
Heart
Failure
Stroke
Cholesterol
This is the amount of fat in
blood
Some blood fats are necessary to
provide important energy sources
Too much fat can cause you to be
overweight, making it much more
difficult to control your diabetes
It can also cause heart problems
How m uch fat does your blood
contain?
The optim al targ et for blood
cholesterol lev el is
LESS THAN 5
1234560
0
20
40
60
80
100
R isk
re duc tio n
55%
Sim vastatin
Number of years on
Proportion without major
Heart problems (%)
1234560
0
20
40
60
80
100
R isk
re duc tio n
55%
Placebo
Number of years on simvastatin
Proportion without major
Heart problems (%)
SCANDINAVIAN SIMVASTATIN
SURVIVAL STUDY
This study showed that
long-term simvastatin
(cholesterol lowering drug)
therapy reduces chances
of dying and heart problems
in patients with diabetes
Do you know whatyour level is?
Are you on target?
FAT
BLOOD
SERUM
Diabetes Control
Blood glucose needs to be kept within
a controlled range
4–7
This can be helped by regular blood
glucose monitoring at home and keeping
an accurate written record. Bring it to clinic!
What is HbA1c%?
This value tells you the amount of glucose
sticking to your blood over the last 60 days
It reflects how well your diabetes has been controlled
The aim is to have a value of less than7.0%
What drugs help to control diabetes?
Metformin,Gliclazide,Glimepiride,
Pioglitazone,Rosiglitazone, Insulin and
many other drugs
UK Prospective Diabetes
Glucose Control Study
The UKPD study shows that goodThe UKPD study shows that good
glucose control can decrease the glucose control can decrease the
risks of:risks of:
Heart attack by 16%
Cataract by 24%
Kidney problems by 33%
-
-
-
-
-
-
-
-
-
-
Are you in control of your diabetes?
What is your HbA1c%?
0
1
2
3
4
5
6
7
8
9
10
HbA1c%
> 16 0 14 0 t o 15 013 0 -1 40 <13 0
< 6
6 t o 7
7 to 8
> 8
Blood Pressure
Risk of Diabetes Complications
Increasing
Eyes
How your eyes work
Your eye has a lens and an opening at the front,
which adjust to bring objects into focus on the
retina at the back of the eye.
The retina is made up of delicate tissue that is
sensitive to light rather like the film in a camera.
At the centreof the retina is the macula, which is
a small area about the size of a pinhead. It is vital
because it enables you to see fine detail.
When was the last time you had
your eyes checked?
Is Diabetes slowly stealing your vision?
•A person with diabetes can have eye disease and not even know it until
serious, irreversible vision loss has occurred
•The only way to diagnose early signs of diabetic eye disease isthrough a dilated
eye exam at least once a year
DIABETIC EYE DISEASE
Diabetic Eye Disease(Diabetic
retinopathy) is the commonest
cause of blindness under the age of 65
in the Western World
37% of diabetes patients have
retinopathy at diagnosis of diabetes
1500 new cases of blindness could be
prevented by yearly screening in UK
20 years after diagnosis 95% with Type
1 diabetes have retinopathy
20 years after diagnosis 60% of patients
with Type 2 diabetes have retinopathy
Laser treatment can save eye sight
getting worse in 90% of patients
Normal retina Diabetic Retinopathy
Macula Optic Disc Fatty Haemorrhage
Deposits
Feet
•During a lifetime, your feet may walk the equivalent of four
times around the world!
•To ensure that they continue their trip through life without
complaint, it pays to look after your feet!
It is important that you examine your feet regularly. You should
also feel inside all shoes for any seams or stitching which could
rub the foot and lead to problems.
It is important that you receive regular foot advice or treatment.
People suffering from diabetes can often experience loss of sensation
in their feet. Even the smallest injury can lead to infection, which if
not treated promptly, may lead to serious complications.
Foot Problems
15% of patients with diabetes will develop
foot ulcers due to nerve damage and reduced
blood flow
Foot ulcers come before 85% of amputations
in people with diabetes. Foot ulcers are the
commonest cause of amputation in the UK
Liverpool Diabetes Clinic: Foot Protection Programme
When patients with diabetes and foot deformities attended regular clinics with a
trained podiatrist and foot education, it was found that
At 2 years ulceration was reduced to 2.4% compared with 3.5%
Amputation was reduced by 3 times
When was the last time you had your feet checked?
GuardianDrugs
30
25
20
15
10
5
0
Any cardiovascularHeart Attack
problem
-14%
-29%
ASPIRIN
Diabetes UK recom m ends taking
aspirin to prevent against heart
problem s in all diabetes patients
(grea ter tha n 30 yrs ) with any of the
following:
Heart attack, angina, high blood
pressure, eye problem s, blood
vessel diseases and kidney
problem s
Also if: Indo -Asian, overweight, high
cholesterol, Heart Disease risk
greater than 15%, fam ily history,
history of heart disease, sm okers
ACE-inhibitors are drugs that have a special role in preventing diabetic com plications.
The HOPE study showed that one ace inhibitor, ‘Ram ipril’reduced:
The names of these drugs end in ‘PRIL’
Do you know if you are taking any of
the guardian drugs?
ACE INHIBITORS
% Decrease in Events
· Heart D isease
· Stroke
· K idney
· Eye disease
What are Guardian Drugs?
Guardian drugs are given to protect you from further diabetes
complications
Diabetes Care 4 U!
Welcome to Diabetes Care 4 U! Here you will find posters packed full
of information and innovative ideas to ensure you have great Diabetes
Care! Before you enter into the unique experience let us go overthe
problems of diabetes.
DIABETIC EYE DISEASE
Most common cause of
blindness in people of
working age
HEART and BLOOD VESSELS
2 to 4 fold increased risk of
heart disease and stroke
75% have hypertension
DIABETIC KIDNEY
DISEASE
20% of all new patients
needing renal dialysis
therapy have diabetes
FOOT PROBLEMS
15% of people with diabetes develop foot
ulcer; 5-15% of these need amputation
If you think any area of your care needs to be addressed please
make a note and discuss this with your Diabetes Care Team.
Enjoy the Posters!
Stroke
Eye
Disease
Heart Disease
High Blood Pressure
Kidney Disease
Remember with
good care all
complications
can be reduced
or even
prevented!
Pain or loss of the lower
legs due to impaired
blood flow
Peripheral Neuropathy
(nerve disease)
Assess for end organ diseaseAssess for end organ disease
Assess for nephropathy – Assess for nephropathy –
inc risk of PIH. inc risk of PIH.
Assess & Rx.retinopathy :Assess & Rx.retinopathy :
may may PROGRESS.PROGRESS.
Assess for neuropathy :Assess for neuropathy :generallygenerally
remains stable during pregnancyremains stable during pregnancy
Assess and treat Assess and treat
Vasculopathy.Vasculopathy.CAD is a relative CAD is a relative
C/I for pregnancyC/I for pregnancy
Pre existing DiabetesPre existing Diabetes
Assess for nephropathy – Assess for nephropathy –
inc risk of PIH. inc risk of PIH.
Assess & Rx.retinopathy :Assess & Rx.retinopathy :
may may PROGRESS.PROGRESS.
Assess for neuropathy :Assess for neuropathy :generallygenerally
remains stable during pregnancyremains stable during pregnancy
Assess and treat Assess and treat
Vasculopathy.Vasculopathy.CAD is a relative CAD is a relative
C/I for pregnancyC/I for pregnancy
Pre existing DiabetesPre existing Diabetes
Maternal RisksMaternal Risks
–PIH /PETPIH /PET
–polyhydramniospolyhydramnios
–preterm labourpreterm labour
–operative delivery ~50%operative delivery ~50%
–birth traumabirth trauma
–infectioninfection
–increase in insulin requirementsincrease in insulin requirements
–DKADKA
Preexisting DiabetesPreexisting Diabetes
–PIH /PETPIH /PET
–polyhydramniospolyhydramnios
–preterm labourpreterm labour
–operative delivery ~50%operative delivery ~50%
–birth traumabirth trauma
–infectioninfection
–increase in insulin requirementsincrease in insulin requirements
–DKADKA
Preexisting DiabetesPreexisting Diabetes
Fetal RisksFetal Risks
congenital anomalies 3X inc. riskcongenital anomalies 3X inc. risk
unexplained stillbirth unexplained stillbirth
shoulder dystociashoulder dystocia
macrosomiamacrosomia
IUGRIUGR
Preexisting DiabetesPreexisting Diabetes
congenital anomalies 3X inc. riskcongenital anomalies 3X inc. risk
unexplained stillbirth unexplained stillbirth
shoulder dystociashoulder dystocia
macrosomiamacrosomia
IUGRIUGR
Preexisting DiabetesPreexisting Diabetes
Neonatal Risks Neonatal Risks
hypoglycemiahypoglycemia
hypocalcemiahypocalcemia
hyperbilirubinemia/polycythemiahyperbilirubinemia/polycythemia
idiopathic RDSidiopathic RDS
delayed lung maturitydelayed lung maturity
prematurityprematurity
predisposition to diabetespredisposition to diabetes
Preexisting DiabetesPreexisting Diabetes
hypoglycemiahypoglycemia
hypocalcemiahypocalcemia
hyperbilirubinemia/polycythemiahyperbilirubinemia/polycythemia
idiopathic RDSidiopathic RDS
delayed lung maturitydelayed lung maturity
prematurityprematurity
predisposition to diabetespredisposition to diabetes
Preexisting DiabetesPreexisting Diabetes
Congenital anomaliesCongenital anomalies
3x the general population risk 3x the general population risk
approaches the gen. pop.risk (2-3%) approaches the gen. pop.risk (2-3%)
if optimal control in periconception if optimal control in periconception
periodperiod
related to glycemic control during related to glycemic control during
embryogenesis embryogenesis
Preexisting DiabetesPreexisting Diabetes
3x the general population risk 3x the general population risk
approaches the gen. pop.risk (2-3%) approaches the gen. pop.risk (2-3%)
if optimal control in periconception if optimal control in periconception
periodperiod
related to glycemic control during related to glycemic control during
embryogenesis embryogenesis
Preexisting DiabetesPreexisting Diabetes
CVSCVS
:ASD/VSD, CoA :ASD/VSD, CoA
:Transposition, :Transposition,
:Cardiomegaly:Cardiomegaly
CNSCNS
:Anencephaly,:Anencephaly,
:NTD,:NTD,
:Microcephaly:Microcephaly
GI GI ::duodenal atresia, duodenal atresia,
anorectal atresia, situs anorectal atresia, situs
inversusinversus
GUGU : :renal agenesis renal agenesis
:Polycystic kidneys:Polycystic kidneys
MSKMSK
:caudal regression:caudal regression
:siren:siren
Congenital anomalies
Preexisting DiabetesPreexisting Diabetes
:ASD/VSD, CoA :ASD/VSD, CoA
:Transposition, :Transposition,
:Cardiomegaly:Cardiomegaly
CNSCNS
:Anencephaly,:Anencephaly,
:NTD,:NTD,
:Microcephaly:Microcephaly
GI GI ::duodenal atresia, duodenal atresia,
anorectal atresia, situs anorectal atresia, situs
inversusinversus
GUGU : :renal agenesis renal agenesis
:Polycystic kidneys:Polycystic kidneys
MSKMSK
:caudal regression:caudal regression
:siren:siren
Congenital anomalies
Preexisting DiabetesPreexisting Diabetes
Maternal SurveillanceMaternal Surveillance
Blood pressureBlood pressure
Renal function *Renal function *
Urine culture **Urine culture **
Thyroid functionThyroid function
BG control HB A1C*BG control HB A1C*
* q trimester * q trimester
•** monthly** monthly
Preexisting DiabetesPreexisting Diabetes
Blood pressureBlood pressure
Renal function *Renal function *
Urine culture **Urine culture **
Thyroid functionThyroid function
BG control HB A1C*BG control HB A1C*
* q trimester * q trimester
•** monthly** monthly
Preexisting DiabetesPreexisting Diabetes
Fetal SurveillanceFetal Surveillance
U/S for dating/viability ~ 8 weeksU/S for dating/viability ~ 8 weeks
Fetal anomaly detectionFetal anomaly detection
nuchal translucency 11-14wnuchal translucency 11-14w
maternal serum screenmaternal serum screen
anatomy survey 18-20 wanatomy survey 18-20 w
Fetal echo 22 w Fetal echo 22 w
Preexisting Preexisting
DiabetesDiabetes
U/S for dating/viability ~ 8 weeksU/S for dating/viability ~ 8 weeks
Fetal anomaly detectionFetal anomaly detection
nuchal translucency 11-14wnuchal translucency 11-14w
maternal serum screenmaternal serum screen
anatomy survey 18-20 wanatomy survey 18-20 w
Fetal echo 22 w Fetal echo 22 w
Preexisting Preexisting
DiabetesDiabetes
Preexisting Diabetes
Multidose InsulinMultidose Insulin
breakfastbreakfast 25% H 25% H
lunch lunch 15% H 15% H
suppersupper 25% H 25% H
hs hs 35% NPH 35% NPH
Indicates insulin as aIndicates insulin as a
% of total daily dose% of total daily dose
Gabbe Obstet Gynecol 2003
Multidose InsulinMultidose Insulin
breakfastbreakfast 25% H 25% H
lunch lunch 15% H 15% H
suppersupper 25% H 25% H
hs hs 35% NPH 35% NPH
Indicates insulin as aIndicates insulin as a
% of total daily dose% of total daily dose
Gabbe Obstet Gynecol 2003
Insulin TherapyInsulin Therapy
onset (h) peak(h) onset (h) peak(h)
duration (h)duration (h)
insulin analogs insulin analogs .25 .25 0.5-1.50.5-1.5
6-86-8
rapid acting rapid acting 0.5 0.5 2-42-4
8-128-12
intermediate intermediate 1-1.51-1.5 4-84-8
12-1812-18
onset (h) peak(h) onset (h) peak(h)
duration (h)duration (h)
insulin analogs insulin analogs .25 .25 0.5-1.50.5-1.5
6-86-8
rapid acting rapid acting 0.5 0.5 2-42-4
8-128-12
intermediate intermediate 1-1.51-1.5 4-84-8
12-1812-18
Insulin PumpInsulin Pump
–Allows insulin release close to Allows insulin release close to
physiologic physiologic
–Use short acting insulinUse short acting insulin
–50-60% of total dose is basal rate50-60% of total dose is basal rate
–40-50% given as boluses40-50% given as boluses
Potential complicationsPotential complications
Pump failure, Infection , Pump failure, Infection ,
Increased risk of DKA if aboveIncreased risk of DKA if above
happenshappens
Insulin Insulin
TherapyTherapy
–Allows insulin release close to Allows insulin release close to
physiologic physiologic
–Use short acting insulinUse short acting insulin
–50-60% of total dose is basal rate50-60% of total dose is basal rate
–40-50% given as boluses40-50% given as boluses
Potential complicationsPotential complications
Pump failure, Infection , Pump failure, Infection ,
Increased risk of DKA if aboveIncreased risk of DKA if above
happenshappens
Insulin Insulin
TherapyTherapy
Peripartum ManagementPeripartum Management
Withhold subcutaneous insulin from Withhold subcutaneous insulin from
onset of labour or inductiononset of labour or induction
IV D10 @50cc/hIV D10 @50cc/h
IV short acting insulin inIV short acting insulin in
NS usually starting atNS usually starting at
0.5-1u/h*0.5-1u/h*
*10u insulin in 100 cc NS(1U=10cc)*10u insulin in 100 cc NS(1U=10cc)
Withhold subcutaneous insulin from Withhold subcutaneous insulin from
onset of labour or inductiononset of labour or induction
IV D10 @50cc/hIV D10 @50cc/h
IV short acting insulin inIV short acting insulin in
NS usually starting atNS usually starting at
0.5-1u/h*0.5-1u/h*
*10u insulin in 100 cc NS(1U=10cc)*10u insulin in 100 cc NS(1U=10cc)
Timing of Delivery Timing of Delivery
GDM Diet controlledGDM Diet controlled
Same as non diabetic Same as non diabetic
Offer induction at 41 weeks Offer induction at 41 weeks
if undelivered if undelivered
GDM on Insulin/Type II/Type IGDM on Insulin/Type II/Type I
If suboptimal control deliver followingIf suboptimal control deliver following
confirmation of lung maturity if <39confirmation of lung maturity if <39
weeksweeks
Otherwise deliver by 40 weeksOtherwise deliver by 40 weeks
Generally do not allow to go posttermGenerally do not allow to go postterm
GDM Diet controlledGDM Diet controlled
Same as non diabetic Same as non diabetic
Offer induction at 41 weeks Offer induction at 41 weeks
if undelivered if undelivered
GDM on Insulin/Type II/Type IGDM on Insulin/Type II/Type I
If suboptimal control deliver followingIf suboptimal control deliver following
confirmation of lung maturity if <39confirmation of lung maturity if <39
weeksweeks
Otherwise deliver by 40 weeksOtherwise deliver by 40 weeks
Generally do not allow to go posttermGenerally do not allow to go postterm
Mode of DeliveryMode of Delivery
*Macrosomic infants of diabetic*Macrosomic infants of diabetic
mothers have higher rates mothers have higher rates
of shoulder dystocia than non of shoulder dystocia than non
diabetic mothers diabetic mothers
*Ultrasound estimates of fetal*Ultrasound estimates of fetal
weight become significantlyweight become significantly
inaccurate after 4000ginaccurate after 4000g
*Reasonable to recommend C/S *Reasonable to recommend C/S
delivery if EFW is >4500gdelivery if EFW is >4500g
*Macrosomic infants of diabetic*Macrosomic infants of diabetic
mothers have higher rates mothers have higher rates
of shoulder dystocia than non of shoulder dystocia than non
diabetic mothers diabetic mothers
*Ultrasound estimates of fetal*Ultrasound estimates of fetal
weight become significantlyweight become significantly
inaccurate after 4000ginaccurate after 4000g
*Reasonable to recommend C/S *Reasonable to recommend C/S
delivery if EFW is >4500gdelivery if EFW is >4500g
insulin rate usually based on BG and pre-insulin rate usually based on BG and pre-
delivery insulin requirementdelivery insulin requirement
eg. For each 75-100 total units /24h of eg. For each 75-100 total units /24h of
pre-delivery insulin, 1 unit per hour pre-delivery insulin, 1 unit per hour
neededneeded
measure capillary BG hourly / VPG q2-3hmeasure capillary BG hourly / VPG q2-3h
target: 4-6mmol/Ltarget: 4-6mmol/L
Peripartum Peripartum
ManagementManagement
delivery insulin requirementdelivery insulin requirement
eg. For each 75-100 total units /24h of eg. For each 75-100 total units /24h of
pre-delivery insulin, 1 unit per hour pre-delivery insulin, 1 unit per hour
neededneeded
measure capillary BG hourly / VPG q2-3hmeasure capillary BG hourly / VPG q2-3h
target: 4-6mmol/Ltarget: 4-6mmol/L
Peripartum Peripartum
ManagementManagement
Following deliveryFollowing delivery
stop insulin infusionstop insulin infusion
Begin sub Q insulinBegin sub Q insulin
Resume previous MDIResume previous MDI
schedule at 1/2 -2/3 theschedule at 1/2 -2/3 the
pre pregnancypre pregnancy dose dose
Maintain IV D5W @50cc/h Maintain IV D5W @50cc/h
until oral feeds tolerateduntil oral feeds tolerated
Peripartum Peripartum
Management Management
stop insulin infusionstop insulin infusion
Begin sub Q insulinBegin sub Q insulin
Resume previous MDIResume previous MDI
schedule at 1/2 -2/3 theschedule at 1/2 -2/3 the
pre pregnancypre pregnancy dose dose
Maintain IV D5W @50cc/h Maintain IV D5W @50cc/h
until oral feeds tolerateduntil oral feeds tolerated
Peripartum Peripartum
Management Management
Oral HypoglycemicOral Hypoglycemic
agents agents
Traditionally not Traditionally not
recommended in pregnancyrecommended in pregnancy
Recent RCT of Recent RCT of oral oral
glyburide vs insulin glyburide vs insulin for GDMfor GDM
440 patients440 patients
BG measured 7x dailyBG measured 7x daily
Treatment started after 11 weeks Treatment started after 11 weeks
gestationgestation
agents agents
Traditionally not Traditionally not
recommended in pregnancyrecommended in pregnancy
Recent RCT of Recent RCT of oral oral
glyburide vs insulin glyburide vs insulin for GDMfor GDM
440 patients440 patients
BG measured 7x dailyBG measured 7x daily
Treatment started after 11 weeks Treatment started after 11 weeks
gestationgestation
Glyburide Glyburide InsulinInsulin
Achieved N BGAchieved N BG 82%82% 88%88%
LGA infantsLGA infants 12%12% 13%13%
MacrosomiaMacrosomia 77 44
C SectionC Section 2323 2424
HypoglycemiaHypoglycemia 99 66
PreeclampsiaPreeclampsia 66 66
Anomalies Anomalies 22 22
Oral Hypoglycemic agents Oral Hypoglycemic agents
Langer NEJM 2000
Achieved N BGAchieved N BG 82%82% 88%88%
LGA infantsLGA infants 12%12% 13%13%
MacrosomiaMacrosomia 77 44
C SectionC Section 2323 2424
HypoglycemiaHypoglycemia 99 66
PreeclampsiaPreeclampsia 66 66
Anomalies Anomalies 22 22
Oral Hypoglycemic agents Oral Hypoglycemic agents
Langer NEJM 2000
THE END
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