GESTATIONAL DM.pptx

NURSING

1. Deepa Rawat

2. General objective INTRODUCTION DEFINITION INCIDENCE TYPE RISK FACTORS CLINICAL MANIFESTATION PATHOPHYSIOLOGY

3. INTRODUCTION D iabetes Mellitus is a endocrine and metabolic disorder in which inability in carbohydrate ,fat and protien resulting in raised blood glucose level .   Diabetes mellitus is derived from the Greek word diabetes meaning siphon - to pass through and the Latin word mellitus meaning   honeyed or sweet.

4. Diabetes Mellitus In Pregnancy Diabetes Mellitus is a common medical disorder encounter in pregnancy. Pregnancy is a diabetogenic state due to insulin resistance increase during pregnancy . Placental hormones are increase during pregnancy to disturbed insulin action.

5. INCEDENCE . Diabetes remains the 7 th leading cause of death in the united states in 2010. According to the National Center for Heath Statistics [2004] , iabetes now occurs in approximately 4 – 14 percent women. 10 to 20 precent of patient with diabetes are geststional diabetes.

6. TYPES Diabetes mellites in pregnancy are 2 types = Pre-gestational Diabetes Mellietes Gestational Diabetes Mellietes

7. 1. Pre-Gestational Diabetes Mellitus In which the diabetes daigenosed before pregnancy. There are mainly 2 types. Type -1 diabetes mellitus Type -2 diabetes mellitus

8. Type-1 Diabetes Mellitus Also known as the- Insulin Dependent Diabetes Mellitus [IDDM]. Juvenile Diabetes Mellitus It characterized by loss of the insulin –producing beta cells of the pancreas leading to insulin deficiency .

9. Pathophysiology and Risk factors . Risk factors = Genetic Environmental   Viral infection Pathophysiology = Autoimmune reaction in which the beta cells that produce insulinare destroyed. Alpha cells produce excess glucons causing huperglycemia .

10. Clinical Features Polyuria Polydipsia Polyphagia Weight loss Decrese fatigue Blurred vision Diabetic ketoacidosis Metabolic acidosis

11. Type-2 Diabetes Mellitus Also known as Non Insulin Diabetes Mellitus[ NIDDM]. Type 2 is charactrised by the presens of insulin are low ,high ,normal and beta cell disfunctioning . Type 2 are most common type of diabetes 95 cases . Risk factors= Obesity Physical activity Family history Intacke of high calorie diet

12. PATHOPHYSIOLOGY B-Cell defect genetic enviornment (obesity) Abnormal secreation insulin resistance Relative insulin deficincy Beta-cell exhaustion IDDM TYPE 2 DM

13. DEFINITION The word gastation actually refers to during pregnancy Gastational diabetes mellitus is the most common medical complicatin of pregnancy GDM define as a impaired glucose tolerence with 1 st recognised druring 2&3 trimester(24to28week) of pregnancy

14. RISK FACTORS Previous history of GDM positive family history of DM type2 High risk group( aferican americans,asian american ) Over age > 30 years Smoking Obesity

15. HORMONAL CHANGES PLACENTA The placenta act as a endocrine organ producing several important hormones during pregnancy Placenta produce variety of hormonrs Steroid Protien DURING THE FIRST TRIMESTER Carpos luteum placenta secreat esteroid hormone Esteron progestron

16. Estrogan and prosteron level are raise in blood These hormones estiulates the beta-cell hyperplacia to secreat insulin Promote increase glycogan store Decrease hepatic production of glucose lead to decrease fasting blood gluse level in the 1 st trimester

17. DURING 2&3 TRIMESTER *Placenta secreat daibetogenic and protin hormone Human placental lectose Estrogen and progestron Placental insulinase Increase hepatic glucose production Decrease hepatic glycogan store These hormone antagonise insuline effectiveness Raising placenta hormone increase insulin registance Leading to hyperglycemia occuse after meals.

18. PATHOPHYSIOLOGY Due to etiological factoes During 2&3 trimaster screat placental hormone (Human placental lectose , Estrogen and progestron ,Placental insulinase ) these hormone antagonised effect for insulin increase blood suger level Body dose not made insulin properly Matenal blood glucose in fetas throgh placenta Fetal hyperglycemia Activated pancreatic hyperplasia of beta-cell(12week start insulin production) Insulin increase in fetus

19. EFFECT OF DAIBETES ON PRTEGNANC MATENAL EFFECT IN PREGNANCY Abortion Infection Prterm labor Hypertansion Plyhdraminos DURING LABOUR Sholder distocia Prineal injuries

20. FETAL EFFECT

21. DAIGNOSIS

22. FASTING ; <95 mg/dl 1HR : <180 mg/dl 3HR : <140 mg/dl

23. INVESTIGATION URINE CULTURE Should be done at the initial visit at 4-6week interval to rule out asymptomatic bactoriuria . OPTHALMOLOGICAL EXAMINATION this is performed in all daibetics at the intial antenatal examination and develop retinal changes RENAL FACTION A base line serum cretinine is optain at in the initial visit and value is more than 0.8 mg/dl . Renal fuction is assesd every 4week ECG : suspected ischemic heart disease patient

24. MATERNAL SERUM ALFA FECTOPROTIEN: Estimation is done between 16&20 weeks to screen the nural tube defect ULTRASOUND :it is indicate in the 1 st trimester for acurate dating of pregnancy In eary growth lag ina pregatationa daibetes is an indicate of a fetal malformation and early abortion 2 nd trimester : detail anomalies sacle is perform abt 18-20 weeks Fetal ecocardiography to rule out cardic anomalies is done aroud 20-24weeks. 3red trimester: monitor macrosomia .

25. MANAGMENT

26. (2)EXERCISE Exercise is an important component in maitaining glucose control Improves physical and psycological weelbeing of the patient Exercise must be avoided at the peak time of insulin action. Exercise sach as Deepbrithing Walking yoga

27. (3)PHARMACOLOGICAL INSULIN INFUTION: If a contineously inslin infution is needed,25units of regular insulin are added to 25mg of normal saline The IV rate and supplimantal regular insuline based on every 1to2 hr capillary boold glucose value INTERMITENT SUBCUTINEOUS INSULIN

28. ORAL ANTIDIABETIC AGENT SULFONYLURESECOND GENERATION AS Glyburide (20mg) Micronase MEGLITINIDES Repaglinide (16mg) INSULIN SENSITIZERS Biguanides (500mg) Metformin (850mg) Thiolidinedine ALFA GLUSE INHIBITORS Acarbose (25mg)