DIABETES MELLITUS

1. DIABETES MELLITUS

2. DIABETES MELLITUS
 A chronic metabolic disorder characterized
by a deficiency in insulin production by the
islets of Langerhans resulting in improper
metabolic interaction of carbohydrates,
fats protein and insulin.

3. RISK FACTORS
a) Family History
b) Rapid Hormonal Change in pregnancy
c) Tumor/ infection of the pancreas
d) Obesity
e) Stress

4. DIAGNOSIS
1. Screening test
 Performed at 26-28 weeks gestation; earlier between 24-28 weeks for
women at risk for gestational diabetes
 Uses 50g oral glucose challenge
 Finding: a plasma glucose of 140 mg/dl needs a follow up test with 3 hrs.
glucose tolerance.
2. Glucose Tolerance test: 100g GTT; commonly done between 28-34 weeks
of pregnancy. The presence of two out of these 4 venous samples is considered
an abnormal results:
 Fasting blood sugar: greater than 105mg/dl
 1 hr. after: serum glucose greater than 165mg/dl
 3 hrs. after; serum glucose greater than 145 mg/dl

5. 3. 2-hr Postprandial blood sugar(PPBS): Abnormal result; greater than
120mg/dl.
The goals for glycemic control include fasting blood glucose levels
(FBS) less than 105 mg/dl and 2hrs. Postprandial levels of less than
120mg/dl.
4. Glycosylated Hemoglobin (maternal hemoglobin
irreversibly bound to glucose): measures Long Term (3
months) COMPLIANCE to treatment. Normal value 4%-8% of
woman’s total hemoglobin, increasing during
hyperglycemia.
5. Urine glucose monitoring INACCURATE as the urine of a
pregnant mother is normally with sugar.
6. Phosphatidyl - Glycerol (PG)

6. Signs and Symptoms
 History
• Family history of diabetes; gestational diabetes in previous pregnancy
• Previous large infant weighing 4000g or more
• Previous infant with congenital defects; polyhydramnios
• Fetal wastage: spontaneous abortion , fetal death, stillbirths
• Obesity with very rapid weight gain
• Increased incidence of vaginal moniliasis and UTI
• Marked Abnormal enlargement (effect of polyhydramnios and macrosomia)
 Signs of Hyperglycemia: 3P’s
• Polyphagia- excessive appetite
• Polydipsia- excessive thirst
• Polyuria- excessive urine
 Weight Loss
 Increased blood and urine sugar

7. COMPLICATION
 Hemorrhage
 Infections
 Hypoglycemic shock

8. Management
 Frequent regular prenatal visit
 Diet
 Insulin
 Serial Ultrasonography

10. FOCUS/ PROBLEM DATA ACTION INTERVENTION RESPONSE
• HYPOGLYCEMIC
SHOCK
Subjective:
The patient
experience sweating
with cold, clammy
skin, pallor, tremors
and hunger.
Objective:
BP
PR
RR
Temp.
At the end of our 8
hrs. of duty the
patient will able to:
1. Have enough bed
rest
2. Decrease sugar
level
Assessment
1. Monitor vital
signs
2. Assess blood
glucose level
Intervention
1. Administer IV
fluid, as ordered.
2. Provide
medication as
physician’s
ordered.
Educative
1. Instruct to have
enough balance
diet.
At the end of our 8
hrs. of duty. Goals
were met. The
patient will able to:
1. Have normal
glucose level
2. Have sufficient
rest