Our aim is to reduce morbidity and mortality related to Non communicable diseases such as hypertension, diabetes, cardiovascular disease, stroke, Obesity, Cancer and lifestyle diseases among those least able to withstand the burden of the disease.
Our aim is to reduce morbidity and mortality related to Non communicable diseases such as hypertension, diabetes, cardiovascular disease, stroke, Obesity, Cancer and lifestyle diseases among those least able to withstand the burden of the disease.
D. Ware Branch, MD is a Professor and Obstetrician/Gynecologist at the University of Utah, Chairman of Obstetrics and Gynecology at the Intermountain Medical Center, and Medical Director of the Women and Newborns’ Clinical Program at Intermountain Healthcare. Dr. Branch has extensive experience in treating women with gestational diabetes and will share his insights into best practices and evidence.
Diabetes during Pregnancy - Risk Factors, Detection, & TreatmentAshutosh Pandit
Diabetes during pregnancy can severely affect the health of both - mother & baby. Find out the symptoms and complications of Gestational Diabetes and learn how it can be detected & treated.
Our aim is to reduce morbidity and mortality related to Non communicable diseases such as hypertension, diabetes, cardiovascular disease, stroke, Obesity, Cancer and lifestyle diseases among those least able to withstand the burden of the disease.
D. Ware Branch, MD is a Professor and Obstetrician/Gynecologist at the University of Utah, Chairman of Obstetrics and Gynecology at the Intermountain Medical Center, and Medical Director of the Women and Newborns’ Clinical Program at Intermountain Healthcare. Dr. Branch has extensive experience in treating women with gestational diabetes and will share his insights into best practices and evidence.
Diabetes during Pregnancy - Risk Factors, Detection, & TreatmentAshutosh Pandit
Diabetes during pregnancy can severely affect the health of both - mother & baby. Find out the symptoms and complications of Gestational Diabetes and learn how it can be detected & treated.
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
In this interactive lecture Dr. Vicky Guanzon joins me in discussing the updates on the Diagnosis and Treatment of Diabetes in Pregnancy. Delivered at the L'Fischer Hotel in Bacolod City on August 6, 2015.
Philippine CPG on Diagnosis & Screening for Gestational DiabetesIris Thiele Isip-Tan
Philippine CPG on diagnosis and screening of gestational diabetes presented for comments at the 3rd Unite for Diabetes Annual Convention this September.
Symposium presentation at 2017 annual convention of the Philippine Society of Endocrinology, Diabetes & Metabolism. 23 March 2017, EDSA Shangrila Hotel.
Achieving Hba1c targets: Strategies For Initiating and Intensifying Diabetes ...Nemencio Jr
This module highlights the appropriate HbA1c targets that reduce microvascular and macrovascular complications in appropriate populations and how to safely achieve them with current anti-hyperglycemic agents
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
In this interactive lecture Dr. Vicky Guanzon joins me in discussing the updates on the Diagnosis and Treatment of Diabetes in Pregnancy. Delivered at the L'Fischer Hotel in Bacolod City on August 6, 2015.
Philippine CPG on Diagnosis & Screening for Gestational DiabetesIris Thiele Isip-Tan
Philippine CPG on diagnosis and screening of gestational diabetes presented for comments at the 3rd Unite for Diabetes Annual Convention this September.
Symposium presentation at 2017 annual convention of the Philippine Society of Endocrinology, Diabetes & Metabolism. 23 March 2017, EDSA Shangrila Hotel.
Achieving Hba1c targets: Strategies For Initiating and Intensifying Diabetes ...Nemencio Jr
This module highlights the appropriate HbA1c targets that reduce microvascular and macrovascular complications in appropriate populations and how to safely achieve them with current anti-hyperglycemic agents
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is defined as glucose intolerance that first emerges or is first recognized during pregnancy. Gestational diabetes mellitus (GDM) affects between 2% and 5% of pregnant women. Data show that increasing levels of plasma glucose are associated with birth weight above the 90th percentile, cord blood serum C-peptide level above the 90th percentile, and, to a lesser degree, primary cesarean deliveries and neonatal hypoglycemia
Gestational diabetes Mellitus is defined as:
“Glucose intolerance of any severity with onset or first recognition during pregnancy”
This definition is applicable irrespective of whether the condition resolves after delivery or not.
It does not exclude the possibility that diabetes could have antedated pregnancy.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Diabetesasia.org is your diabetes resource for asking queries, education, relating and distribution your private diabetes experience or those you care for.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
Our aim is to reduce morbidity and mortality related to Non communicable diseases such as hypertension, diabetes, cardiovascular disease, stroke, Obesity, Cancer and lifestyle diseases among those least able to withstand the burden of the disease.
Our aim is to reduce morbidity and mortality related to Non communicable diseases such as hypertension, diabetes, cardiovascular disease, stroke, Obesity, Cancer and lifestyle diseases among those least able to withstand the burden of the disease.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
The WDF mission:
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
The WDF mission:
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
More from Jain hospital,Mahavir Sikshan Sansthan (20)
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
3. Objective
• To define GDM
• To understand the need for diagnosis &
management of GDM
• To understand protocol for diagnosis of GDM
• To understand the MNT for management of
GDM
• To understand the counselling tips for GDM
4. PREGNANCY IS A DIABETOGINEC STATE
1. Increased placental hormones
2. Increased free fatty acid which interfere with glucose uptake
As pregnancy advances insulin resistance and diabetogenic
stress due to placental hormones necessitate compensatory
increase in insulin secretion. When this compensation is
inadequate gestational diabetes develops.
‘Gestational Diabetes Mellitus’ [GDM] is defined as
carbohydrate intolerance with onset or recognition
during pregnancy.’
5. Why do you want to screen for
Diabetes in Pregnancy ?
• Incidence is high in our country
• Index pregnancy has risk for the mother and
the fetus
• Neonatal period is stormy
• Long term risks for the mother and the baby
6.
7. Contribution of India, China, and USA in estimated
global prevalence of Type 2 DM during 2010
(Global Prevalence being 284.81 million)
8. Prevalence of GDM in our
country is 16.55% by WHO
criteria of 2 hr post prandial
glucose >140mg/dl(75 g
glucose).
Seshaiah V, Balaji V, J Obstet Gynecol
India 2005
9. Gestational Diabetes mellitus is defined as
impaired Glucose tolerance with onset or
first recognition during pregnancy
10. GDM is a public health problem
• GDM higher in India than west – 10 -14.3 %
• 50-60% risk for women to develop Type II diabetes in
next 10 years
• 20-30% risk of developing Type II diabetes for
children in early life
• 40-50% risk of developing GDM in next pregnancy
11. Effect of Gestational diabetes in Mother
Keto-acidosis
Increased Infections
Pre-eclampsia
Poly-hydramnios
Obstructed labor, Increased LSCS
Prolonged labor, PPH
In later life in 60%
after pregnancy
women can develop
DM
12. Effect of Gestational diabetes in Baby
Early Abortion
Large size baby, birth injuries
Preterm births, Fetal Death
Stormy neonatal period
Congenital abnormality
13. Why screen for GDM??
Consequences of diabetes on the fetus –
First trimester-
Malformations;
fetal wastage
Second
Trimester-
Hypertrophic
cardiomyopathy;
Polyhydramios;
PIH; Fetal
loss;Prematurity
Third Trimester
Macrosomia;
Hypoglycemia;
Hypocalcaemia;
IUD
Neonatal Problems
Birth Injuries ;
Metabolic
disturbances; RDS,
polycythemia
hyperbilirubinemia
14. Vicious cycle of diabetes in pregnancy
Pregnant
woman with
diabetes
Child of a
diabetic
woman
Young
woman with
diabetes
Lifecycle
rather than
Lifestyle
approach
15. Whom to screen?
National Diabetes Data Group advocates
universal screening for GDM.
Selective Screening - Righ risk Factors –45%
of the pregnant women will go unscreened.
35% - 50%of GDMs would be missed
16. Universal Testing for GDM
• All pregnant Women in community should be tested
for diagnosis of GDM at all delivery points
17. When to Screen ?
Guidelines
Early screening –
to pick up
undiagnosed
preexisting
diabetes( HbA1c
>6)
Early Screening - In
patients with High
Risk factors
Repeat at 24-
28weeks
Also around 32- 34
weeks
19. Protocol for Investigation
• Testing of GDM twice during ANC
• First testing at first antenatal contact in 1st trimester
• 1st test is negative – 2nd test at 24-28 weeks
• A gap of 4 weeks between two tests
• If PW comes after 28 weeks only once test done
• Test positive at any time management followed
20. Challenges with the OGTT
• Cumbersome test
• Cut off values - C&C or NDDG ??
• What to do if only one level abnormal ?
• What if GCT positive and OGTT negative ?
21. Test for GDM diagnosis
• Single step testing - 75 gm oral glucose in 300 ml of
water orally irrespective of last meal
• GDM Diagnosis - 2 hour PP equal or >140 mg/dl
• Plasma standardized glucometer used
• If vomiting with in 30 min - repeat test next day
22. DIPSI Recommended method
One step procedure Irrespective of
previous meal
75gm oral glucose load
2 hrs later Plasma glucose
Simple Economical and feasible
24. Two hour plasma glucose
Plasma glucose level Status
>200 mg/dl Diabetes
>140-199mg/dl GDM
120-139 mg/dl GGI
<120 mg/dl Normal
25. 3 times more pick up than with two step
Suitable for Indian setting
•Saves time & cost.
Avoids repeated visits
Does away the need to confirm by OGTT
No need to remember many values
Reduces repeated invasive sampling.
V Seshiah, AK Das, Balaji V, Shashank R Joshi,
MN Parikh, Sunil Gupta For Diabetes In
Pregnancy Study Group (DIPSI)+
One step 75gm OGTT - Advantages
26. Logistics required for screening
For plasma glucose testing
Glucose pouches 75gms
Disposable glasses and stirrers
Drinking water 300ml
Glucometer with calibration strips
Sterile lancet
Cotton spirit swab or alcohol wipes
Register to record the results
Yellow and black dust bins
Puncture proof container
Glucometer calibration is recommended
after 20 measurements, using calibration
strips, provided with glucometer
27. Universal testing for GDM
Positive
(2 hr PG ≥ 140 mg%)
Negative
(2 hr PG <140mg%)
Manage as
GDM as per
guidelines
Repeat Testing
at 24-28 weeks
Positive
(2 hr PG ≥140 mg%)
Manage as GDM as
per guidelines
Negative
(2 hr PG <140mg%)
Manage as Normal
ANC
Pregnant Woman in Community
Testing for GDM at 1st Antenatal visit
(75 g oral glucose- 2 hr Plasma Glucose value)
28. Calibration of glucometer
• Glucometer to be calibrated after every 20 glucose
testing by calibration strips or fluid
• Calibration means checking accuracy & correctness
to get accurate results
29. Assessment for Diabetes in Pregnancy
Diabetes in previous pregnancy
Family history of diabetes.
Delivery of a large baby (> 4kgm)
Poor Obstetric history(previous stillbirth)
More than 3 spontaneous abortions
30. Assessment for Diabetes in pregnancy
Age >30 years, <30 years with obesity
Persistent Glycosuria.
Polyhydramnios.
Chronic hypertension or early onset pre-
eclampsia.
Recurrent or persistent candidiasis or
urinary tract infection
31. High risk gestational diabetes
• History of stillbirth.
• History of neonatal death.
• History of fetal macrosomia.
• Concomitant obesity and/or hypertension.
• Development of oligohydramnios, polyhydramnios
or pre-eclampsia
• Inadequate metabolic control with diet alone.
32. VALUE OF HBA1C…
• HBA1c is a measure of glucose control over 8-10 weeks
• Cut off is taken as 6 %
• Helps distinguish between pre GDM and GDM, when GDM
diagnosed in early pregnancy
• > 9.5 % -- congenital anomalies 22 %
• Spontaneous abortions -- 14 %
• > 11 % --- terminate pregnancy ??
33. Cut off for Blood Sugar in Non pregnant
• F blood sugar > 126 mg%
• Impaired fasting 100-125 mg%
• Normal fasting < 100 mg%
• 2 Hour PP blood sugar > 200 mg%
• Impaired PP 140 – 199 mg%
• Normal 2 hour PP < 140 mg%
34. Traditional management of GDM
Safety in every step of the way
Diet Exercise Insulin
GDM Gynecologists (Obstetricians)
Dietitians
Medicine (Endocrinologists)
36. Management of Pregnant Woman with GDM
Medical Nutrition Therapy (MNT)
After 2
weeks
2 hr PPPG
< 120 mg%
Continue MNT
120 mg%
Start Insulin Therapy
Monitor 2 hr PPPG
- Upto 28 wks: Once in 2 weeks
- After 28 wks: Once a week
- Monitor FBG &2 hr PPPG every 3rd
day or more frequently till Insulin dose
adjusted to maintain normal plasma
glucose levels
- Monitor 2 hr PPPG once weekly
Pregnant Woman with GDM
38. Medical nutrition therapy
• MNT is carbohydrate controlled balanced meal plan
• Nutritional assessment should be individualized
• Pre-pregnancy BMI, optimal weight gain & Energy
requirement (BMR x PAL) during pregnancy to be
defined
39. First step-Medical Nutrition Therapy
General principles: 10 -12 kg weight gain (300 kcal/d)
Calorie counting: wise distribution of calories
No fasting
Dietician charts a diet plan according to Body Weight
Obese women : 25-30 kcal / kg
Non-obese : 30-35 kcal /kg
Underweight: 35-40 kcal/kg
Dietary compliance is evaluated and reinforced during
hospital visits
Dietary variety/choices should be added ,
41. Pre-pregnancy weight, BMI & Optimal Weight
gain during Pregnancy
Pre-pregnancy
Weight
BMI (kg/m2) Total wt gain range
(kg) in pregnancy
Normal weight 18.5 to 24.9 11.5 to 16 kg
Under weight < 18.5 12.5 to 18 kg
Over weight 25 to 29.9 7 to 11.5 kg
Obese (include
all classes
grade I, II, III)
Equal/more than
30
5 to 9 kg
42. Energy Requirement (BMR x PAL) Calculations
ICMR 2009
• BMR
calculation
• BMR (KCal/d) for
adult female 18-30
years = 14 x BW
(Kg) + 471
• BMR (K.Cal/d) for
adult female 30-60
years = 8.3 x BW
(Kg) + 788
• PAL (Physical
activity level)
values
Sedentary work –
1.53
Moderate work –
1.8
Heavy work – 2.3
• 350 K.Cal to
be added in
2nd & 3rd
trimester for
additional
energy
requirement
43. 43
Choice of diet
• CHO with low GI
• Lean proteins
• Balance of Poly and mono
unsaturated fats
Avoid
• Eating for two
• Fast & feasts
• Health Drinks
44.
45. Low GI Legumes & lentils, dried beans, peas,
green gram, Bengal gram (rich in fibre)
(30-40%)
Medium GI Fruits (45-55%)
High GI Cereals like rice, white bread, root
vegetables-potato, carrot, candy bars
and syrupy foods (65-70%)
Diet with low GI are generally rich in fibre and high fibre
improves glucose tolerance
Glycemic index of foods
46. Signal system
Healthy vs unhealthy food choices
Steamed
brown rice
White rice Biryani
Whole grain
bread
White
bread
Cakes,
cookies,
croissants
Steamed/
grilled fish
Stir fry fish Deep fry fish
Fresh fruit
Unsweeten
ed fruit
juice
Candied fruit,
sweetened
fruit juice
Whole
wheat roti
Maida
roti/Naan
Paratha
/Puri
Green salad
Salad with
mayonnaise
Salad with
cream and
cheese
What to Eat?
(Quality of food)
47. Understanding Food properly
• Carbohydrates foods are essential for healthy diet of mother & baby
• Large amount of carbohydrate at one time should be avoided
• Complex carbohydrates preferred over simple carbohydrates
• Carbohydrate should be spread over 3 small meals and 2-3 snacks
• Have 2-3 carbohydrates at each major meals & 1-2 at every snack
• Saturated fat like ghee should be less than 10% of total calories
• Obese & overweight PW should take low fat diet
• Moderate caloric restriction in GDM may improve glycemic control
• Hypocaloric diet may lead to ketonemia & ketonuria
48. • Protein – requirement increases to allow fetal growth –
additional 23 g/d is required
• 2-3 servings should be consumed every day
• Fiber - High fiber foods control blood sugar better
51. Delivery
• Controlled GDM on diet/insulin - at 39 or 40 weeks -
spontaneous delivery / induction
• GDM on insulin - uncontrolled blood glucose to be referred
for delivery by gynecologists – may need LSCS
• LSCS for obstetrical indication/ macrosomia > 4kg fetal weight
52. Immediate neonatal Care
• Essential new born care for every newborn
• Early breast feeding to avoid hypoglycemia
• Monitoring for hypoglycemia (cut off < 44 mg/dl)
– to be started after one hour of delivery
– every 4 hours (prior to next feed)
– till four stable glucose values are obtained
• Evaluate neonate for RDS, convulsions, hyperbilirubinemia
53. OGTT to be done 6
weeks after
delivery with 75
gm of glucose to
evaluate glycemic
status
GDM women
are at higher
risk of DM &
CVS diseases
Intensive life style
intervention
delays & reduces
the risk for
development of
DM & CVS
problems
54. Post delivery follow up
• Maternal glucose levels usually returns to normal after delivery
• FPG & 2 hr PPPG is performed on 3rd day of delivery
• 75 gm GTT at 6 weeks postpartum
• Cut off for normal blood glucose values are
– F plasma glucose equal or > 126 mg/dl
– 75 g OGTT 2 hour plasma glucose
• Normal < 140 mg/dl
• IGT 140-199 mg/dl
• Diabetes equal or > 200 mg/dl
• Test normal - Women is counselled about life style modifications, weight
monitoring & exercise
• Test positive women should consult physician
55. The postpartum period is an important platform to initiate
contraception, early preventive health for mother and the child
who are both at higher risk of:
• Future Obesity
• Metabolic Syndrome
• Diabetes
• Hypertension
• Cardiovascular Disorders
This can best be achieved by linking mother’s follow up to the child’s vaccination and well baby clinic visit
A sticker of red dot can
alert care giver about
GDM offspring and
follow up for
contraception &
discussion about life
style changes
56. Preconception care – Goals of Treatment
Optimal HbA1C
Medical Nutrition therapy (MNT)
Self monitoring of blood glucose (SMBG)
Self administration & adjustment of insulin doses
Education about hypoglycemia
Physical activity
57. Contain the epidemic of Diabetes
The timely action taken now in screening all pregnant
women for glucose intolerance, achieving euglycemia in
them and ensuring adequate nutrition may prevent in all
probability, the vicious cycle of transmitting glucose
intolerance from one generation to another.
To contain the epidemic of diabetes we have to
“Focus on the Fetus for the Future”.
58. Counselling Tips
• Blood sugar control is very important for neonate & female
• Modification in diet is easy and very important
• GDM women needs Insulin injections only during pregnancy
• Injecting insulin over abdomen is 100% safe
• As of now Oral hypoglycemic not recommended
• GDM on Insulin should always keep sugar/ glucose
• GDM should have institutional delivery
60. Management of GDM
• GDM +ve PW should be started on MNT for 2 weeks
• 2 hrs PPPG repeated after 2 weeks
• 2 hr PPPG is > 120 mg/dl Insulin to be started
• 2 hr PPPG is < 120 mg/dl
– test repeated every 2 weeks in 2nd tri
– every week in 3rd trimester
61. Target Blood Sugar during Pregnancy
• GDM diagnosis DIPSI Test Blood Sugar > 140
mg%
• F Blood Sugar < 95 mg%
• 2 hour PP Blood Sugar < 120 mg%
• Cut off for Hypoglycemia < 70 mg%
• Cut off neonatal blood sugar > 45 mg%
62. Recognition & Management of
Hypoglycemia
• Hypoglycemia - when blood glucose < 70 mg/dl
• Symptoms & Signs of Hypoglycemia
– Early – tremors of hands, sweating, palpitation, hunger, easy fatigue,
headache, mood changes, irritability, low attentiveness, tingling around
mouth or lips, any other abnormal feeling
– Severe – Confusion, abnormal behavior, visual disturbances, nervousness,
anxiety,
– Uncommon – seizures & loss of consciousness
• Take 3 spoon full (15-20 gm) of glucose in water/5-6 TSF
sugar /fruit juice/any sweet food
63. Pre-conception care & counselling
• Women with h/o GDM to be counselled for plasma glucose
estimation before next pregnancy
• Desired plasma glucose levels
– Fasting -< 100 mg/dl
– 2 hr PPPG -< 140 mg/dl
• Appropriate anti hypertensive to be started if needed
• Counselled to consult gynecologist as soon as she misses her
period
64. Carbohydrate - are a problem !
Choice Based On Glycaemic Index of Foods
Glycaemic index of food
It is the extent of rise in blood sugar in response to a food in
comparison with the response to an equivalent amount of
glucose
The CHO that produce only small fluctuation in blood glucose
are called low GI foods and are recommended for GDM
women