The document discusses diabetes mellitus and its influence on pregnancy. It defines diabetes as a chronic disease resulting from insufficient insulin production. During pregnancy, diabetes can increase risks for both mother and fetus, such as abortion, preeclampsia, growth restriction, and neonatal complications. Gestational diabetes develops during pregnancy and usually resolves after delivery but increases later diabetes risk. The document outlines nursing interventions for gestational diabetes including glucose monitoring, dietary changes, exercise, education, and insulin administration if needed.

1. ‫الرحيم‬ ‫الرمحن‬ ‫هللا‬ ‫بسم‬
َ‫ك‬َ‫ن‬‫ا‬َ‫ح‬ْ‫ب‬ُ‫س‬ ْ‫ا‬‫و‬ُ‫ل‬‫ا‬َ‫ق‬َ‫م‬ْ‫ل‬ِ‫ع‬ َ‫ال‬َ‫ل‬‫آ‬َ‫ن‬ّ‫ال‬ِ‫إ‬
‫ا‬َ‫م‬‫آ‬َ‫ن‬َ‫ت‬ْ‫م‬ّ‫َل‬‫ع‬ّ‫ن‬ِ‫إ‬َ‫ع‬ْ‫ال‬ َ‫ت‬ْ‫ن‬َ‫أ‬ َ‫ك‬ُ‫م‬‫ي‬ِ‫ل‬
ُ‫م‬‫ي‬ِ‫ك‬َ‫ح‬ْ‫ال‬
‫العظيم‬ ‫اهلل‬ ‫صدق‬
‫سورة‬‫البقرة‬‫أية‬32
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan1

2. Diabetes Mellitus
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan2

3. 3
• Chairman of obstetrics &woman health
nursing department
• Pre. Vice dean for students &Education
Affair
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan

4. Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan4

5. Diabetes Mellitus
Definition
• Diabetes mellitus is a chronic disease resulting from a relative or
absolute lack of insulin, which is required for carbohydrate metabolism.
• In diabetes mellitus, the pancreas does not produce sufficient amounts of
insulin to allow necessary carbohydrate metabolism.
• With inadequate amounts of insulin, glucose cannot enter the cells and
remains in the blood.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan5

6. Etiology
Insulin deficiency may be caused by:
◘ Damage to beta cells in the pancreas.
◘ Increased insulin ruirement as in obesity
and pregnancy.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan6

7. •Mother with family history of diabetes and
hypertension
•Obesity
•Polyhydrominos.
•Mother over 45 years of age and less than 20years.
•Multiparty .
•Repeated unexplained abortion or still birth.
•Previous macrocosmic infant.
Risk factors for gestational diabetes:
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan7

8. Influence of Diabetes on Pregnancy
Outcome:-
1-Maternal :-
Increased incidence of abortion
Increased incidence of preeclampsia
Increased incidence of prenatal mortality and
morbidity
Preterm labor
Polyhydrominos
Infection
Incidence of cesarean section.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan8

9. 2- Fetal and Neonatal :
• Hypoglycemia or hyperglycemias
• Intrauterine growth restriction
• Intrauterine fetal death.
• Fetal congenital malformation
• Neonatal hyperbilirubinemia
• Macrosomia
• Prematurity and RDS.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan9

10. Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan
Cont.
During labor:
Mother:
► Obstructed labor.
► Incidence of cesarean
section.
Fetus:
► Prematurity.
► Neonatal hypoglycemia.
► Respiratory distress.
► Macrosomia.
10

11. Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan11
Postpartum:
• Postpartum hemorrhage
• . Infection.

12. Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan
Symptoms of Diabetes Mellitus
•Excessive thirst and hunger.
•Frequent urination.
•Blurred vision.
•Weight loss.
•Recurrent infections
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13. Gestational Diabetes Mellitus (GDM):
•Onset of symptoms occurs
during pregnancy.
•Usually disappears after
delivery.
•Women with GDM are at
risk for developing DM at a
later date.
Symptoms of Diabetes
Mellitus
• ◘ Excessive thirst and
hunger.
• ◘ Frequent urination.
• ◘ Blurred vision.
• ◘ Weight loss.
• ◘ Recurrent infections.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan13

14. Diagnostics
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan14

15. Fasting Plasma Glucose
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan15

16. Oral Glucose Tolerance Test
(OGTT)
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan16

17. Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan
Nursing Intervention for Gestational Diabetes
• Controlling serum glucose
• Dietary adjustment
• Insulin:
• Prevent, recognize and treat hypo- or hyperglycemia
• Ultrasound assessment at 20 week of gestation.
• Educate the patient regarding self-care measures:
• Activity and exercise:
• Hospitalization:
►From 32 week till delivery for patient with vascular changes.
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18. Teach pt. to estabilish and maintain a pattern of regular exercise &
Benefits of exercise :
• promotes use of CHO & enhances action of insulin
•  blood glucose levels
•  need for insulin
➢ perform exercise after meals to ensure an adequate level of blood
glucose
➢ carry a rapid-acting source of glucose during exercise
➢ excessive or unplanned exercise may trigger hypoglycemia
➢ take insulin and food before active exercise
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan18

19. Teach pt. to practice good personal hygiene and positive health
promotion to avoid diabetic complications:-
1. Teach pt. about diabetic foot care
▪ continue taking insulin or oral hypoglycemic agents
▪ maintain fluid intake
▪  frequency of blood testing or urine testing
2. help pt. identify stressful situations in lifestyle that might
interfere with good diabetic control
3. encourage good daily hygiene
4. advise regular eye exams
5. Teach aggressive care for minor skin cuts
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan19

20. 20 Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan