This document provides information on Gestational Diabetes Mellitus (GDM), including its pathophysiology, risks, diagnosis, and management. GDM is defined as glucose intolerance that begins during pregnancy and affects approximately 1 in 10 pregnancies worldwide. If left untreated, GDM can lead to complications for both the mother and baby. The document discusses screening, treatment involving diet, exercise and possibly insulin therapy, monitoring during pregnancy, delivery timing and considerations, as well as postpartum care and follow-up. Capacity building and training of healthcare personnel on national GDM guidelines is also emphasized.
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.
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
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.
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
The Primary Care Physician's guide to management of Pregnancy DiabetesHanifullah Khan
A guide on the screening, diagnosis and management of diabetes in pregnancy aimed at facilitating the handling of this condition in a primary care setting. Includes details on medications and dosages
- gestational DM is critical metabolic disorder during pregnancy .
- According to a 2014 analysis by the Centers for Disease Control and Prevention, the prevalence of gestational diabetes is as high as 9.2%
- this presentation is about Gestational DM , introduction , diagnostic criteria , principles of approach and treatment and the sequels of such pregnancy and it`s effect of coming infant .
- this presentation is done by ; Dr. Nawras Mahir Farhan .
- References : most info.s in this presentation , from Dewhurst's Textbook of Obstetrics and Gynaecology, gynecology and obstetrics by ten teachers .
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Introduction
Gestational Diabetes Mellitus (GDM) is defined as
Impaired Glucose Tolerance (IGT) with onset or first
recognition during pregnancy
Worldwide, one in 10 pregnancies is associated with
diabetes, 90% of which are GDM
Undiagnosed or inadequately treated GDM can lead to
significant maternal & foetal complications
Women with GDM and their offsprings are at increased
risk of developing Type 2 diabetes later in life
2
3. Patho-physiology
GDM is characterised by hyper-insulinaemia and
insulin resistance
In first trimester and early second trimester,there is
increased insulin –due to high levels of oestrogen
In late second and early third trimesters,there is
insulin resistance - due to a number of antagonistic
hormones especially, placental lactogen, leptin,
progesterone, prolactin, cortisol and adiponection
These hormones have the insulin blocking effects
3
5. Implications of Diabetes in Pregnancy
The risk of serious injury at birth - Doubles
The likelihood of Caesarean delivery - Triples
The incidence of Neonatal Intensive
Care Unit admission - Quadruples
5
7. Effects of Pregnancy on Diabetes
During pregnancy, there is altered carbohydrate
metabolism and impaired insulin action
Insulin requirement increases as pregnancy
advances
Accelerated starvation----rapid activation of lipolysis
with short period of fasting
Higher risks of Ketoacidosis complications
Accelerates vascular changes
7
10. Hyperglycaemia in
1st trimester
Impaired
organogenesis
Congenital
abnormalities
Chronic maternal
hyperglycaemia
Foetal
hyper-insulinemia
Foetal hyperglycaemia
Increased foetal
oxygen demand
Glycosylated
Hb carries less
oxygen
molecule and
O2 binds more
avidly and
releases O2
less
Decreased Oxygen
tension (hypoxemia)
Increase in anaerobic
metabolism
Increased lactate and
academia
Abortion/ IUD
Increased
erythropoiesis
Polcythaemia and
hyper viscosity
RBC breakdown and
Neonatal hyper-
bilirubinemia
10
11. GDM: Risk Factors
Age >25years
BMI >25kg/m²
Increased weight gain during
pregnancy
Previous history of large for
gestational age infants
History of GDM during
previous pregnancies
previous stillbirth with
pancreatic islet hyperplasia on
autopsy
Ethnic group ( East Asian,
Pacific Island ancestry)
Elevated fasting or random
blood glucose levels during
pregnancy
Family history of diabetes in
first degree relatives
History of metabolic X
syndrome
History of type I or type II
Diabetes Mellitus
Unexplained fetal loss
11
12. GDM: Maternal Complications
During Pregnancy
• Abortion
• Preterm labour (due to infection or
polyhydramnios)
• Pre-eclampsia
• Polyhydramnios
• Maternal distress due to oversized fetus
and polydramnios
• Microangiopathy- Nephropathy,
retinopathy, neuropathy
• Large vessel disease
– Coronary artery disease
– Thromboembolic disease
– Infection
– Hypo and hyperglycaemia
During labour
• Prolonged labour
• Shoulder dystocia
• Perineal injuries
• PPH
• Operative interference
• Increased risk of
Caesarean delivery
Puerperium
• Puerperal sepsis
• Lactational failure
12
14. GESTATIONAL DIABETES PRE-EXISTING DIABETES
• No increased risk of congenital
anomalies
• Increases risk of foetal macrosomia
• Increases risk of having Caesarean
section
• Increased risk for metabolic syndrome
and type II diabetes later in life (>50%
women with gestational diabetes
develop type II DM)
• Babies born to women with gestation
diabetes are at increased risk for
obesity, glucose intolerance and
diabetes in adolescence
• Higher risk of congenital
malformations and miscarriages
• Recurrent urinary tract infections
• Vulvo-vaginal infections with poor
control
• Associated with risk of (PPPPRIM)
• Pre-eclampsia,
• Polyhydraminos,
• PPROM,
• Preterm labour,
• Risk of operative deliveries
• IUGR
• Macrosomia
• Ketoacidosis in type I, progression of
microvascular complications
• Caesarean section rates invariably
increased due to fetal macrosomia, poor
blood sugar control, polyhydramnios or
associated with failure of induction 14
15. The White classification, named after Priscilla White on
the effect of diabetes types on perinatal outcome.
It distinguishes between gestational diabetes (type A) and diabetes that
existed before pregnancy (pre-gestational diabetes).
There are 2 classes of gestational diabetes (diabetes which began during
pregnancy):
Class A1: gestational diabetes; diet controlled
Class A2: gestational diabetes; medication controlled
The second group of diabetes which existed before pregnancy can be split up
into these classes:
Class B: onset at age 20 or older or with duration of less than 10 years
Class C: onset at age 10-19 or duration of 10–19 years
Class D: onset before age 10 or duration greater than 20 years
Class E: overt diabetes mellitus with calcified pelvic vessels
Class F: diabetic nephropathy
Class R: proliferative retinopathy
Class RF: retinopathy and nephropathy
Class H: ischemic heart disease
Class T: prior kidney transplant
15
16. Signs
Elevated serum glucose
Glycosuria is of uncertain
significance
Ketonuria
Elevated glycosylated
haemoglobin
Greater than normal
abdominal circumference
GDM: Diagnosis
Symptoms
Asymtomatic
Insidious onset
Polyuria, polyuria,
polyphagia
Fatigue and weight loss
Women with established
diabetes may have
retinopathy or neuropathy
16
18. Who should be tested :
The first testing - first antenatal contact as early as
possible
The second testing -24-28 weeks of pregnancy if the first
test is negative
At least 4 weeks gap between the two tests
All Pregnant Women to be tested even if they come late in
pregnancy
If presents beyond 28 weeks of pregnancy-only one test
to be done
18
19. How to Test:
Single step testing - 75 gm oral glucose & measure plasma
glucose 2 hour after ingestion
75 gm glucose mixed with 300 ml water ingested whether the
PW comes in fasting or non-fasting state
A plasma standardised glucometer should be used to evaluate
blood glucose 2 hours after the oral glucose load
The threshold plasma glucose level of ≥140 mg/dl is taken
as cut off for diagnosis of GDM.
19
22. Antenatal care:
All diabetic women are managed in a multidisciplinary combined
obstetric and diabetic clinic with specialist obstetrician,
diabetologist, specialist midwife, paediatrician and dietician
All women should receive dietary instruction, with individual
recommendations based on weight and height
Patient should receive nutrition counselling from a registered
dietician
Daily calories should be made up approximately 40%
carbohydrate, 20% proteins and 40% fats.
This should improve blood glucose levels
22
25. Role of Ultrasound:
Preferably done in first trimester to confirm gestational
age by dates
Repeated at 18 to 20 weeks gestation to evaluate the
foetus for congenital anomalies
Particularly important in patients with pre-existing type 1
and 2 diabetes and elevated first trimester HbA1c
(>6.5%)
Should be done at 30 to 32 weeks and 36-38 weeks of
gestation to evaluate foetal size, amniotic fluid index, and
to help ascertain the mode of delivery
25
26. Tests of Foetal wellbeing
Daily foetal movement counting:
32 weeks gestation and continue until
delivery.
Amniotic fluid index and biophysical
profile.
These tests are usually conducted
twice weekly and are instituted at
32 to 34 weeks of gestation in women
on insulin and can be done from
34-36 weeks of gestation in women
whose diabetes is controlled by diet.
Some clinicians manage patients with
dietary control without any additional
testing.
26
27. Sulfonylureas
Insulin secretagogues
Glipizide, glyburide
Increase insulin
secretion, decrease
hepatic glucose
production with
resultant reversal or
hyperglycaemia and
indirect improvement of
insulin sensitivity
Meglitinides
Biguanides
Decrease insulin
resistance
Alpha glucosidase
inhibitors eg
acarbose)
Decrease intestinal
absorption of starch
and glucose
Thiazolidinediones
Eg rosiglitazone and
pioglitazone
Not Recommended in National Guidelines - only Insulin to be used27
28. Time and Mode of Delivery
All pregnant women advised during the antenatal care about
the potential risks of pregnancy progressing beyond term
Gestational diabetes
GDM on diet with no complications can be delivered at 40
weeks
GDM on insulin should be delivered by induction of labour at
38-39 weeks
Pre-existing diabetes
Diabetes itself not an indication for Caesarean Section
Pregnant women with diabetes who have a normally grown
fetus should be offered elective birth through induction of
labour, or by elective caesarean if indicated, after 38 completed
weeks
Pregnant women with ultrasound features of macrosomic fetus
(fetal weight more than 4.5kg) and poorly controlled blood sugar
are delivered by elective caesarean section.
28
29. Post-delivery Follow up of GDM Cases
Women with GDM are at higher risk for Type 2 Diabetes mellitus.
Maternal glucose levels usually return to normal after delivery.
GDM cases are not discharged after 48 hours unlike others, FPG
& 2 hr PPPG is performed on the 3rd day of delivery
Subsequently, ANM to perform 75 g GTT at 6 weeks postpartum
Cut offs for normal blood glucose values are:
Fasting plasma glucose: ≥ 126 mg/dl
75 g OGTT 2 hour plasma glucose
Normal: < 140 mg/dl
IGT: 140-199mg/dl
Diabetes: ≥ 200 mg/dl
29
31. Role of Health Personnel at different
levels of Health Facility:
Village Level
ASHA: To mobilise & counsel PW for timely testing &
follow up
Sub-centre Level
ANM: Testing/MNT/Referral of cases needing medical
management
Maintaining records, monitoring & follow up
31
32. Role of Health Personnel at different
levels of Health Facility...contd.
PHC/ UPHC Level
GDM controlled on MNT can be delivered by ANM/SN
GDM on Medical management with Insulin therapy- by MOs
GDM not controlled by Insulin therapy/GDM with
complications should –to referred to higher facility for care
by a specialist
Maintaining records, monitoring & follow up
32
33. Role of Health Personnel at different
levels of Health Facility ..contd.
DH & All CEmOC centres
All jobs as defined under PHC level
+
Specialist/Gynaecologist/MO: Management of all types of
GDM cases
MC & other Super-speciality centres
Comprehensive management of GDM including all
referral cases
33
38. Screening for GDM
Most patients with GDM have normal fasting
glucose levels.
The challenge of glucose tolerance must be done
for most cases with GDM.
38
39. Screening –at the 24 weeks visit
OGTT should be done.
There are some controversies.
whether the universal or selective OGTT
should be done?
Which blood glucose level should be the
optimal cutoff for diagnosis?
39
40. Screening Strategy
Every pregnant woman to undergo OGTT at
about 24 weeks of gestation.
If the GDM symptoms are present after 24 weeks,
the OGTT should be done again.
40
43. Ante-partum Management
There is a consensus that once diabetes is
diagnosed, the treatment should be
recommended for diabetes during pregnancy.
The goals of treatment are to prevent macrosomia,
avoid ketosis, and detect pregnancy
complications (eg, hypertension, intrauterine
growth restriction, and fetal distress).
The management includes diet, exercise and
insulin.
43
44. Diet Therapy
The goals of diet therapy in GDM are to avoid ketosis,
achieve normal blood glucose levels, obtain proper
nutrition, and gain weight appropriately.
The amount and distribution of carbohydrate should
be based on clinical outcome measures (eg, hunger,
blood glucose levels, weight gain), but a minimum of
175 g of carbohydrate per day should be provided.
Carbohydrate should be distributed throughout the
day in 5 to 7 meals and snacks.
Use of a low–glycemic index diet decreases the need
for insulinto maintain euglycemia.
44
45. Exercise
Experts recommend that women with GDM should
exercise regularly to control blood glucose levels.
but an improvement in clinical outcomes has not
been demonstrated from compliance with this
recommendation.
45
46. Insulin Therapy
Traditionally, insulin is used if dietary management
does not maintain blood glucose at normal levels.
Insulin may be initiated at 0.7 U/kg actual body
weight/d given in divided dosages: two-thirds of the
daily dosage before breakfast and the remainder of
the dosage before dinner.
Insulin therapy require close monitoring and
adjustment based on blood glucose levels, meal
choices, and activity levels.
46
47. Obstetrics Management
The goal of intra-partum GDM management is
to avoid operative delivery, shoulder dystocia,
birth trauma, and neonatal hypoglycemia.
For patients who have maintained excellent
control of blood glucose levels with diet and
exercise, delivery is recommended at 40 weeks.
For patients with medication-requiring GDM,
induction at 38 to 39 weeks’ gestation is
recommended
47
48. Obstetrics management…contd
In general, women with gestational diabetes
who do not require insulin seldom require early
delivery or other interventions.
Elective cesarean delivery to avoid brachial
plexus injuries in macrosomic infants is an
important issue.
48
49. Postpartum Management
In most women with GDM, hyperglycemia rapidly
resolves shortly after delivery.
It is reasonable to measure a single random or
fasting blood glucose level before discharge from
the hospital.
49
50. Postpartum Management..contd
Postpartum glucose tolerance testing is important for
women who had GDM.
Women with GDM have a 7-fold increased risk of
developing type 2 diabetes mellitus compared with those
who had a normoglycemic pregnancy.
At 6 to 12 weeks postpartum, only one-third of women
with persistent glucose intolerance have an abnormal
fasting blood glucose level.
Therefore, to detect all women with glucose intolerance,
a 75-g, fasting, 2-hour, oral glucose tolerance test is
recommended.
50
51. Summary- Key Points
Universal testing of all PW for GDM
Testing recommended twice in pregnancy at 1st
antenatal visit and then at 24-28 weeks of gestation
Single step 75 g 2 hr PPPG test to be performed
PW testing positive (2 hr PPPG > 140mg/dl) should be
started on MNT for 2 weeks
If 2 hr PPPG ≥ 120 mg/dL after MNT, medical
management (Insulin therapy) of PW to be started
PW to be monitored by 2 hr PPPG throughout pregnancy
51
52. Summary-Key Points..contd
Antenatal visits 2 weekly in 2nd trimester & weekly in 3rd
trimester
PW on Insulin therapy with uncontrolled Blood glucose levels
(2 hr PPPG ≥120 mg/dl) or insulin requirement >20 U/day
should be referred for delivery at CEmOC centres
GDM pregnancies associated with delay in lung maturity of
foetus- routine delivery prior to 39 weeks not recommended.
Vaginal delivery preferred, LSCS for only obstetric
indications or foetal macrosomia
Postpartum evaluation of glycaemic status by a 75 g OGTT
at 6 weeks after delivery.
52