The seminar discusses diabetes mellitus as a common metabolic disorder in pregnancy, particularly gestational diabetes, which affects 1-4% of pregnancies and can lead to long-term diabetes in 50% of affected women. It covers classification, pathophysiology, potential candidates, diagnosis, and management strategies, emphasizing the importance of monitoring blood glucose levels and dietary adjustments. The seminar highlights both antepartum and postpartum management along with nursing diagnoses related to the condition.

1. SEMINAR ON
METABOLIC DISORDER IN
PREGNANCY
(DIABETES MELLITUS)
PRESENTED BY
PREETI KULSHRESTHA
M. SC. NURSING FINAL YEAR
OBS. & GYNECOLOGY

2. INTRODUCTION
• The term Diabetes Mellitus describes a metabolic disorder that
affects the normal metabolic of carbohydrate, fats & protein.
• Diabetes Mellitus is a metabolic disorder caused by defects in
insulin secretion or action, which lead to abnormalities in the
metabolism of carbohydrate, lipids & protein.
• It is the most common medical complication of pregnancy.

3. DEFINITION
• Diabetes Mellitus is a chronic metabolic disorder due to either
insulin deficiency or due to peripheral tissue resistance to the
action of insulin.
• Gestational Diabetes Mellitus is defined as carbohydrate
intolerance of variable severity with onset or first detection
during the present pregnancy.

4. INCIDENCE
• About 1-4% of all pregnancies are complicated by Diabetes
Mellitus.
• 90% of them are Gestational Diabetes Mellitus.
• 50% of women with Gestational Diabetes Mellitus will became
overt diabetics (Type II) over a period of 5-20 years.

5. POTENTIAL CANDIDATE FOR
GESTATIONAL DIABETES MELLITUS
• Strong familial history of diabetes
• Have given birth to large infants (4kg or more)
• Have unexplained fetal losses
• Presence of polyhydramnios or recurrent vaginal candidiasis in
present pregnancy
• Over the age of 30
• Obesity

6. CLASSIFICATION
• .
National Institute of health
classification of Diabetes.
The white classification was
first propose by Pricilla White
M.D. in 1932.
Types of Diabetes Mellitus.
Type I : Insulin Dependent
Diabetes Mellitus (IDDM).
Gestational Diabetes Mellitus
(GDM) not requiring insulin
Pre-gestational Diabetes Mellitus
• Type I : Insulin Dependent
Diabetes Mellitus (IDDM).
• Type II: Non Insulin
Dependent Diabetes Mellitus
(NIDDM).
Type II: Non Insulin
Dependent Diabetes Mellitus
(NIDDM).
Gestational Diabetes Mellitus
(GDM) requiring insulin
Gestational Diabetes Mellitus
(GDM)
Type III: Gestational Diabetes
Mellitus (GDM).
Overt Diabetes Mellitus

7. Pre-gestational Diabetes Mellitus
• DEFINITION - When diabetic women is pregnant known as Pre-
gestational Diabetes Mellitus.
• TYPES –
1.Type I : Insulin Dependent Diabetes Mellitus (IDDM).
2. Type II: Non Insulin Dependent Diabetes Mellitus (NIDDM).
• INCIDENCE-
0.1%-0.5% in 10% of all diabetic women.

8. Contd.
• PATHOPHYSIOLOGY-
Inadequate production of insulin
Accumulates glucose in the blood stream (Hyperglycemia)
Hyperosmolarity of blood (attract ICF into vascular sys.)
Cellular dehydration and expanded blood volume
Kidney excreates large volume of urine (polyurea)
Attempt to regulate excess blood volume & to excreate unusable glucose – glucosuria
Excessive thirst (cellular dehydration with polyurea)

9. Contd.
Body compensate for its ability to converts carbohydrates (glucose) into the energy
The body burns protein (muscles), fat
End product are ketones or fatty acids
When these are excess – ketoacidosis (weight loss)
{breakdown of fat and protein in tissues}
Starvation (Polyphagia)

10. Contd.
MATERNAL INVESTIGATION
History collection
Physical examination
BP monitoring
Laboratory test-
Routine prenatal blood test
LFT
Thyroid function test
Glycosylated HB-A
Urine test-culture
Sensitivity
24hrs urine collection
vision test
FETAL INVESTIGATION
Ultrasonography
Fetal kick counts
FHR
CST- biophysical profile

11. MANAGEMENT –
ANTEPARTUM INTRAPARTUM POSTPARTUM
1. Patient counselling.
2. Diet
3. Monitoring blood glucose
level
4. Urine – sugar and ketone,
creatine etc.
5. Insulin therapy
6. Exercise
1. Monitor glucose level
2. Maintain iv fluids (Ringer
Lactate, 5% dextrose)
3. Fetal monitoring &
Partography
1. Monitoring blood glucose
level
2. Diet
3. Advice for breastfeeding

12. Gestational Diabetes Mellitus
• DEFINITION – It is defined as CHO intolerance of variable severe with
onset or first recognition during the pregnancy & disappear at the end of
pregnancy subsequently reoccur in subsequent pregnancy.
• INCIDENCE-
2-6% of pregnant women 90% cases pregnant mothers.

13. Contd.
• RISK :
Obesity
Hypertension
Maternal age > 35 years
Hydramnios
Previous obstetrical history

14. Contd.
• PATHOPHYSIOLOGY :
Fetal demand rise during late pregnancy
Maternal nutrition ingestion induces greater more sustained levels of blood glucose
Maternal insulin resistance also increases
Maternal insulin demand increases 3 folds
Majority capable to increase insulin production & compensate insulin resistance and maintain
normoglycemia
Pancrease unable to produce insulin or insulin is not effective
Gestational Diabetes Mellitus

15. Contd.
• INVESTIGATION-
History collection
Examination
Blood investigation

16. MANAGEMENT –
ANTEPARTUM INTRAPARTUM POSTPARTUM
1. Diet :-
• 2000-2200 kc/day, ideal
weight gain, obese women
menu plan is done to prevent
weight gain, reduction of fat
intake, exclusion of simple
sugar.
• Insulin sugar, non rapid
insulin 2-3 injection/day
• Self monitoring of glucose.
1. Monitor glucose level
2. IV glucose not given bolus
1. 95% return to
normoglycemia in this
period
2. Reduce weight and maintain
normal range in case of overt
diabetes.

17. Overt Diabetes
• DEFINITION :
Overt diabetes is a condition in which the patient shows an abnormal
glucose tolerance test with or without symptoms and a raised fasting blood
glucose level.
• INCIDENCE :
24% women with overt diabetes.

18. Contd.
• DIAGNOSIS :-
Fasting plasma glucose exceeds 126mg/dl
The 2 hour post glucose value exceeds 200mg/dl

19. Contd.
• MANAGEMENT :-
DIET :-
The daily calorie requirement is 50-55kcal/kg of body weight.
Additional 200 kcal should be given to meet the needs of the fetus
The diet should contains carbohydrate-50%, protein-20% , fat 25-30%.
If the patient is obese, fat should be avoided.
The patient should be given high fiber diet.
Usually a 4 meal is given with = a. breakfast 25%
b. lunch 30%
c. dinner 30%
d. bed time snacks 15%

20. Contd.
FETAL MONITORING:-
 Sonographic evaluation are done to detect verities of congenital malformations, fetal
macrosomia, growth retardation.
Assessed for fetal well-being at 32 weeks.
INSULIN THERAPY :-
Insulin infusion should be given at the rate of 1 unit per hour for blood glucose of 70-130mg/dl.
2units/hr. for blood glucose of 130-160 mg/dl.
3 units/hr. for blood glucose of 160-200 mg/dl.

21. Contd.
• NURSING DIAGNOSIS :-
1. Risk for imbalanced nutrition related to inability to ingest sufficient quantity of
nutrients/inability to utilize nutrients appropriately/lack of information about
eating appropriately.
2. Risk for fetal injury related to elevated maternal serum glucose levels.
3. Risk for maternal injury related to tissue hypoxia/increased maternal serum
glucose level/ altered immune response.
4. Deficient knowledge regarding diabetic condition, treatment, prognosis and self
care related to lack of information/unfamiliarity with information resources.