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.
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.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
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.
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.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
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.
Gestational Diabetes is a kind of diabetes that only pregnant women get.If a woman get diabetes or high blood sugar when she is pregnant, but she never had it before, then she has gestational diabetes.
- 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 .
Presentation: Dr Amanda Daley, Effectiveness of regular weighing and feedback by community midwives in preventing excessive gestational weight gain (POPS 2) – Theme 1 Maternity & Child Health
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.
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 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.
Gestational Diabetes is a kind of diabetes that only pregnant women get.If a woman get diabetes or high blood sugar when she is pregnant, but she never had it before, then she has gestational diabetes.
- 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 .
Presentation: Dr Amanda Daley, Effectiveness of regular weighing and feedback by community midwives in preventing excessive gestational weight gain (POPS 2) – Theme 1 Maternity & Child Health
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.
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.
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
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.
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.
Screening for gestational diabetes an update by dr alka mukherjee nagpur ms i...alka mukherjee
Gestational Diabetes Mellitus (GDM) is defined as any glucose intolerance with the onset or first recognition during pregnancy. This definition helps for diagnosis of unrecognized pre-existing Diabetes also. Hyperglycemia in pregnancy is associated with adverse maternal and prenatal outcome. It is important to screen, diagnose and treat Hyperglycemia in pregnancy to prevent an adverse outcome. There is no international consensus regarding timing of screening method and the optimal cut-off points for diagnosis and intervention of GDM. DIPSI recommends non-fasting Oral Glucose Tolerance Test (OGTT) with 75g of glucose with a cut-off of ≥ 140 mg/dl after 2-hours, whereas WHO (1999) recommends a fasting OGTT after 75g glucose with a cut-off plasma glucose of ≥ 140 mg/dl after 2-hour. The recommendations by ADA/IADPSG for screening women at risk of diabetes is as follows, for first and subsequent trimester at 24-28 weeks a criteria of diagnosis of GDM is made by 75 g OGTT and fasting 5.1mmol/l, 1 hour 10.0mmol/l, 2 hour 8.5mmol/l by universal glucose tolerance testing. Critics of these criteria state that it causes over diagnosis of GDM and unnecessary interventions, the controversy however continues. The ACOG still prefer a 2 step procedure, GCT with 50g glucose non-fasting if value > 7.8mmol/l followed by 3-hour OGTT for confirmation of diagnosis. In conclusion based on Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study as mild degree of dysglycemia are associated with adverse outcome and high prevalence of Type II DM to have international consensus It recommends IADPSG criteria, though controversy exists. The IADPSG criteria is the only outcome based criteria, it has the ability to diagnose and treat GDM earlier, thereby reducing the fetal and maternal complications associated with GDM. This one step method has an advantage of simplicity in execution, more patient friendly, accurate in diagnosis and close to international consensus. Keeping in the mind the diversity and variability of Indian population, judging international criteria may not be conclusive, thus further comparative studies are required on different diagnostic criteria in relation to adverse pregnancy outcomes
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
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.
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
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
2. Objectives
After completing this Module the participant
will be able to
• Discuss the benefit of self monitoring of blood
glucose (SMBG) when available
• Determine appropriate timing of SMBG depending
on availability of strips
• Decide on expected target values for fasting and
post prandial BG
• Discuss methods of fetal monitoring
2
4. How often should SMBG occur?
Daily monitoring provides immediate feedback to the
mother and is the ideal.
• Woman must know targets
• Must know how to respond to results out of target
range
When resources are limited
• Once weekly monitoring until targets reached
• When targets reached check once per month until
late in the 2nd trimester
• Then increase to every 1 - 2 weeks
Metzger, Buchanan et al 2007
Seshiah Balaji, 2006 4
6. HbA1C during pregnancy?
May be valuable in determining those who had
undiagnosed diabetes prior to pregnancy
May give indication of overall control during
pregnancy BUT
Not valuable for day-to-day management during
pregnancy
May give falsely low results
Other factors such as anemia make it unreliable
6
7. Fetal movement counting
The rationale - decreased fetal movements may signal
decreased oxygenation which often precedes fetal
demise
Reduction of activity associated with chronic fetal distress
Among inactive fetuses, approximately 50% are either
stillborn, tolerate labor poorly or require resuscitation at
birth
7
Lalor et al 2008
8. Fetal movement
• Inexpensive, involving the mother, easy to use
• Foetal movements related to maternal glucose
levels
• Patients taught generally from late third
trimester - after 35 weeks at routine ANC
• Reduced activity needs to be evaluated by
NST (non stress test)
8
9. Other parameters
Blood pressure – every visit
Values above 140/90 mm Hg are of concern
If > 140/90 re measure same day; If > 150/100 initiate
therapy
If BP > 140/90 check urine for albuminuria
Estimate Urine albumin / sugar dip stick
Though urine sugar not of value in a known GDM, albumin is
important as sometimes predates BP in preeclampsia
9
10. Ultrasound fetal measurement
Early pregnancy scan - 7-8 weeks
• Dating and viability
• Dating important to offer appropriate timing for
antenatal visits/ scans and delivery
• Accurate dating prevents iatrogenic prematurity
10
11. 11-13 week scan
• As for non- diabetic pregnancies
• Can pick up 60% of structural abnormalities –
value for women with suspected diabetes or
early gestational diabetes
11
12. 18-20 week target scan
• Detailed level 2/3 scan to ensure structural
normalcy
• Foetal echo for all DM and GDM detected early
in pregnancy
Reece CA 2004
12
13. Serial growth scan
• 28 weeks onwards, growth estimation is done
by ultrasound to monitor fetal growth and
identify both SGA and LGA babies.
• Scan to monitor growth is recommended every
4 weeks till 36 weeks.
• Growth plotted on growth charts to see centiles
13
Julie DL 2007, NICE 2008
15. Growth - macrosomia
• Macrosomia is common in GDM especially if there is
poor control
• If macrosomia is suspected, then additional
measurements that can be taken:
• include frontal truncal skin fat layer,
• skin thickness above the scapula,
• amniotic fluid index
• Post prandial blood sugars rather than fasting
sugars correlate better with birth weight and foetal
size
15
16. Growth - IUGR
IUGR seen in
- Women with vasculopathy
- Preeclampsia
- Diabetes with too strict glycaemic control
SGA babies(< 10th centile for GA) have an
increased risk of perinatal morbidity and mortality
16
18. Antenatal surveillance
From 36 weeks, CTG / modified BPP are tests of
fetal well being
No consensus or recommendation on when to
start such tests or the frequency of monitoring
In women who want to await spontaneous labour,
these tests are indicated weekly after 38 weeks
18Coustan 2009, NICE 2008
19. References
American Diabetes Association. Standards of Medical Care 2015. Diabetes Care 2015;38(suppl 1):
S77
Austin M.M., Haas L., Johnson T., Parkin C.G., Parkin C.L., Spollett G., Volpone, M.T. (2006). AADE
Position Statement: Self-monitoring of blood glucose: benefits and utilization. The Diabetes
Educator, 32:835-847.
Bode, B.W. (2007). Incorporating postprandial and fasting plasma glucose into clinical management
strategies. Insulin, 2:17-29.
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes
Association 2013 Clinical practice guidelines for the prevention and management of diabetes in
Canada; Diabetes and pregnancy. Can J of Diabetes. 2013;37(suppl 1):S168-183.
Coustan D, Glob. libr. women's med. (ISSN: 1756-2228) 2009; DOI 10.3843/GLOWM.10162
Julie DL 2007
Lalor JG, Fawole B, Alfirevic Z, Devane D. Biophysical profile for fetal assessment in high risk
pregnancies. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD000038. DOI:
10.1002/14651858.CD000038.pub2
Landon and Gabbe Antepartum surveillence in gestational diabetes Diabetes Supplement 2 50-54,
1985
McAndrew L., Schneider, S.H., Burns, E., Levethal, H. (2007). Does patient blood glucose monitoring
improve diabetes control? The Diabetes Educator, 33:991-1011.
Metzger, BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth
International workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care.
2007;30(Supple 2):S251-260.
National Collaborating Centre for Women’s and Children’s Health. Diabetes in pregnancy. Revised
reprint July 200. London:RCOG Press. (www.nice.org.uk)
NICE 2008
Parkin C.G., Hinnen, D., Campbell, K., et al. (2009). Effective Use of Paired Testing in Type 2
Diabetes: Practical Applications in Clinical Practice, The Diabetes Educator, 35, 915.
19
20. Reece CA 2004
Roberts AB, Stubbs SM, Mooney R, et al. Fetal activity in pregnancies complicated by maternal diabetes mellitus. Br J
Obstet Gynaecol. 1980;87:845–849.
Seshiah V, Balaji V, et al. Gestational Diabetes Mellitus – Guidelines. J Assoc Physic of India. 2006;54:622-28.
The International Diabetes Federation Clinical Guidelines Task Force, in conjunction with the SMBG International
Working Group. Guideline on Self-Monitoring of Blood Glucose in Non-Insulin-Treated Type 2 Diabetes, 2009.
Vintzileos AM. Antenatal assessment for the detection of fetal asphyxia: an evidence-based approach using indication-
specific testing. Ann N York Acad Sci. 2000;900:137–150.
,
20
Editor's Notes
The International Diabetes Federation Clinical Guidelines Task Force, in conjunction with the SMBG International Working Group. Guideline on Self-Monitoring of Blood Glucose in Non-Insulin-Treated Type 2 Diabetes, 2009.
Austin M.M., Haas L., Johnson T., Parkin C.G., Parkin C.L., Spollett G., Volpone, M.T. (2006). AADE Position Statement: Self-monitoring of blood glucose: benefits and utilization. The Diabetes Educator, 32:835-847.McAndrew L., Schneider, S.H., Burns, E., Levethal, H. (2007). Does patient blood glucose monitoring improve diabetes control? The Diabetes Educator, 33:991-1011.Bode, B.W. (2007). Incorporating postprandial and fasting plasma glucose into clinical management strategies. Insulin, 2:17-29.Parkin C.G., Hinnen, D., Campbell, K., et al. (2009). Effective Use of Paired Testing in Type 2 Diabetes: Practical Applications in Clinical Practice, The Diabetes Educator, 35, 915.
Guidelines recommend that monitoring would ideally be done daily. In many countries women monitor before and after every meal. While this gives immediate feedback regarding levels however the value is limited if the woman does not know how to respond to the results, either adjusting intake or insulin.
Frequent testing may not be practical in many cases. Therefore in cases where good control is yet to be achieved, monitoring should be done more frequently. Once control is achieved then, One measurement per month up is sufficient up until the late second trimester and every 1 - 2 weeks thereafter. This way BG monitoring could be combined with visits to the clinic.
How many of your patients are able to monitor their own blood glucose?
How often can or do women come to the clinic to have their blood glucose monitored?
Metzger BE, Buchanan TA, Coustan DR, De Leiva A, Hadden DR, Hod M. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus, Diabetes Care. 2007; 30(suppl 2):S251-260.
Seshiah V, Balaji V, et al. Gestational Diabetes Mellitus – Guidelines. J Assoc Physic of India 2006;54:622-28.
These are the target levels for women once they are pregnant. Note they are slightly lower than target levels for non – pregnant people with diabetes. Targets are lower to protect the baby from exposure to too much glucose in the womb.
Metzger, BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30(Supple 2):S251-260.
National Collaborating Centre for Women’s and Children’s Health. Diabetes in pregnancy. Revised reprint July 200. London:RCOG Press. (www.nice.org.uk)
American Diabetes Association. Standards of Medical Care 2015. Diabetes Care 2015;38(suppl 1): S77
Seshiah V, Balaji V, et al. Gestational Diabetes Mellitus – Guidelines. J Assoc Physic of India 2006;54:622-28.
Lalor JG, Fawole B, Alfirevic Z, Devane D. Biophysical profile for fetal assessment in high risk pregnancies. Cochrane Database Syst Rev.2008:CD000038. [PubMed]:
When Blood glucose is high the baby will move less, when low the baby may be very active.
Landon and Gabbe Antepartum surveillence in gestational diabetes Diabetes Supplement 2 50-54, 1985
Roberts AB, Stubbs SM, Mooney R, et al. Fetal activity in pregnancies complicated by maternal diabetes mellitus. Br J Obstet Gynaecol. 1980;87:845–849.
Vintzileos AM. Antenatal assessment for the detection of fetal asphyxia: an evidence-based approach using indication-specific testing. Ann N York Acad Sci. 2000;900:137–150.
Delayed conception sometimes see when ovulation is irregular in diabetes hence an accurate dating is a must – will help in interpretation of correct growth
for dating
Women with diabetes do not have an increased risk of numeric chromosomal anomalies such as Klienfelter
Some biochemical markers tend to be lower in women with type 1 diabetes than in women without diabetes.
Infants of mothers with diabetes are three times more likely than infants in general to manifest all types of birth defects. Cardiac, neural tube, and skeletal defects are most common, but a particular set of anomalies affecting the lower half of the body, the "caudal regression syndrome," is highly specific for diabetic pregnancy. (Reece CA 2004)
A fetal echo must be offered and done in a standardised detailed fashion, to all pregnant women with diabetes, given the increased incidence of anomalies. As some of the women with GDM / DM are obese, the timing of the scan and fetal echo may be pushed to 20 - 22 weeks for better visualisation.
It is important to plot the growth of the baby based on the scan to see progression.
BPD ??
HC Head circumference
AC Abdominal circumference
Rt F L – right femur length
EFW – Estimated Fetal Weight