Gestational Diabetes The Cause Pregnancy It is thought

Gestational Diabetes

The Cause • Pregnancy- It is thought that hormones emitted by the placenta during pregnancy may block the action of the mother’s insulin in her own body creating insulin resistance.

Signs and Symptoms • Most women will not experience any notable signs/symptoms • Sugar in urine • Unusual thirst • Frequent urination • Fatigue • Nausea • Blurred vision • Frequent vaginal, bladder, and/or skin infections

Risk Factors • Women age greater than 25 • Family or personal health history • Excess weight • Ethnicity

Complications (Mother) • Preeclampsia • Development of future diabetes • Possible C/S

Complications (Baby) • Generally healthy babies, but with excessive birth weight due to extra insulin in the baby’s body. • Preterm birth resulting in respiratory distress • Hypoglycemia, again due to the high level of insulin being produced by the baby’s body. • More likely to develop type 2 diabetes later in life

Testing (Two-Step Process) • Preformed after the 24 th week • Glucose Challenge Testing- the mother drinks a sugary beverage provided by the laboratory where the testing is being done. An hour later a blood glucose level is taken. • If the patient fails the challenge they come back for a 3 -hour glucose tolerance test. For this test the mother must fast before drinking the liquid. Her blood is tested prior to drinking and then 3 more times every 60 mins. • (one step testing is available and done similarly to the two step system, taking 2 hrs vice 3)

• MONITOR GLUCOSE LEVELS • Special meal planning • Physical activity • Medication (very unusual) • Close monitoring of fetus • Delivery Treatment

Local Resources • Hospitals provide frequent educational seminars for women that cover a large range of subjects to include gestational diabetes. • Public Health - Dayton and Montgomery County Center • Annual diabetes Dayton Expo • Presentations offered at many locations in Dayton • Cooking classes for families dealing with diabetes, low cost testing, educational classes • https: //www. diabetesdayton. org/copy-of-classes • Holy family Prenatal Care- Gestational diabetes testing, education and referrals for better pregnancy health outcomes • http: //holyfamilyprenatalcare. org/services/prenatal-care-services/ • Local American Diabetics Association Centers • http: //www. diabetes. org/diabetes-basics/gestational/ • https: //www. odh. ohio. gov/health/diabetes/odpcpresource. aspx • http: //www. daytonreachout. org/2015 -16 Diabetes. Dayton. Resource. Guide. pdf • https: //www. childrensdayton. org/kidshealth/a/gestational-diabetes-esp

After Delivery • Monitoring of blood glucose levels for both mother and baby. • Giving the baby a quick source of glucose. This may be as simple as giving a glucose and water mixture as an early feeding. Or, the baby may need glucose given intravenously. The baby's blood glucose levels are closely monitored after treatment in case hypoglycemia occurs again. • Checking for hypocalcemia (low calcium levels) • Giving oxygen or using a breathing machine (if respiratory distress occurs) • Care for any problems arising from a birth injury • Care for any problems that occur with a birth defect

Nurses Role • Record of maternal characteristics • Age • BMI • Family hx • Prior glucose intolerance • Gestation age • Diagnosis of GDM • Glucose monitoring • Physical assessment • Education • Possible Nursing Diagnosis • Risk for Altered Nutrition: Less Than Body Requirements • Risk For Maternal Injury • Risk For Fetal Injury • Deficient Knowledge

NCLEX Style Questions • A nurse implements a treatment plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement made by the client indicates a need for further education? 1. “I need to stay on a diabetic diet” 2. “I will preform glucose monitoring at home” 3. “I need to avoid exercise because of the negative effects it will have on my pregnancy. ” 4. “I need to be aware of any infection and report signs of infection immediately to my health care provider. ”

NCLEX Style Questions Cont. • Answer: 3 • Exercise is safe for the client with gestational diabetes and is helpful in lowering the blood glucose level.

NCLEX Style Questions Cont. • Clients with gestational diabetes are usually managed by which of the following therapies? 1. Diet 2. Long acting insulin 3. Oral hypoglycemic drugs or insulin

NCLEX Style Questions Cont. • Answer: 1 • Oral drugs are contraindicated in pregnancy, long acting insulin is not needed for blood glucose control in the client with GD