hypoglycemia and hyperglycemia in the pregnanat patient

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Presented by: Excalibur Group Daphney Jacques, Bridgette Jenkins, Opal Jobson- Cudjoe , Kelly Miller

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Page 1: Hypoglycemia and hyperglycemia in the pregnanat patient

Presented by: Excalibur Group

Daphney Jacques, Bridgette Jenkins, Opal Jobson-Cudjoe , Kelly Miller

Page 2: Hypoglycemia and hyperglycemia in the pregnanat patient

Objectives

Distinguish between normal and abnormal blood glucose levels based on patient population

Classify the different diagnosis associated with hypoglycemia/hyperglycemia based on patient age

Compare the common causes of hypoglycemia/hyperglycemia based on patient population

Page 3: Hypoglycemia and hyperglycemia in the pregnanat patient

ObjectivesFormulate the appropriate interventions for

hypoglycemia/hyperglycemia management based on patient population

Differentiate between the different medications used to manage the hypoglycemic/hyperglycemic patient.

Predict immediate complications of hypoglycemia/hyperglycemia

Page 4: Hypoglycemia and hyperglycemia in the pregnanat patient

Objectives State potential long term complications of uncontrolled

blood sugar levels Determine the appropriate educational strategies to

prevent hypoglycemia/hyperglycemia

Page 5: Hypoglycemia and hyperglycemia in the pregnanat patient

NORMAL BLOOD GLUCOSE for PREGNANT WOMEN

65mg/dl (fasting)<140 mg/dl (2 hr pp)

Page 6: Hypoglycemia and hyperglycemia in the pregnanat patient

CLASSIFICATION OF DIABETES IN PREGNANT WOMEN (cdc.gov)

Pregestational DiabetesType I: primarily due to pancreatic islet beta cell destruction.Type II: most common type of diabetes that is a result of

insulin resistance or insufficiency.

Gestational DiabetesAny degree of glucose intolerance with the onset or first

recognition occurring during pregnancy.

Page 7: Hypoglycemia and hyperglycemia in the pregnanat patient

SCREENING FOR GESTATIONAL DIABETES (Lowdermilk, Perry, & Bobak) Screening should be done between 24-

28 weeks gestation. Glucose Tolerance Test (GTT): 50

grams of glucose is consumed, blood is taken after 1 hour and sent to a laboratory for evaluation.

140mg/dl or greater is considered as positive

Oral Glucose Tolerance Test (OGTT) is done if the GTT is positive.

After a overnight fast, a fasting blood glucose level is drawn. Then 100 grams of glucose is consumed and blood is drawn at 1, 2 and 3 hour intervals.

The patient is diagnosed with gestational diabetes if 2 or more values are met or exceeded:

Fasting 105mg/dl 1 hr 190mg/dl 2 hr 165mg/dl 3 hr 145mg/dl

Page 8: Hypoglycemia and hyperglycemia in the pregnanat patient

HYPOGLYCEMIA IN PREGNACYBlood glucose: < 60mg/dlCauses: excess insulin, insufficient food, excessive exercise or

work, vomiting or diarrhea.

Page 9: Hypoglycemia and hyperglycemia in the pregnanat patient

SIGNS & SYMPTOMS OF HYPOGLYCEMIA

Irritability

Hunger

Sweating

Nervousness

Dizziness

Weakness

Fatigue

Headache

Page 10: Hypoglycemia and hyperglycemia in the pregnanat patient

MANAGEMENT OF HYPOGLYCEMIACheck blood sugar when symptoms first appear (fingerstick)Eat 10-15 grams of simple carbsRecheck blood glucose 15 minutes after intakeNotify healthcare provider if blood glucose remains lowIf patient is unconscious call 911If in hospital administer 50% dextrose or glucagon as ordered. Recheck blood sugar, send urine/blood to lab

Page 11: Hypoglycemia and hyperglycemia in the pregnanat patient

HYPERGLYCEMIA IN PREGNACYBlood glucose > 200 mg/dl

Causes: Insufficient insulin, excess or wrong kinds of food, infection, illness, injuries, emotional stress or insufficient exercise

Page 12: Hypoglycemia and hyperglycemia in the pregnanat patient

SIGN & SYMPTOMS OF HYPERGLYCEMIA

Thirst

Nausea/Vomiting

Abdominal pain

Constipation

Drowsiness

Dim vision

Increased urination

Fruity breath

Rapid, weak pulse

Rapid breathing

Page 13: Hypoglycemia and hyperglycemia in the pregnanat patient

MANAGEMENT OF HYPERGLYCEMIANotify healthcare providerAdminister insulin in

accordance with blood glucose level (sliding scale)

Give IV fluids (NS or 0.45 NS)

Monitor blood & urine laboratory testing

Page 14: Hypoglycemia and hyperglycemia in the pregnanat patient

MANAGEMENT OF DIABETES IN PREGNACY

Diet2000-2500 daily, less if overweight or morbidly obeseExerciseActive women are encouraged to continue physical activity,

sedentary are encouraged to get active. Walking is recommended

Monitoring of blood glucose levelsFindersticks are done at home. Usually done upon waking

(fasting) and after meals (postprandial)Insulin therapy: done on a individual basis to maintain normal

blood glucose levelsClose monitoring of fetus after 40 weeks until delivery

Page 15: Hypoglycemia and hyperglycemia in the pregnanat patient

COMPLICATIONS OF DIABETES IN PREGNACY

Congenital malformationsMacrosomia: infant weight

of 4,000-4,500 gramsIntrauterine growth

retardation (IUGR)StillbirthRespiratory Distress

Syndrome (RDS)

Spontaneous abortion in early pregnancy

Shoulder DystociaPregnancy induced

hypertension (PIH)Infections (UTI’s, yeast

infection)Ketoacidosis

Page 16: Hypoglycemia and hyperglycemia in the pregnanat patient

PREVENTIONSeek counseling before getting pregnancyMaintain a healthy weightExercise regularlyEat healthy and balanced mealsSeek prenatal care early in pregnancyKeep all prenatal appointmentsFollow regime prescribed by physician

Page 17: Hypoglycemia and hyperglycemia in the pregnanat patient

REFERENCESCDC.GOV (2009). Information on gestational diabetes.

Retrieved July 9, 2009, from: http://diabetes.niddk.nih.gov/dm/pubs/gestational/

Lowdermilk, D., Perry, S., & Bobak, I. (1999). Maternity Nursing (5th. Ed). St. Louis: Mosby.

Page 18: Hypoglycemia and hyperglycemia in the pregnanat patient

CASE STUDYMaria, a 40 y/o G4P3 at 29 weeks present to Labor &

Delivery with c/o dizziness, headache, nausea and vomiting for 3 days. After interviewing Maria, you note that she has not had any prenatal care, has a h/o diabetes Her past obstetrical history includes delivery of a 4500 gram male complicated by shoulder dystocia. She weighs 312 pound. Her Bp 129/83, HR 82, RR 26 and Temp 98.8. A UA shows 3+ glucose, and negative ketones. Her accucheck is 179mg/dl.

Page 19: Hypoglycemia and hyperglycemia in the pregnanat patient

CASE STUDY DISCISSION

Questions 1. What tests, if any, should be done to evaluate the Maria’s glucose

tolerance? 2. How is the diagnosis of gestational diabetes mellitus (GDM) established?

3. What would be the best treatment and follow-up strategy for Maria?Discussion

This patient has several risk factors for GDM. She is over the age of 30, has a history of GDM and is obese. All these place her at a greater risk for developing GDM. She needs to be referred to a dietician or diabetic counselor. She needs to continue prenatal care and started on insulin therapy. Maria should be followed closely for the remainder of the pregnancy. Birthing options (vaginal vs caesarean section) should be discussed with the patient. Maria should also be followed closely after delivering to assess for the development of Type II diabetes.