Gestational Diabetes Case Study

Afton is a 31yo, primigravida, who is currently 23 weeks 6 days. She has type 2 diabetes but her A1C coming into pregnancy was just under 6. A recent A1C in June was 6.1. She is currently on insulin with Levemir and NovoLog. She also has chronic HTN and takes labetalol. She is on a baby aspirin for preeclampsia prevention. She has been following in our perinatal diabetes program and we have made some adjustments. Because of her type 2 diabetes she is here today for a fetal ECHO.

In 2014, diabetes was responsible for 4.9 million deaths, approximately one death every seven seconds (Bone, 2015). For some women, pregnancy can precipitate diabetes causing numerous subsequent lifelong complications for both the mother and her fetus/newborn. The previous shocking statistic is just one of the many reasons why implementing evidence-based practice (EBP) protocols is an essential aspect in providing great patient care. In addition, EBP is crucial in improving patient outcomes while decreasing negative outcomes that can result in lifelong complications due to gestational diabetes. The process of establishing an EBP requires research to be critically appraised before it could be used

Along with all the worries and complications a woman might face while pregnant, one of the more serious conditions is gestational diabetes. Gestational diabetes occurs in 4% of all pregnancies (Seibel, 2009). Many women are not informed about the disease, some may not know that they need to be tested, and others may have heard about it, but want more information on what may cause it and/or how to prevent and treat it. Either way this disease needs to be taken seriously by every pregnant woman or woman planning to get pregnant to protect not only herself but the unborn child.

Amanda manages her gestational diabetes with diet. She experiences a few episodes of postprandial hyperglycemia, but does not have to go on insulin. At her 36-week

The researchers identified gaps in knowledge from the various reviews (Polit & Beck, 2010, p.185). They acknowledge that although there is an abundance of literature documenting outcome data related to management of diabetes in pregnant woman, there are few qualitative studies that explore issues of reproductive health and diabetes from the viewpoint of the woman. They highlighted a Swedish study of women's perspective and pointed out its limitations. These gaps supported the need for further study.

Diabetes mellitus is becoming an increasingly prevalent chronic disease which affects not only the sufferer, but also affects their family, society and numerous healthcare disciplines. According to the International Diabetes Federation (2013), an astounding 382 million people worldwide are living with diabetes. There are several different sub-types of this disease which include: Type 1 (T1DM), Type 2 (T2DM) and Gestational diabetes mellitus. Within Australia, an enormous 85.3% of the population living with this disease are suffering from T2DM (Australian Bureau of Statistics, 2012). These statistics highlight the severity of T2DM as it is rapidly becoming the type of greater concern, especially since this “adult-onset” disease is becoming

Type II diabetes mellitus (DM), also referred to as non-insulin dependent diabetes, is a relative, rather than absolute, deficiency of insulin (ADA, 2004). It is global problem and has been identified as one of the “most challenging contemporary threats to public health” (Schauer et al., 2012). One is at risk for developing type II diabetes if they are overweight, over the age of 45, have a relative with type II diabetes, are sedentary, gave birth to a baby over 9 pounds, or had gestational diabetes (Center for Disease Control and Prevention [CDC], 2016).

Diabetes is a disease that causes the human body to not create or not use insulin effectively. The body needs insulin to take the energy or sugars and turn it into energy. The human body needs energy to survive. Diabetes can be broken into three main categories. Type 1 diabetes is where the body makes no insulin at all. Type 2 diabetes is where the body does not produce enough insulin or it does not use it correctly. Gestational diabetes is more of a type 2 diabetes for pregnant women, which usually returns to normal after birth (Ruder 7-8).

Gestational diabetes mellitus (GDM) is an intolerance of glucose documented for the first time during pregnancy. It is usually a short-term type of diabetes and the most common health problem with pregnant women. GBM is caused by the way the hormones in pregnancy affect the mother. GDM accounts for 5-7% of all pregnancies (American Diabetes Association, 2010). During pregnancy the placenta develops and becomes the main bond between the mother and the baby. It is used to make sure the baby has and gets enough nutrients. The placenta makes several hormones which make it hard for insulin to control blood glucose and block the action of the mother’s insulin in her body (American Diabetes Association, 2010). Hormonal changes during the

Gestational diabetes is a disease that affects pregnant women it’s a glucose intolerance that is started or diagnosed during pregnancy. Based on recently announced diagnostic criteria for gestational diabetes, according to the American Diabetes Association, it is estimated that gestational diabetes affects 18% of pregnancies. Pregnancy hormones can block insulin therefore causing the glucose levels to increase in a pregnant woman’s blood. Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy (American Diabetes Association). Without enough insulin, glucose cannot leave the blood and be changed to

JB was terrified during the interview because she also had a history of gestation diabetes with her last son and was not eating as nutritionous as she wanted to and did not exercise regularly despite having available resources. This author can understand her fear for developing diabetes as the literature indicates that it is the sixth leading cause of death and is cited as a global epidemic (Castro et al. 2008). The author also understand her risk for developing type 2 diabetes, like many of her maternal relatives, because it is closely linked to obesity and sedentary lifestyle which are factors the patient has at this time (Shulze & Hu 2005). This author will not just solely focus on her risk factors but on promoting her prevention of diabetes and well being in the future through the development of a

Between 5.5 and 8.8% of pregnant women develop GDM in Australia. Risk factors for GDM include a family history of diabetes, increasing maternal age, obesity and being a member of a community or ethnic group with a high risk of developing type 2 diabetes. While the carbohydrate intolerance usually returns to normal after the birth, the mother has a significant risk of developing permanent diabetes while the baby is more likely to develop obesity and impaired glucose tolerance and/or diabetes later in life. Self-care and dietary changes are essential in treatment.

Education about diet, exercise, glucose monitoring, and insulin adjustments are important for self-managing diabetes during pregnancy (Gilbert, 2011). Even though there is a common understanding that there is an increased need of antenatal care for women with GDM, there is still uncertainty about how often blood glucose should be monitored, the recommended diet, and the amount of exercise required (González-Quintero, 2008). GDM patients should acquire knowledge and skills regarding self- regulation, in order to better prepare and monitor their dietary intake, exercise and blood glucose levels (Limruangrong, 2011). Although GDM does decrease after pregnancy, over half of women with GDM will acquire Type 2 diabetes (Bone,

Many women are diagnosed with gestational diabetes mellitus during pregnancy. “Pregnancy complicated with GDM is accompanied by risks of adverse maternal and fetal outcomes including preeclampsia, cesarean delivery, excessive fetal growth, and shoulder dystocia” (Harrison et al., 2016, p. 351). Because of these risks these women need to be followed closely and counseled on how to achieve and maintain glycemic control. This is done by providing patient education, lifestyle modifications, glucose monitoring, and use of insulin or oral hypoglycemic agents when indicated (Harrison et al., p. 351). All of this can lead to an increase in office visits for these individuals. In a

“Within a 10 year period. 40-60% of women with GDM develop type 2 diabetes mellitus (T2DM), and many others develop it later in life.” (A.Lindmark, B. Smide, J. Leksell, 2010, p. #16). Although this percentage is high, it has been shown through research that the development of T2DM can be prevented or delayed. Pregnant women in Sweden are given an oral glucose tolerance test if they are found to have high glucose levels, they are then referred to a specialist maternity clinic. At the clinic they received information from multiple sources; midwife, dietitian and physician. Lindmark et al. stated that these healthcare providers instructed the women to change their diet and reduce sugar intake. After, “all the women