Gestational diabetes: Nursing

Gestational diabetes also known as gestational diabetes, mellitus or GDM for short is glucose intolerance that occurs during pregnancy.

Whereas pregestational diabetes is diabetes that is present prior to pregnancy. All right.

So, hormones produced during pregnancy cause changes in maternal glucose metabolism to support the pregnancy and to allow the fetus to receive a steady supply of glucose necessary for fetal growth and development.

The early part of pregnancy can be described as an anabolic state which increases fat stores, augments blood supply and supports the growth of the fetus and maternal tissue like uterus placenta and breast tissue.

During this time, insulin secretion increases along with glucose utilization and storage in adipose and muscle cells. Later as the pregnancy progresses, it begins to exert a diabetic genic effect on glucose metabolism, which means that there's increasing maternal insulin resistance and decreased utilization of glucose.

This results in higher levels of maternal blood glucose and increased transfer of glucose to the fetus during this time.

GDM can develop when maternal insulin production is unable to compensate for the increased insulin resistance resulting in hyperglycemia.

GDM is more likely to affect those who have risk factors for diabetes mellitus including obesity, a family history of diabetes and advanced maternal age like all types of diabetes.

Mellitus, clinical manifestations of GDM include polyuria or increased urine production, polydipsia or increased thirst and polyphagia or increased hunger.

If left untreated gestational diabetes can lead to complications. For example, excessive fetal nutrient intake can lead to macrosomia or large birth weight and result in the need for cesarean birth.

Screening for GDM occurs between 24 and 28 weeks of gestation by measuring fasting blood glucose levels during an oral glucose tolerance test or OGTT.

The patient is given an oral glucose drink and their blood glucose is measured at timed intervals. GDM is diagnosed if their blood glucose levels are higher than the defined range.

Treatment is focused on lifestyle modifications to manage blood glucose levels including regular physical activity as tolerated and diet changes which include a balance of carbohydrate protein and fat intake.

If blood glucose levels aren't stabilized with lifestyle modifications, subcutaneous insulin or oral antidiabetic therapy will be needed when caring for a patient with gestational diabetes.

Your goal of care is promoting self management of blood glucose levels. Begin by consulting with a registered dietitian for dietary recommendations to meet your patient's caloric and nutritional needs.

Teach your patient to avoid foods high in sugar, to spread consumption of carbohydrates throughout the day and to eat balanced nutrient dense meals.

Next, teach them how and when to check their blood glucose as prescribed. Be sure to remind them to put their results along with their daily food intake in a logbook to show their health care provider.

If your patient is prescribed insulin, show them how to draw up their insulin and the location of preferred injection sites.

Be sure to review the symptoms of hypoglycemia, including fatigue, hunger, dizziness, tremors and confusion. If these occur, advise them to check their blood glucose level and then consume oral glucose tablets or juice and 15 minutes later recheck their blood glucose.

If their blood glucose level doesn't increase, advise them to go to the emergency department. Finally remind your patient to keep all follow up prenatal care appointments, advise them to contact their health care provider if they're unable to maintain their blood glucose in the target range or if they become sick because this might require changes to their medication regimen.

All right. As a quick recap gestational diabetes or GDM is glucose intolerance that occurs during pregnancy.

GDM develops when pregnancy exerts a diabetogenic effect on maternal glucose metabolism resulting in increasing maternal insulin resistance and decreased utilization of glucose.

GDM is diagnosed with an oral glucose tolerance test during the second trimester. Treatment in nursing care is focused on lifestyle modifications to manage blood glucose levels.