DIABETES MELLITUS

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 An endocrine disorder in which the
pancreas cannot produce adeqaute
insulin to regulate body glucose levels.
 Pregnancy places demands on
carbohydrate metabolism and causes
insulin requirements to change:
a. First trimester – decrease
b. 2nd trimester – increase
c. After placental delivery- decrease

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 Not a good candidate for oral
contraceptive
 Not a candidate for using IUD

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Classifications of Diabetes
Mellitus
Type Description
Type 1 •Formerly known as insulin
dependent diabetes mellitus
•A state characterized by te
destruction of the beta cells in the
pancreas that usually leads to
absolute insulin dependency

Type 2 •Formerly known as non-insulin

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Types Description
3. Gestational Diabetes A condition of abnormal glucose
metabolism that arises during
Risk Factors: pregnancy ( 24th-28th weeks)
- obesity
-Age over 25 years
-Hx of large babies ( 10 lb or more)
-Hx of unexplained fetal or
perinatal loss
-Hx of congenital anomalies in
previous pregnancies
-Hx of polycystic ovary syndrome
-Family hx of diabetes
-Member of a population with a
high-risl for diabetes

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Types Description
Impaired Glucose Homeostasis A state between normal and
diabetes in which the body is no
longer using and secreting insulin
properly.
A.Impaired fasting glucose – a
state when fasting plasma glucose
is at least 110 but under 126mg/dl
B.Impaired glucose tolerance – a
state when the results of the oral
glucose tolerance test are at leasr
140 but under 200mg/dl in the 2
hour sample

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Clinical presentation
 Polyuria
 Polydipsia
 Polyphagia
 pruritus
 Weight loss
 Frequent UTI
 Large fetus

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Complications
Maternal Fetal
PIH Macrosomia
Infection Congenital anomalies
Polyhydramnios Stillbirth
Spontaneous abortion Spontaneous miscarriage

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Diagnostic test
1.Oral glucose challenge test

a.50 g glucose challenge test

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Oral Glucose Tolerance test
 100 g Glucose tolerance test
- Done at 32- 34 weeks
- If the serum glucose level at 1 hour is more
than 140mg/dl, the woman is scheduled for
a 100 g, 3 hour fasting glucose tolerance
test
- If 2 of the 4 blood samples collected for this
test are abnormal or if the fasting value is
above 95mg/dl diabetes is present

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Oral glucose challenge test values
( fasting plasma glucose values)
for pregnancy
Test type Pregnant glucose level (mg/dl)
by carpenter and coustan
Fasting 95
1 hour 180
2 hours 155
3 hour 140

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2. Serum alpha-fetoprotein level
3. UTZ
4. Creatinine clearance test each
trimester (NV= 0.8 – 1.4 mg/dl)
5. NST
6. Recording for fetal movements
7. Lecithin/ sphyngomyelin ratio at week
36
8. Biophysical profile

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9. Glycosylated hemoglobin- used to
detect degree of hyperglycemia
- Reflects the average blood glucose
levels over the past 4-6 weeks ( the time
the RBC were picking up glucose)
HB1Ac
10. Opthalmic examination
11. Urine culture for UTI

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Therapeutic management
1. Insulin
- Short acting insulin ( regular) combined
with an intermediate type
- 2/3 is given in the morning
- 1/3 is given in the evening
- Self administered 30 min in a ratio of
2:1 ( intermediate to regular ) and again
just before dinner in a ratio of 1:1

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 Oral hypoglycemic NOT
RECOMMENDED for pregnant because
they cross the placenta and potentially
teratogenic to fetus.
 Route: Subcutaneously
 Regular insulin ( clear)
 If mixing insulin: draw clear (regular) hen
cloudy ( intermediate)
 Site: 2 inches from belly button

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2. Blood glucose monitoring
- Fingerstick technique – use of glucose
meter
- FBS= below 95-100 mg/dl
- 2 hr postprandial level below 120 mg/dl

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3. Insulin pump therapy
- An automatic pump about the size
ofmp3 player
- A syrnge of regular insulin is placed in te
pump chamber ans a small gauge
needle is attached to a lngth of thin
polyethylene tubing and implanted into
the subcutaneous tissue of a woman’s
thigh or abdomen

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Nursing care management
1. Complete patient database and
document test results during pregnancy
2. Educate both patient and her family
regarding:
a. Nutrition
- 1800-2400 calorie diet divided into 3
meals and 3 snacks
- Rduced amount of saturated fats and
cholesterol, increased dietary fiber

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- 20% CHON, 40-50% CHO, 30% fat
- IV supplementation for those who
cannot eat due to N/V
- Final snack of the day one of CHON and
complex carbohydrate to allow slow
digestion during the night
- Weight gain at 25-30 lb

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b. Exercise
- Lowers serum glucose and the need for
insulin
- May cause hypoglycemia- insulin is
released quickly
- Extreme exercise will cause
hypoglycemia and ketoacidosis

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3. Explain the importance of continued
evaluation even during postpartum and
even when blood glucose levels are
normal.
4. Encourage regular exercise (
3-4xx/week; duration: 15-30 minutes;
HR maintains between 130-180 bpm
5. Ensure patient’s preparation for
intensive and regular intrapartum
assessment

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6. Advise contraception in diabetic woman
7. Monitor BP and lipid levels
8. Woman who is type 1 or 2 should meet
with her OB before she becomes
pregnant

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Signs and symptoms of
hypoglycemia and hyperglycemia
Hypoglycemia-common in the Hyperglycemia- common in the
2nd and 3rd month 6th month
Sweating fatigue
Pallor, cold clammy skin Flushed , hot skin
Disorientation, irritability Dry mouth, excessive thirst
Headache Frequent urination
Hunger Rapid, deep breathing, fruity
breath odor
Blurred vision Depressed reflexes
Nervousness Drowsiness, headache
Shallow breathing but normal PR
Urine (-) for glucose and ketones
Blood glucose level <60mg/dl
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