Discharge planning for inpatients with diabetes should begin at the time of admission to

ensure a smooth, safe and well documented transition from hospital to discharge
destination.
>>>>>>>>>>>.
Medication
Instruct in detail to take the medications as directed by the physician and to follow what
has been prescribed
R: Taking your medicine as prescribed or medication adherence is important for
controlling chronic conditions, treating temporary conditions, and overall longterm health
and well-being. Thus, taking medicines that are not prescribed by the physician could
lead to getting worse of the disease, hospitalization, even death. And one of the
important part of medication adherence is by having a personal connection between
your health-care provider. Also encourage them to take their medications religiously and
should not stop taking or change their medications unless they first talk with their doctor.

Encourage to prepare a written form consisting of reminders to ensure that the patient
takes the right medication and the right frequency

R: To ensure compliance of the medications Having lists aid clients in remembering

medications and when to take them for proper guidance.

Educate not to decrease their medication dosage to save money.

R: Taking medicine as directed and the full amount of the medicine will help to get the
full benefits.That is why there is a need to emphasize to the patient the importance on
talking with their doctor about the ways that can reduce the costs on their medications.
Generic and brand-name drugs have the same active ingredients. Meaning, they will
have the same efficacy for treating your condition. The main difference is the cost to
you.
So, Brand-name drugs tend to be more expensive because of the lengthy drug
development process. Manufacturers charge more to recoup costs. When a patent
expires, other manufacturers can produce the medication, and competition drives the
price down

>>>>>>>>>>>>
Next is the Exercise, wherein it helps manage Gestational Diabetes by increasing the
number of doors available for the insulin keys to fit in. This subsequently increases the
amount of sugar which can be burned by cells. Exercise also helps reduce blood sugar
levels through the additional energy expended during the exercise and in the hours after
exercise which further assists in reducing blood sugar levels.
Exercise
Educate to get physical activity as directed.
R: Physical activity, such as exercise, can help keep the blood sugar within the
recommended levels. Physical activity can also keep the weight in a healthy range
during pregnancy. That’s why it is important to talk to your healthcare provider about the
type and amount of physical activity that is best for you.

The U.S. Department of Health and Human Services recommends at a minimum for
healthy pregnant and postpartum women
Encourage to do a 150 minutes per week of moderate-intensity aerobic activity
Options include:
 Brisk walking
 Swimming, and cycling
 Light weights training
 Body weight exercises
 Pilates
 Daily pelvic floor strengthening exercises Are also importantn inclusion for all
pregnant woman
R: Moderate physical activity is an important part of a healthy pregnancy. It helps the
insulin in the body work better. Thus, it can be an effective way to help control blood
sugar levels.

Things to consider:
 Always check with your obstetrician or midwife prior to beginning a new exercise
program
 Always seek guidance from an Accredited Exercise Physiologist for exercise
prescription
 Speak to your obstetrician, midwife or diabetes educator for guidance on
exercise timing if you are taking insulin medications.
>>>>>>>>>>>>
Treatment

 Educate the “15-15 Rule” commonly used as a guideline for hypoglycemia

treatment because Many medical professionals recommend following the 15-15
rule when your blood sugar is between 55 to 69 mg/dL.

 Check glucose level with meter to determine if blood glucose is below 70 mg/dL.
 Eat or drink 15 g of simple, concentrated carbohydrates. Examples include:
o Glucose tablets (follow instructions)
o 4 ounces (1/2 cup juice or regular soda)
o 1 tablespoon of sugar, honey, or corn syrup
o Hard candies, jellybeans, or gumdrops (check label)
 Wait 15 minutes.
 Check blood glucose again.
 Consume an additional 15 g carbohydrate if blood glucose is still below 70
mg/dL.
 Repeat these steps until your blood sugar is at least 70 mg/dL.
 Follow up with a light snack or meal once glucose is stable.
 Mild to moderate hypoglycemia can usually be reversed rapidly (within 5-10
minutes).
 Avoid foods high in fat because they slow the absorption of carbohydrates.
 Remind to make a note about episodes of hypoglycemia and to discuss with their
health care provider why it happened and ways to prevent it.

R: Hypoglycemia is a true medical emergency which requires prompt recognition and

treatment to prevent organ and brain damage. The spectrum of symptoms depends
on duration and severity of hypoglycemia and varied from autonomic activation to
behavioral changes to altered cognitive function to seizures or coma

Discuss the dangers of not complying with the treatment regimen

R: To let the patient and significant others know about the possible harmful or negative
side effects of not following the treatment regimen

>>>>>>>>>>>>
Now for the hygiene, well during pregnancy, women should be especially careful about
their personal hygiene. Pregnant women sweat more and have more vaginal discharge
than non-pregnant women (due to hormonal changes), and they may be more
vulnerable to infection by germs in the environment. Keeping the body clean helps
prevent infection.
So here are the 4 Steps to Total Diabetes Body Care

The feet, skin, eyes, and teeth and gums need special attention if you have diabetes.
Here are steps to take to care for these parts of the body:

Hygiene

Common foot problems can cause many complications, including athlete's foot, fungal
infections in nails, calluses, corns, blisters, bunions, dry skin, sores, hammertoes,
ingrown toenails, and plantar warts.

Educate to make time for foot care daily. Such as:

 Wash, dry and examine the tops and bottoms of your feet.
 Check for cracked skin, cuts, scratches, wounds, blisters, redness, calluses, and
other changes.
 Use antibiotic creams recommended by the doctor and apply sterile bandages to
protect cuts.
 Prevent ingrown toenails by cutting toenails straight across; don't cut corners.
 Don't go barefoot and always protect your feet. And make sure you wear properly
fitting footwear.

If you develop even minor foot problems, treat them right away or see a doctor. And see
a foot doctor (podiatrist) every two or three months.

R: Diabetes can reduce blood circulation and damage the nerves to the feet so
checking your feet daily means you can catch small things and get them treated before
they become serious. Make it part of your daily morning routine -- it doesn't take long.

Encourage to have Skin Care

Bacterial infections, fungal infections, and itching are common skin problems anyone
can develop, but they're especially problematic for people with diabetes because of poor
blood flow and because the body may not be fighting infection well.
  Bacterial infections like boils (hair follicle infections) require antibiotic treatment.

 Boost your body's ability to fight infection, and help prevent dry skin, by
controlling you blood sugar. Use talcum powder in areas prone to infections and
use moisturizing lotions and soaps when needed. (Don't put lotions between
toes; extra moisture there can trigger fungus growth.)

R: Diabetes often causes extremely dry skin and this can lead to cuts and cracks, which
can let bacteria get inside and cause infections. Moisturizing is an easy way to prevent
this. Taking good care of the skin, can treat and prevent uncomfortable changes.

Encourage to practice good oral hygiene habits:

 brushing at least twice daily (or preferably after every meal) with a toothpaste
that contains fluoride and flossing daily

Most people develop gum problems during their lives but, if you have diabetes, your
risks are higher for serious gum disease -- and for getting it at an earlier age.

R: Good oral health habits can help prevent pain and infections from tooth and gum
disease. Because with diabetes, the body is more vulnerable to bacteria and infection.
High blood sugar levels can make gum disease worse, resulting in bleeding, tender
gums, and gums that pull away from teeth. In time, you may need gum surgery to save
your teeth, so taking care of your teeth is even more important. High blood sugar can
weaken white blood cells. These are your body's main way to fight infections that can
occur in the mouth
>>>>>>>>>>>>
Out-Patient

Instruct the patient to comply with the scheduled follow up Diabetes screening after 4 to
12 weeks they give birth:

R: Screening is used to check if they have developed diabetes, problems with fasting
glucose levels, or glucose intolerance. And may also need to have tests for diabetes
every 1 to 3 years for life. You may need other tests or treatment if you have any of
these. Testing may be repeated every 1 to 3 years if you had GDM but normal tests
within 12 weeks of giving birth.

Advice client about the importance of talking with their primary health carer such as their
midwife and diabetes educator about maternal and/or neonatal outcomes
R: The primary health carer can provide support by encouraging patients to talk
about their concerns and fears and can help them learn what they can control and
offer ways for them to cope with what they cannot.
>>>>>>>>>>>>
A gestational diabetes diet is a meal plan that helps control your blood sugar levels
throughout your pregnancy. Too much carbohydrate in one meal or snack can cause
your blood sugar to rise to a very high level. High blood sugar levels throughout your
pregnancy can cause your baby to gain too much weight and lead to other health
problems. A healthy meal plan will help you keep your blood sugar within the
recommended range.
The first step in treating gestational diabetes is to modify your diet to help keep your
blood sugar level in the normal range. It's a good idea to meet with a registered dietitian
to develop a customized eating plan to help you manage your blood sugar.
Diet
 Follow your meal plan as directed:
R: Talk to a dietitian or healthcare provider about the best meal plan for you. He
or she may recommend that you eat 3 small meals and 2 to 4 snacks every day.
Control the amount of carbohydrates (such as bread, cereal, and fruit) you eat at
each meal and snack. Too much carbohydrate in 1 meal or snack can cause
your blood sugar to rise to a high level. Your dietitian or provider will tell you how
much carbohydrate to eat at each meal and snack. Eat foods that are a good
source of fiber, such as vegetables and legumes (beans and lentils).

Encourage to have the Diabetes Plate Method”

 Draw a line down the middle of the plate. Then, on one side, cut in half again,
giving you a total of three sections.
o Fill 1/2 the plate with non-starchy vegetables.
o Add carbohydrates (whole grains and starchy vegetables) to fill 1/4 the
plate.
o Add lean protein to the last 1/4 section of the plate.
 Choose water or a low-calorie drink.

R: It is a strategy to change portion size to larger amounts of non-starchy vegetables

and smaller portions of starchy foods. (American Diabetes Association, 2020)
“Carbohydrate Counting” (ADA, 2021b) is a technique that tracks carbohydrate intake
to keep blood glucose in the target range. Tools are available to assist with counting
carbohydrates. These are particularly helpful to track whole foods, fruits, grains, and
vegetables without nutritional labels.
  Spread carbohydrates throughout the day.

R: Just eat 3 small to medium meals and 2 to 4 snacks. It may need to eat a
snack in the evening to prevent low blood sugar during the night. Eat the same
amount of carbohydrate during meals and snacks each day.

 Eat fewer servings of carbohydrate at breakfast than at other meals.

R: The blood sugar level tends to be higher in the morning. Eat fewer servings of
carbohydrate to keep the blood sugar level from increasing even more.

 Do not skip meals or cut out carbohydrates to control your blood sugar
level.

R: Blood sugar can fall to a level that is too low to be safe.

Tell not to smoke:

R: Nicotine is dangerous for you and the baby and can make it harder to manage the
GDM. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you
quit. They still contain nicotine. Ask your healthcare provider for information if you
currently smoke and need help quitting.
XI. REVIEW OF RELATED LITERATURE

The life course perspective of gestational diabetes: An opportunity for the

prevention of diabetes and heart disease in women
Reference:
eClinicalMedicine. (2022). The life course perspective of gestational diabetes: An
opportunity for the prevention of diabetes and heart disease in women. Retrieved from
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00024-4/
fulltext#seccesectitle0001

GDM is usually described as glucose intolerance of various severity that initially

appears during pregnancy, is becoming more common, with maternal hyperglycemia
now impacting one out of every six pregnancies worldwide. It has traditionally been
defined as any degree of glucose intolerance that begins or manifests during
pregnancy, but it is now recognized that this definition fails to distinguish between
women who have pre-existing diabetes that was not diagnosed before pregnancy (i.e.
diabetes in pregnancy (DIP)) and those who have hyperglycemia detected on routine
antepartum testing (typically in the late second trimester) that does not mellitus.

Hence, GDM is a chronic cardiometabolic illness that identifies women who have
an increased lifetime risk of acquiring type 2 diabetes and cardiovascular disease. It is
often misunderstood as a medical consequence of pregnancy. The diagnosis of GDM
opens up the enticing option of early intervention and risk mitigation by identifying high-
risk women early in the natural history of these illnesses. However, a number of clinical
challenges/obstacles (discussed here) must be solved before such promise may be
realized in practice. Finally, by combining this GDM life course view with coordinated
efforts to overcome these barriers, this once-in-a-lifetime opportunity for the primary
prevention of diabetes and heart disease in women may be realized.

Moreover, human pregnancy is characterized by a steady loss in maternal insulin

sensitivity from mid-gestation onwards, which partly helps to promote nutritional supply
to the fetus, as stated in Immediate implications of GDM in pregnancy.
For glucose homeostasis to be maintained, the pancreatic beta-cells must boost their
insulin output in response to this insulin resistance in the later part of pregnancy.
Women with GDM have a chronic deficiency in beta-cell activity that usually first comes
to light in the form of maternal hyperglycemia, which occurs as a result of their inability
to properly adjust for the challenge given by late-pregnancy insulin resistance.

Furthermore, there is a number of patient characteristics have also been

discovered as predictors of postpartum follow-up adherence. Recent delivery
experience/newborn health issues, adjustment to new baby (e.g. lack of time, burden of
childcare, emotional stress), concerns about postpartum and future health (e.g. feeling
healthy and not in need of care, fear of receiving bad news), dissatisfaction with care,
and logistics of accessing care were all identified as barriers in a qualitative study by
Bennett et al. Patients were also shown to be more likely to receive screening if they
had GDM in a prior pregnancy, diagnosis of GDM at an earlier gestational age, older
maternal age, greater education and income, and lower parity in a systematic review by
Nielson et al.

Finally, several strategies have been investigated to address the low rates of
postpartum screening adherence among mothers who have just given birth to a baby
with GDM. Verbal and written counseling, postal reminders, phone calls, SMS
reminders, and sophisticated order sets embedded into electronic medical records are
all examples of interventions that have shown varied degrees of adherence
improvement after adoption. In practice, however, postpartum testing rates are still low.
Finally, before GDM's potential for primary prevention can be completely realized, the
problem of inadequate postpartum follow-up must be addressed.
The effect of exercise on the prevention of gestational diabetes in obese and
overweight pregnant women: a systematic review and meta-analysis

Reference:
Nasiri-Amiri, F. et. al. (2019). The effect of exercise on the prevention of gestational
diabetes in obese and overweight pregnant women: a systematic review and meta-
analysis. Retrieved from https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-
019-0470-6

Gestational diabetes mellitus (GDM) is one of the most common

complications of pregnancy, and its incidence is rising around the world as type
two diabetes becomes more prevalent. Some review articles that look at the
influence of exercise activities on preventing GDM, regardless of obesity, have
shown contradictory results. As a result, the goal of this study was to conduct a
systematic evaluation of articles on the influence of exercise activities on the
prevention of GDM in pregnant women who were obese or overweight.

A total of 5107 papers were found in various databases during the initial
search. After screening the titles and abstracts and removing duplicate and
unrelated titles, a total of 56 papers were chosen. The authors then read the
whole text of the publications and selected eight to analyze. The characteristics
of the papers that looked at the influence of exercise activities on the incidence of
GDM in overweight and obese women in comparison to a control group. In terms
of the type, style, and intensity of exercise, different studies differed. The total
number of pregnant women who took part in these trials was 1441. 727 women
were in the intervention group, while 714 were in the control group. All of the
women were fat or overweight in the first or second trimester of pregnancy, and
all of the pregnancies were singletons with no maternal chronic disease or fetal
anomalies. It's possible that these ladies were both nulliparous and multiparous.

Moreover, because of variances in the types of exercise and the use of a

mixture of diverse activities in some studies, the researchers of the current study
were unable to evaluate the effect of exercise type on the incidence of GDM.
Moreover, because the intensity of exercise in all of the articles in this study was
moderate, the researchers were unable to analyze the influence of different
intensities of exercise on the risk of getting GDM. Furthermore, the duration of
exercise varied between 15 and 50 minutes in various studies, and researchers
were unable to compare the exercise duration due to a lack of access to a
significant number of studies.

Exercise activities did not have a significant effect on the overall incidence
of GDM in obese or overweight pregnant women, but when the effect measure
was taken into account, the incidence of GDM was 24 percent lower in the
intervention group than in the control group. The disparity between the two
groups is significant. Hence. because most studies' responses to exercise were
based on limited evidence, and current research was essentially limited to the
responses of a hormone to a variety of types, intensities, or durations of
exercises, and no study was found that considered the various aspects of
exercise on other factors affecting gestational diabetes;

As a result, more research is needed to determine the effect of exercise on

GDM in pregnant women who are fat or overweight. Therefore, systematic review
literatures both indicate knowledge gaps on the research subject and pave the
way for future investigations, it appears that further randomized controlled trials
are needed to reach a complete conclusion on the kind, intensity, and duration of
exercise in the prevention of GDM.

Pregnancy, Gestational Diabetes, and COVID-19

Reference:
Ross, S. et al. (2021). Pregnancy, Gestational Diabetes, and COVID-19. Retrieved
from https://www.endocrineweb.com/conditions/gestational-diabetes/pregnancy-
gestational-diabetes-covid-19

Mothers-to-be, especially those with gestational diabetes, want to be aware of how

COVID-19 can affect pregnancy. Here are the potential risks—as well as the good
news.

A pregnant woman would probably feel more anxious during their pregnancy
while the novel Coronavirus, or COVID-19, makes its way around the world. You
might be wondering how COVID-19 affects pregnant women and, more
specifically, persons with gestational diabetes. If that's the case, you're not alone
in your worries.

Whether they have gestational diabetes or are a caregiver for or a family member
of someone who has it, they should be aware of the condition and how COVID-19
may affect it. Pregnant women are not inherently more likely to contract
Coronavirus, according to Sherry Ross, MD, OBGYN, but being pregnant in
general compromises the immune system. Ross argues that having gestational
diabetes adds still another layer to the situation, despite the fact that gestational
diabetes carries a lesser risk than diabetes before pregnancy. Pregnant women
are especially vulnerable to the Coronavirus, and gestational diabetes can
exacerbate symptoms.

During COVID-19, expectant mothers with gestational diabetes have a

bright future. During the COVID-19 epidemic, things appear to be looking up for
pregnant women with gestational diabetes, according to Dr. Roshan. "If patients
maintain normal blood glucose levels, they should be at the same risk as other
pregnant or non-pregnant patients," he explains.

First and foremost, make sure a pregnant woman should have insulin and
any other medications they might need, especially if they’re in quarantine.
According to Dr. Ross, this involves staying ahead of their prescription. However,
not every woman with gestational diabetes will require medication. Dr. Ross
recommends focusing on resting and exercising, both of which can assist
promote healthy glucose levels, in addition to taking any medication they may
require. If it means performing a YouTube exercise in their living room a few
times a week or going to bed with a good book, they should go for it.

Hence, food is important as well. According to Dr. Roshan, they should eat a low-
carbohydrate diet while monitoring their blood sugar levels. While under quarantine,
make sure that they have access to nutritious, veggie-based groceries. Wherein, they
should consider signing up for a healthy food subscription box or simply eating nutritious
foods when they go out. Blood sugar control is the first step in avoiding pregnancy
complications. Furthermore, consuming healthy foods will strengthen your immune
system, which is especially important during pandemics.

References:
eClinicalMedicine. (2022). The life course perspective of gestational diabetes: An
opportunity for the prevention of diabetes and heart disease in women. Retrieved from
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00024-4/
fulltext#seccesectitle0001

Nasiri-Amiri, F. et. al. (2019). The effect of exercise on the prevention of gestational
diabetes in obese and overweight pregnant women: a systematic review and meta-
analysis. Retrieved from https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-
019-0470-6

Ross, S. et al. (2021). Pregnancy, Gestational Diabetes, and COVID-19. Retrieved

from https://www.endocrineweb.com/conditions/gestational-diabetes/pregnancy-
gestational-diabetes-covid-19

Drugs.com (2022). Gestational diabetes. Retrieved from

https://www.drugs.com/cg/gestational-diabetes-discharge-care.html

https://www.nursingcenter.com/clinical-resources/nursing-pocket-cards/discharge-
planning-for-patients-with-diabetes-mell

Nursing Center. (2018). Discharge planning for patients with diabetes mellitus.
Retrieved from https://www.nursingcenter.com/clinical-resources/nursing-pocket-cards/
discharge-planning-for-patients-with-diabetes-mell
DAPP Guideline. () Diabetes and Pregnancy Program