GESTATIONAL DIABETES MELLITUS CASE STUDY

I. Introduction

Gestational diabetes mellitus (GDM), also known as type III diabetes mellitus, is one of
the most common types of diabetes mellitus and considered the most common complication of
pregnancy. This health problem is like pregnancy-induced hypertension (PIH) that develops
during pregnancy and disappears after the delivery of the fetus, or as the maternal body
returns to its pre-pregnant state. Gestational diabetes mellitus may or may not with co-existing
maternal diabetes. It heightens the level of diabetes (if with previous diabetes) by a notch in
response to the rise in fetal carbohydrate demand. In true GDM, glucose usually returns to
normal by six weeks postpartum, although women with GDM have an increased risk of
developing type 2 diabetes mellitus later in life. The primary concern for any woman with this
disorder is controlling the balance between insulin and blood glucose levels to
prevent hyperglycemia or hypoglycemia. Women with gestational diabetes are at an increased
risk of complications during pregnancy and delivery. 40% of pregnant mothers who develop
GDM will eventually develop non-insulin-dependent diabetes mellitus (NIDDM or type II DM)
within 5 years.

II. Patient’s Profile

Laboratory #: 0002543761

Hospital Unit Case Number: 1053744

Name: Nagtalon, Jean Piano

Age/Sex: 28Y 7M 20D

Address: Bakakeng Central, Baguio City

Birthdate: June 10, 1994

Birthplace: Baguio City

Civil Status: Married

Nationality: Filipino

Occupation: Housewife

Religion: Methodist

Date and Time of Admission: January 30, 2023

Admitting Diagnosis: G4P1 (0121) Pregnancy Uterine 11 6/7 weeks Age of Gestation
by Early Ultrasound, Overt Diabetes Mellitus, Obese, Insulin Requiring, Previous
Caesarean Section 1x for Pre-eclampsia with severe features, uncontrolled (2018
BGHMC) Obese I; Poor OB History for 2 consecutive abortions and 1 Preterm Birth.
 III. Physical Assessment (13 Areas of Assessment)

1. Social Status

Mrs. J is 28-year-old, born on June 10, 1994. She resides at Bakakeng Centra,
Baguio City together with her husband and in-laws. Her husband is a
construction worker for 5 years and is currently working at Baguio City. They have one
daughter and is expecting for their second baby. Mrs. J. stated that she does not
smoke and drink alcohol.

2. Mental Status

She is responsive in verbal stimuli. Mrs. J. was seen awake, and not in any form
of distress. She is conversant, coherent, and responds appropriately to verbal and
non-verbal stimuli. She is well-oriented t time, place, and person. She is
able to initiate activity without assistance. She is able to read and write
and can speak in English, Tagalog and Ilocano. She is responsive and answer
questions being asked.

3. Emotional Status

Mrs. J. is cooperative while performing the interview. She stated that she
does feel fear regarding her condition. She prayed that hopefully she will no
longer suffer from abortion just like what happened from her past
pregnancies.

4. Sensory Perception

The patient has mid farsightedness and able to clearly see objects that are
closer. Her hearing ability is normal. Her sense of smell is normal and she can
distinguish foul and fresh odor. Her lips are light brown in color. Her tongue
is slightly pink and she can taste whatever food she eats.

5. Motor Stability

The patient is able to stand still with her feet less than shoulder width apart.
She was able to walk with a smooth, coordinated gait. She doesn’t need
support when standing up and walking. She tries to perform things alone.

6. Body Temperature

The table below shows the temperature of Mrs. J. during the confinement.

10 am 2pm

Feb. 2, 2023 36.6 36.8

Feb. 3, 2023 36.9 36.7

Feb. 4, 2023 36.8 36.7

 7. Respiratory Status

Respirations were normal in pattern. Table below shows the respiratory

rate of the patient.

10 am 2 pm

Feb.2, 2023 18 20

Feb. 3, 2023 20 19

Feb. 4, 2023 17 20

8. Circulatory Status

The circulatory status of the patient as well as blood pressure noted

below.

10 am 2 pm

Feb. 2, 2023 72 84

Feb. 3, 2023 79 68

Feb. 4, 2023 85 92

Blood Pressure 10am 2pm

Feb. 2, 2023 120/80 120/80

Feb. 3, 2023 120/70 120/80

Feb. 4, 2023 120/70 120/90

9. Nutritional Status

Prior to admission, Mrs. J’s meal intake is two to three times a day. The food
served is usually vegetables, fish, and sometimes meat. She was advised
by the attending physician to avoid eating too much sugary food and increase
fluid intake.

10. Elimination Status

 Mrs. J usually defecates one to three times a day. On Feb. 2, 2023 from morning
until 2pm, she urinates four to six times and on the following day, she
urinated two times.

11. Reproductive Status

Mrs. J had her first menstrual period at age of 15. She got married at age 24. She
had her first pregnancy at age 24. Her siblings have 2-4 years age gap.

12. Sleep – Rest Pattern

She usually sleeps 7-8 hours a day. She usually watches television at home during
rest hours.

13. State of Skin Appendages

Mrs. J’s skin is brown in color, firm and moist. Her hair is thin, fine and black. She
has pink palpable conjunctive and sclera is white in color.

IV. Laboratory Findings and Interpretation

URINALYSIS

A urinalysis is a test of your urine. It's used to detect and manage a wide range of disorders,
such as urinary tract infections, kidney disease and diabetes. A urinalysis involves checking the
appearance, concentration and content of urine.

URINALYSIS CHEMICAL EXAMINATION

Physical Result Reference Physical Result Reference

Examination Range Examination Range

Color Yellow Transparency Slightly

(Clarity) Turbid

Chemical Result Reference Chemical Result Reference

Examination Range Examination Range

Specific 1.017 1.00- 1.005 Glucose Positive 3 Negative

Gravity

pH 6.5 5.0-6.5 Ketone Negative Negative

Leuko Positive 1 Negative Urobilinogen Normal Negative

Esterase

Urine Protein Positive 2 Negative Erythrocyte Trace Negative

 URINE SEDIMENT ANALYSIS BY AUTO PARTILE RECOGNITION

Sediment Result Reference Range Result Reference Range

Pus Cell 4 0-4 22 0-22

RBC 1 0-2 6 0-11

Yeast Cells 0 0-1 0 0-1

Bacteria 1 0-10 6 0-56

ABO BLOOD TYPING

This test is use to determine your blood group. Your blood sample is mixed with antibodies
against type A and B blood. Then, the sample is checked to see whether or not the blood cells
stick together. If blood cells stick together, it means the blood reacted with one of the
antibodies. It indicates whether the blood of two different people is compatible when mixed –
such as the blood of a mother and her baby at birth. If they have different blood group
characteristics, it may cause problems.

Test Name Result

ABO Blood Typing O

Rh Typing Positive

COMPLETE BLOOD COUNT

This test measures the different parts and features of your blood, including red blood cells,
white blood cells, and platelets. A CBC can help diagnose a variety of health problems, such as
anemia, clotting disorders, and infections.

Test Name Result Reference Range

Hemoglobin 158 120-160 g/L

Hematocrit 0.44 0.37-0.47 L/L

WBC Count 11.35 5.0-10.10

RBC Count 5.27 4.04- 5.48

 V. Anatomy and Physiology

Diabetes Mellitus primarily affects the Islets of Langerhans of the pancreas, where
glucagon (from the alpha cells) and insulin (from the beta cells) are produced. Glucagon
raises the blood glucose level, while insulin lowers it. 

 Type 1 DM  (Insulin Dependent) accounts for 5% to 10% of DM and is characterized by

autoimmune destruction of insulin-producing beta cells in the islets of the pancreas,
the loss of function of the beta cells leads to an absolute insulin deficiency. T1DM is
most commonly seen in children and adolescents though it can develop at any age.
 Type 2 DM (Non-insulin Dependent) accounts for around 90% of all cases of diabetes.
In T2DM, the response to insulin is diminished, and this is defined as insulin resistance.
As such, insulin is ineffective and is initially countered by an increase in insulin
production to maintain glucose homeostasis, but over time, insulin production
decreases, resulting in T2DM. T2DM is most commonly seen in persons older than 45
years. It is increasingly now seen in children, adolescents, and younger adults due to
rising levels of obesity, physical inactivity, and energy-dense diets.
 Gestational Diabetes  Mellitus (first detected during pregnancy) can occur anytime
during pregnancy. Generally, affects pregnant women during the second and third
trimesters. According to the American Diabetes Association (ADA), GDM complicates
7% of all pregnancies. Women with GDM and their offspring have an increased risk of
developing type 2 diabetes mellitus in the future .