GESTATIONAL DIABETES

I. Definition
- Gestational diabetes is a type of diabetes that develops during pregnancy, typically around the
second or third trimester, and is characterized by high blood sugar levels. It arises when the
body cannot produce or utilize enough insulin to meet the increased demands of pregnancy.
This condition poses risks to both the mother and the baby, but with proper management
through diet, exercise, and sometimes medication, most women can successfully control their
blood sugar levels and have a healthy pregnancy outcome.

- Pathophysiology of Gestational Diabetes

- Insulin Resistance: Pregnancy hormones like human placental lactogen (hPL), estrogen, and
progesterone increase insulin resistance, making cells less responsive to insulin.
- Increased Insulin Demand: As pregnancy progresses, the need for insulin rises. If the
pancreas cannot produce enough insulin, blood sugar levels increase.
- Placental Hormones: Hormones from the placenta (hPL, cortisol, growth hormone) increase
insulin resistance to ensure more glucose is available for the fetus.
- Genetic and Environmental Factors: Obesity, advanced maternal age, family history of
diabetes, and genetic predisposition can increase the risk of GDM.
- Beta-cell Dysfunction: Some women have pre-existing pancreatic beta-cell dysfunction,
exacerbated by pregnancy's increased insulin demand.

II. Risk Factors

 Overweight or Obesity: OBESITY or (BMI) over 25 are at higher risk.
- Straining Pancreatic Function: The pancreas struggles to produce enough insulin to
compensate. Also physical activity.
 History of Gestational Diabetes: Previous occurrences of gestational diabetes increase the
likelihood of recurrence.
 Family History: Having a close family member with type 2 diabetes increases the risk.
 Age: Women of 25, particularly those over 35, are at higher risk.
- Genetic factors contribute to insulin resistance and beta-cell dysfunction.
- Shared Lifestyle Factors: Families often share habits that influence diabetes risk, such as diet
and activity levels.
 Ethnicity: Certain ethnic groups, including African American, Hispanic, Native American,
South or East Asian, and Pacific Islander, have a higher predisposition.
 Polycystic Ovary Syndrome (PCOS): Women with PCOS are more likely to develop
gestational diabetes.
- Women with PCOS may already have elevated insulin resistance prior to pregnancy
 Previous Large Baby: Giving birth to a baby weighing over 9 pounds previously increases
the risk.
 - High maternal blood sugar levels can lead to increased fetal insulin production, contributing
to fetal overgrowth.
 Sedentary Lifestyle: Lack of regular physical activity contributes to the risk.
- Exercise helps regulate blood glucose levels. Inactivity disrupts this balance, raising the likelihood of
hyperglycemia
 High Blood Pressure: Having high blood pressure prior to pregnancy increases the
likelihood of gestational diabetes.
- hypertension promotes insulin resistance by impairing blood flow, inducing inflammation,
increasing oxidative stress, and contributing to dysfunctional adipose tissue, all of which
interfere with normal insulin signaling and glucose metabolism.

III. Signs and Symptoms

- Gestational diabetes often doesn't present noticeable symptoms, which is why routine
screening during pregnancy is crucial. However, in some cases, women may experience
the following signs and symptoms:

 Increased Thirst: Feeling unusually thirsty and drinking more fluids than usual.
 Frequent Urination: Needing to urinate more frequently than usual, especially at
night.
 Fatigue: Feeling unusually tired or lethargic, despite getting enough rest
- Insulin resistance harder for cells to absorb glucose. Eenergy spikes caused by
 Blurred Vision: Experiencing blurred vision or other changes in eyesight.
 Nausea and Vomiting: Some women may experience nausea and vomiting, similar to
morning sickness.
 Increased Hunger: Feeling hungry more frequently or experiencing intense hunger.
 Unexplained Weight Loss: Despite increased hunger and eating, experiencing
unexplained weight loss.
 increased thirst
 Excess sugar in the blood pulls water from tissues, making you thirsty. The kidneys
work harder to flush out excess sugar, leading to frequent urination.
 needing to pee more often than usual
 Elevated blood sugar levels cause the kidneys to work harder to filter excess glucose,
leading to increased urine production
 a dry mouth
 Dehydration resulting from frequent urination leads to a dry mouth
 tiredness
 Cells aren't getting enough glucose for energy, leading to fatigue
 blurred eyesight
 High blood sugar can affect the lenses in your eyes, causing blurry vision.
 genital itching or thrush
 Yeast infections (thrush) thrive in sugary environments, which can occur with GDM.
IV. Diagnostic
• Glucose Challenge Test
In this test, a health care professional will draw your blood 1 hour after you drink a sweet liquid
containing glucose. You do not need to fast for this test. Fasting means having nothing to eat or drink
except water. If your blood glucose is too high—140 or more—you may need to return for an oral glucose
tolerance test while fasting. If your blood glucose is 200 or more, you may have type 2 diabetes.
• Oral Glucose Tolerance Test (OGTT)
The OGTT measures blood glucose after you fast for at least 8 hours. First, a health care professional will
draw your blood. Then you will drink the liquid containing glucose. You will need your blood drawn
every hour for 2 to 3 hours for a doctor to diagnose gestational diabetes.
High blood glucose levels at any two or more blood test times— fasting, 1 hour, 2 hours, or 3 hours—
mean you have gestational diabetes. Your health care team will explain what your OGTT results mean.
Your health care professional may recommend an OGTT without first having the glucose challenge test.

 Before a meal (fasting): 95 milligrams per deciliter (mg/dL) or less.

 One hour after a meal: 140 mg/dL or less.
 Two hours after a meal: 120 mg/dL or less.
 V. Management – Surgical/Medical/Nursing

Medical Management

 Blood Sugar Monitoring

 Dietary Modifications: focuses on healthy eating with portion control. It emphasizes fruits,
vegetables, and whole grains for sustained energy. Lean protein sources like fish, chicken, and
beans are also important. You'll want to limit unhealthy fats, sugary drinks, and processed
foods. This approach helps manage blood sugar levels.
 Physical Activity: Regular exercise to improve insulin sensitivity.
 Medication: Insulin therapy if blood glucose levels cannot be controlled with diet and exercise
alone. Oral hypoglycemic agents like metformin may also be used.
 Monitoring for Complications: Regular check-ups to monitor the health of the mother and fetus,
including ultrasounds and non-stress tests.

Surgical Management

 Cesarean Section (C-Section): May be recommended if the baby is very large (macrosomia) or if
there are other obstetric complications.

Nursing Management

 Education: Educating the patient about GDM, its implications, and the importance of blood
sugar control.
 Support for Lifestyle Changes: Assisting with dietary planning and encouraging regular physical
activity.
 Monitoring and Documentation: Regularly monitoring blood glucose levels, fetal growth, and
maternal well-being. Keeping detailed records to adjust care plans as needed.
 Administering Medications: Ensuring timely administration of insulin or other prescribed
medications and teaching the patient how to self-administer if necessary.
 Emotional Support: Providing emotional support and counseling to address any concerns or
anxieties related to GDM and pregnancy.
 Postpartum Care: Monitoring for signs of postpartum depression and advising on glucose testing
postpartum to assess the resolution of GDM or the development of type 2 diabetes.
VI. Drug Study
 Insulin: Insulin is the most common medication used to treat gestational diabetes. It
helps to lower blood sugar levels by facilitating the uptake of glucose into cells. Insulin
may be prescribed in various forms, including short-acting, intermediate-acting, and
long-acting formulations.
o Indications: Insulin is indicated for women with gestational diabetes who cannot
achieve target blood sugar levels through diet and exercise alone.
o Side Effects: Side effects of insulin therapy may include hypoglycemia (low blood
sugar), weight gain, injection site reactions (such as redness or swelling), and
allergic reactions (rare).
 Oral Hypoglycemic Agents: In some cases, oral medications may be prescribed to help
lower blood sugar levels in gestational diabetes. However, their use during pregnancy is
less common and typically reserved for cases where insulin therapy is not feasible or
effective.
o Indications: Oral hypoglycemic agents may be considered when diet and
exercise alone fail to adequately control blood sugar levels in gestational
diabetes.
o Side Effects: Side effects vary depending on the specific medication but may
include gastrointestinal upset (such as nausea, vomiting, or diarrhea),
hypoglycemia, and allergic reactions.

VII. 1 Priority NCP

 Diagnosis: Risk for Imbalanced Nutrition: More Than Body Requirements related to
gestational diabetes as evidenced by elevated blood glucose levels and dietary
imbalances.
 Planning: Short-Term:
- The patient will demonstrate understanding of gestational diabetes management
principles before discharge.
- The patient will achieve and maintain blood glucose levels within the target range
during hospitalization.
 Long-Term:
- The patient will adhere to a diabetic meal plan and exercise regimen throughout
pregnancy.
- The patient will demonstrate competency in self-monitoring blood glucose levels
and recognizing signs of hypo/hyperglycemia.
 Dietary control

- 1800 to 2400 kcal divided into 3 meals and 3 snacks

- 20% of protein
- 50% of carbohydrates
- 30% of fats
- reduced saturated fats and cholesterol
- increased dietary fiber

Blood glucose monitoring

- four times a day
- glucometer
- record sugar level and bring it during OB visit

1. Assess and Monitor Blood Glucose Levels:

 Regularly check and document blood glucose levels as per the healthcare provider's
orders.
 Educate the patient on the importance of monitoring blood glucose levels at home and
how to use a glucometer correctly.
2. Dietary Management:
 Collaborate with a registered dietitian to develop an individualized meal plan that
controls carbohydrate intake and ensures balanced nutrition.
 Educate the patient on the importance of a balanced diet, portion control, and the types of
foods that affect blood sugar levels.
 Encourage the patient to keep a food diary to track dietary intake and identify areas for
improvement.
 Fresh fruit, vegetables, low fat dairy products, lean meats, fish, poultry and whole
grains. Limit desserts/sweets and sugars. Avoid syrup, candy, jellies, cookies, honey,
and regular soda.
3. Promote Physical Activity:
 Encourage regular, moderate physical activity as approved by the healthcare provider to
help manage blood glucose levels and maintain a healthy weight.
 Provide information on safe exercises during pregnancy, such as walking, swimming, and
prenatal yoga.
4. Medication Management:
 Administer insulin or other medications as prescribed and monitor their effectiveness.
 Educate the patient about the purpose, dosage, and potential side effects of medications
used to manage gestational diabetes.
5. Provide Education and Support:
  Educate the patient about gestational diabetes, including its effects on pregnancy and
long-term health implications for both the mother and the baby.
 Provide emotional support and counseling to address any concerns or anxieties related to
gestational diabetes and dietary changes.

6. Regular Follow-ups:
 Schedule and encourage attendance at regular prenatal visits for ongoing assessment and
management of gestational diabetes.
 Monitor for any complications related to gestational diabetes, such as hypertensive
disorders or fetal growth abnormalities.
7. Behavioral Modifications:
 Assist the patient in setting realistic and achievable dietary and exercise goals.
 Use motivational interviewing techniques to encourage adherence to the recommended
dietary and lifestyle changes.
Documentation:
 Document blood glucose levels, dietary intake, physical activity, and any medications
administered.
 Record patient education provided and the patient’s understanding of the information.
 Note any barriers to adherence and the interventions implemented to address these barriers.
VIII. Health Teachings
Medication
- Educate on the proper use of insulin or oral hypoglycemic agents, if prescribed.
- Explain potential side effects and how to manage them.
- Instruct on the importance of adherence to the medication schedule.
Environment
- Promote a stress-free environment to help manage blood glucose levels.
- Suggest organizing a supportive home setup for healthy meal preparation and regular
exercise.
- Prevent wounds and injuries
- immunocompromised
Treatment
- Emphasize the importance of regular prenatal visits for monitoring and adjusting treatment
plans.
- Teach self-monitoring of blood glucose and the significance of keeping a log.
Hygiene
- Stress the importance of good personal hygiene to prevent infections, which can complicate
diabetes.
- Advise on proper foot care, including daily inspection and wearing comfortable, well-fitting
shoes.
Outpatient Care
- Ensure understanding of when and how to reach out to healthcare providers for regular check-
ups and emergencies.
- Encourage attendance at all scheduled appointments with healthcare professionals, including
endocrinologists and dietitians.
Diet
- Educate on a balanced diet rich in whole grains, lean proteins, and vegetables, while limiting
simple sugars and refined carbs.
- Provide portion control guidance and the importance of regular mealtimes.
- Suggest keeping a food diary to track dietary intake and blood glucose response.
Safety
- Instruct on recognizing symptoms of hyperglycemia and hypoglycemia and how to respond
appropriately.
- Advise carrying glucose tablets or a fast-acting carbohydrate for hypoglycemia emergencies.
- Emphasize the importance of wearing medical identification indicating gestational diabetes.