Instructions
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CGM use has been shown to: Increase chances of full-term, lower birthweight baby Reduce risk of macrosomia The use of Continuous Glucose Monitoring in gestational diabetes has been demonstrated to improve glycemic control in the third trimester, as well as lower birth weight within healthy ranges for the baby, and reduced risk of macrosomia.[3][4]
Help for the Mother with GDM
It is important for the mother to feel empowered during her pregnancy. To help with this, she should be given information about the tests and appointments she will need, as well as the expectations of her. Specific activities that can help include assisting her in finding ways to manage her stress in a healthy way, evaluating her long-term health and the behaviors that will lead her to extend good self-care during her life.
Postpartum Follow-Up 15% of women with GDM will remain glucose intolerant after delivery 10-15% will develop type 2 diabetes within 2 - 5 years Recommendations: ◦2 hour OGTT six-eight weeks postpartum ◦FBG every year thereafter
Breastfeeding is associated with a decreased risk of the infant developing obesity and diabetes later in life. Breastfeeding increases the woman’s caloric requirements thereby promoting insulin sensitivity and weight loss.
Fasting blood glucose or a random finger stick should be completed before hospital discharge to rule out diabetes. If the mother is diagnosed with type 2 diabetes, medical nutrition therapy and pharmacological therapy should be continued to maintain good glycemic control. All insulins, glyburide, and glypizide may be safely used while breastfeeding. Metformin, if used, will be excreted in the breast milk. Here are some recommendations: 1.The American Diabetes Association recommends oral glucose tolerance testing should be performed periodically to diagnose an impaired glucose tolerance and diabetes mellitus. Fasting blood glucose is not sensitive to these. 2.Because many women who develop gestational diabetes are at high risk for developing metabolic syndrome & cardiovascular disease, risk factors should be evaluated at the times glucose metabolism is being evaluated. 3. It is important to evaluate women who do not have clinical characteristics associated with type 2 diabetes. The measurement of serum anti-GAD antibodies is useful to identify patients with possible type 1 diabetes.
Prevention of Type-2 Diabetes Diabetes Prevention Programs are especially useful in helping women to change their lifestyles in order to avoid type 2 diabetes later in life. Women should be coached to lose weight if necessary, exercise in amounts safe for them, eat healthier, and to employ a medication treatment regimen conducive to regaining control.
Achieve a healthy body weight If overweight, lose 5-7% of body weight Exercise a minimum of 150 minutes per week Include both aerobic & resistance exercise Eat a healthier diet Increase intake of fruits, vegetables, high-fiber carbohydrate, low-fat meats & dairy products, & heart healthy fats Treatment with metformin or pioglitazone
We hope you have gained some useful knowledge about gestational diabetes from this presentation, as well as some tips and tricks that may prove useful when working with patients of this type.
If you would like continuing education credit for taking this course, please click on the link below to fill out the course evaluation and take the post-test.
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