Question

Case Study 1

A 29-year-old G4P2 Hispanic woman, with a history of gestational diabetes mellitus (GDM), presents to her OB/GYN office for a routine prenatal visit at 24 weeks’ gestation. Her physical examination is unremarkable, and her fetal well-being is reassuring. Because of her previous history of GDM, she is at high risk of developing GDM during this pregnancy and the doctor recommends a glucose challenge test, which is the most common method of screening for GDM. Test results reveal that her 1-hour glucose loading test (GLT) is 179 mg/dL (normal value <140 mg/dL). Because her GLT value is high, she then undergoes a 3-hour glucose tolerance test (GTT), which is used for a definitive diagnosis of GDM. The patient is positive for GDM when all of her plasma glucose values are elevated. Treatment recommenda- tions include beginning a diabetic diet, participating in moderate exercise sessions three times a week, daily home glucose monitoring, and weekly antepartum visits to monitor glycemic control. The doctor explained to the mother that GDM poses little risk to her at this time; however, it is associated with an increase in infant birth trauma and perinatal morbidity and mortality with the risk to her fetus directly related to its size. The goal of antepartum treatment of GDM is to prevent fetal macrosomia, which is defined as an estimated fetal weight of ⩾ 4500 grams, and its resultant complications by maintaining desirable maternal blood glucose levels throughout gestation. It was explained that if diet alone did not maintain blood glucose at desirable levels, then hypoglycemic therapy with insulin injections given several times a day may be required.

1. What is the primary treatment for GDM?

Answer 1

The primary treatment of GDM includes diet, insulin ,exercise and monitoring of blood glucose levels.The patient is advised to perform daily kick counts.

The main treatment involves

a)Exercise - brisk walking, swimming and easy jogging reduces maternal glucose levels.

Improves the cardiopulmonary fitness and increases the physiological ,psychological well being of the patient.

b)Glucose monitoring

Routine check up of blood glucose level

HbA1C at the end of first trimester and trimonthy thereafter(<6% is desirable)

C) Diet

Calorie consumption should be

30 kcal/ day for normal weight

24kcal/ day for overweight

12kcal/ day for morbidily obese women

The constituents of diet are

Carbohydrates : 40-50%

Protein : 20 %

Fat : 30 -40%

Saturated fat < 10%

d) Insulin therapy

Starting dose is 0.7 to 1.0 units/ kg/ day

Given in divided doses.

Combination of intermediate acting(isophane) and short acting insulin ( regular insulin)

e) Oral hypoglycemic agents

Metformin and glibenclamide are used

No teratogenic effects.