DR.V.SEKAR COIMBATORE DIABETES FOUNDATION COIMBATORE,TAMIL NADU,INDIA GDM DIAGNOSIS AND MANAGEMENT.

DR.V.SEKAR COIMBATORE DIABETES

FOUNDATIONCOIMBATORE,TAMIL NADU,INDIA

GDM DIAGNOSIS AND GDM DIAGNOSIS AND MANAGEMENTMANAGEMENT

PREVALANCE PREVALANCE 20072007

WDF GDM PROJECT TAMILNADU

RURAL 10.9 %URBAN 18.7 %

SCREENINGSCREENINGSELECTIVE SCREENING OR

UNIVERSAL SCREENING

UNIVERSAL SCREENING BECAUSE OF HIGH

PREVALANCE

ONE STEP OR TWO STEPONE STEP OR TWO STEP

ONE STEP APPROACH OGTT IN 100 GRAMGLUCOSE DIRECTLY

TWO STEP APPROACH IT’S A SCREENING BY 100 GRAM GLUCOSE

CUT OFF – 140MG/DL IDENTIFY 80 % GDM

IF CUT OFF – 130MG/DL IDENTIFY 90 % GDM

PROFESSOR PROFESSOR DR.V.SESHIAHDR.V.SESHIAH

ONE STEP 75GRAM GLUCOSE LOAD 1HR BLOOD SUGAR TESTING CUT OFF 140MG/DL

HIGH RISK INDIVIDUAL SCREENING SHOULD BE DONE IN ALL TRIMESTERS – 1ST, 2ND & 3RD

SCREENING - HBA1CSCREENING - HBA1C

NO ROLE IN DIAGNOSIS

DIAGNOSIS OF GDM WITH A DIAGNOSIS OF GDM WITH A 100GRAM OR 75 GRAM GLUCOSE 100GRAM OR 75 GRAM GLUCOSE

LOADLOAD100 GRAM GLUCOSE

LOADMG/DL

FASTING 95

1 HR 180

2 HR 155

3HR 140

75 GRAM GLUCOSE LOAD

MG/DL

FASTING 95

1 HR 180

2 HR 155

CONT’CONT’

2 OR MORE OF THE VENOUS PLASM CONCENTRATION MUST BE MET OR

EXCEEDED FOR A POSITIVE DIAGNOSIS

THE TEST SHOULD BE DONE IN THE MORNING AFTER AN OVER NIGHT FAST OF BETWEEN 8 & 14 HR & AFTER ATLEAST 3 DAYS OF UNRESTRICTED DIET (> 150G CHO / DAY) & UNLIMITED PHYSICAL ACTIVITY

THE SUBJECT SHOULD REMAIN SEATED

INDICATION FOR INDICATION FOR SCREENINGSCREENING

FAMILY HISTORY OF DIABETESOBESITYBOHINFERTILITYPCORAPID INCREASE IN WEIGHTINCREASED MATERNAL AGEAC > 95%HYPERTENSION

MANAGEMENTMANAGEMENT

TARGET BLOOD SUGAR

FASTING 70 – 90 MG/DLPOST PRANDIAL 90 – 120 MG/DL

ROLE OF SMBGROLE OF SMBG7 POINT BLOOD SUGAR PROFILE IN IDENTIFYING THE GLUCOSE INTOLERANCE DURING PREGNANCY

CLINICAL CASE STUDYCLINICAL CASE STUDY

MRS.E.KRISHNAVENI 26YRS WITH NORMALGTT - FASTING 88 1HR 142 2HR 122 3HR 109,HBA1C 5.9%.IVF CONCEIVED,WT GAINED 9KGS IN 6 MONTH AMENHORREA, SCAN REPORTSHOWS POLYHYDRAMNIOSIS

PATIENT IS ADVICED TO TAKE NORMAL DIETWITH 7 PIONT BLOOD SUGAR PROFILE

CONT’CONT’NAME DAY BB

FABF

BL AL BD AD 3.AM

E.KRISHNAVENI

1 ST 85 93 83 130 86 144 79

2 ND 75 98 86 134 79 136 86

MEAL MEAL PLANPLAN

CALORIE DENSE DIET VS NUTRIENT DENSE DIET

GLYCEMIC LOADGLYCEMIC LOAD

PUFFED RICE RICE

CONT’

REDUCE AND REPLACE WITH VEGETABLES

GLYCEMIC LOAD NO FIBER

REDUCE THE QUANTITY OF RICE REPLACE WITH

VEGETABLES

GLYCEMIC INDEX

FRUIT JUICES

RICE / RAGI KANJI

STANDARDIZATION OF STANDARDIZATION OF FOODFOOD

MEASURING SPOONS MEASURING CUPS WEIGHING SCALE

PRATICALLY HOW MUCH IT IS POSSIBLE

WEIGHING SCALE

WHY WEIGHING MACHINE ?DURING PREGNANCY CALORIE

REQUIREMENT HAS TO BE MAINTAINED

SIZE MAY VARY

HOW TO CALCULATE THE HOW TO CALCULATE THE CALORIE REQUIREMENT ?CALORIE REQUIREMENT ?1ST TRIMESTER – PRE PREGNANCY WT * 30 CALS

Eg: 60*30 = 1800 CALS + 100 CALS =1900 CALS /DAY

2ND TRIMESTER- PRE PREGNANCY WT * 30 CALSEg: 60*30 = 1800 CALS + 200 CALS =2000 CALS /DAY

3RD TRIMESTER- PRE PREGNANCY WT * 30 CALSEg: 60*30 = 1800 CALS + 300 CALS =2100 CALS /DAY

ROLE OF SMBG IN THE MEAL PLAN

NAME DAY

BBF

ABF BL

AL BD

AD

3.00 AM

MRS .SANGEETHA

1ST 85 130 98

83 86 117

79

200 G IDLIADVISED SPLIT DIET

2 ND

72 98 94

105

85 111

86

150 G IDLI

INSULIN THERAPYINSULIN THERAPYINDICATION – MORE THAN TWOOCCASION THE CONTROL IS NOT

ACHIEVED

FASTING > 90MG/DL ,POST PRANDIAL >120MG/DLABNORMAL SCAN REPORT

- AC 95%

- INCREASED FETAL GROWTH

- POLYHYDRAMNIOSIS

PRE MIX – BASAL PRE MIX – BASAL BOLUSBOLUSPRE MIX – ADJUSTING THE DOSE ACCORDING TO THE NEED MAY NOT BE POSSIBLE

BASAL BOLUS – PRECIOUS ADJUSTMENT OF FASTING,POST PRANDIAL CONTROL IS POSSIBLE

SHORT ACTING SHORT ACTING ANALOGUEANALOGUE

LISPRO OR

ASPART

MONITORINGMONITORINGREGULAR SMBG