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Gestational Diabetes Dka

Gestational Diabetes: Once You’re Diagnosed

Gestational Diabetes: Once You’re Diagnosed

If you’re a pregnant woman, probably one of the last things you want to hear is that you have gestational diabetes. Your thoughts might range from, “What did I do to cause this?” to “Will my baby be OK?” First, keep in mind that it’s perfectly normal to feel scared and worried. Second, while gestational diabetes (GDM) is indeed serious, remember that, with proper management, you can have a healthy baby. Once you’re diagnosed If you find out that you have GDM, be prepared to learn a lot about diabetes! You’ll likely be referred to a diabetes educator and/or a dietitian. You might also be referred to an endocrinologist, a doctor who specializes in diabetes and other endocrine disorders. In most cases, you’ll be seen by a member of your health-care team about every two weeks. Be prepared to start checking your blood glucose with a meter, following a meal plan, checking your urine for ketones, recording your food and glucose levels, and possibly starting on insulin. In other words, be prepared to do some homework! Your team is there to support you and make sure that you receive the right treatment. Treating GDM There are a number of ways in which GDM is treated, and they all work together to help ensure that your blood glucose levels stay in a safe range throughout your pregnancy. Remember that the goal is to keep your blood glucose in a normal range; this is because, when blood glucose levels are too high, the extra glucose crosses the placenta to the baby. Too much glucose can cause your baby to be too large, and may cause other complications for both you and your baby during delivery and later on (such as Type 2 diabetes). Nutrition and meal planning. The saying that “you’re eating for two” during your pregnancy is partly correct. You ARE eating f Continue reading >>

A Case Of A Woman With Late-pregnancy-onset Dka Who Had Normal Glucose Tolerance In The First Trimester

A Case Of A Woman With Late-pregnancy-onset Dka Who Had Normal Glucose Tolerance In The First Trimester

Hiromi Himuro, Takashi Sugiyama, Hidekazu Nishigori, Masatoshi Saito, Satoru Nagase, Junichi Sugawara and Nobuo Yaegashi Department of Obstetrics and Gynecology Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan Summary Diabetic ketoacidosis (DKA) during pregnancy is a serious complication in both mother and fetus. Most incidences occur during late pregnancy in women with type 1 diabetes mellitus. We report the rare case of a woman with type 1 diabetes mellitus who had normal glucose tolerance during the first trimester but developed DKA during late pregnancy. Although she had initially tested positive for screening of gestational diabetes mellitus during the first trimester, subsequent diagnostic 75-g oral glucose tolerance tests showed normal glucose tolerance. She developed DKA with severe general fatigue in late pregnancy. The patient's general condition improved after treatment for ketoacidosis, and she vaginally delivered a healthy infant at term. The presence of DKA caused by the onset of diabetes should be considered, even if the patient shows normal glucose tolerance during the first trimester. The presence of DKA caused by the onset of diabetes should be considered, even if the patient shows normal glucose tolerance during the first trimester. Symptoms including severe general fatigue, nausea, and weight loss are important signs to suspect DKA. Findings such as Kussmaul breathing with ketotic odor are also typical. Urinary test, atrial gas analysis, and anion gap are important. If pH shows normal value, calculation of anion gap is important. If the value of anion gap is more than 12, a practitioner should consider the presence of metabolic acidosis. Background Diabetic ketoacidosis (DKA) is an acute metabol Continue reading >>

Pregnancy Complicated By Diabetic Ketoacidosis

Pregnancy Complicated By Diabetic Ketoacidosis

Maternal and fetal outcomes Despite intensified insulin treatment and strict surveillance of metabolic control in diabetic women during pregnancy, diabetic ketoacidosis (DKA) complicates 2–9% of diabetic pregnancies (1) and represents the leading cause of fetal loss, with a fetal mortality rate of 30–90% (1–3). From August 1991 to December 2001, 2,025 pregnant women with diabetes were admitted to the University of Tennessee Women’s Hospital. Of these, 888 women (44%) received insulin therapy, and 11 women (1.2%) presented with DKA (blood glucose: 377 ± 27 mg/dl, pH: 7.22 ± 0.01, bicarbonate 7.9 ± 3 mEq/l, and positive serum ketones). White’s diabetic classification included class A2, four patients (27%); class B, five patients (45%); class C, one patient (9%); and class D, one patient (9%). The four women with gestational diabetes mellitus (GDM) were African-American, had a mean age of 25 ± 1 year, a BMI of 34 ± 3 kg/m2, and an estimated gestational age of 29 ± 1 weeks. Patients with a previous history of diabetes had a mean duration of diabetes of 6 ± 1 year, a mean age of 27 ± 1 year, a BMI of 30 ± 2 kg/m2, and a gestational age of 28 ± 1 weeks. Infection (27%) and a history of the omission of insulin therapy (18%) were the most common precipitating causes. There were no maternal deaths, and the mean maternal length of hospital stay was 7 ± 2 days. Two patients presented with intrauterine fetal demise, and there was one additional fetal death giving an overall fetal death rate of 27%. During labor, four patients had nonreassuring fetal heart rate tracings in the form of late decelerations that resolved with correction of DKA. At birth, the mean (5 min) Apgar was 8.7 ± 0.4, and fetal weight was 1,278 ± 202 g. Four obese women with DKA had newly d Continue reading >>

Internet Scientific Publications

Internet Scientific Publications

S Fei Ngu, J Saravanamuthu. Diabetic Ketoacidosis In Newly Diagnosed Gestational Diabetes With Type 2 Diabetes Postpartum. The Internet Journal of Gynecology and Obstetrics. 2006 Volume 6 Number 2. Diabetic ketoacidosis is a rare complication of gestational diabetes. We report a case of a previously healthy woman with an uncomplicated pregnancy, presenting in the third trimester with diabetic ketoacidosis and who was diagnosed with type 2 diabetes postpartum. Diabetic ketoacidosis is a rare complication of gestational diabetes with significant maternal and neonatal morbidity and mortality. Although more common in patients with type 1 diabetes, it has been described in those with type 2 diabetes as well as gestational diabetes, especially with the use of corticosteroid and -adrenergic agonists for premature labour.1,2,3 Therapy is directed toward aggressive correction of fluid imbalance, replacement of electrolytes, restoration of glucose homeostasis and treatment of precipitating factors in an intensive care setting. We describe a woman with an uncomplicated pregnancy presenting in the third trimester with diabetic ketoacidosis and who was diagnosed with type 2 diabetes postpartum. A previously healthy primigravid 38 years old Black African woman presented at 30 weeks and five days of gestation for the first time at our unit, having booked for antenatal care elsewhere, complaining of three days history of vomiting, back pain and reduced fetal movements. On direct questioning, she also has polyuria and polydypsia. There was no family history of diabetes. On examination, she was tachypnoeic, hyperventilating, tachycardic and dehydrated but afebrile. Abdominal examination was otherwise normal for the gestational age. Venous plasma glucose was 28 (<7.8) mmol/L, sodium 128 Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

DKA is usually signaled by high blood sugar levels. The important fact to remember is that without enough insulin, the body cannot burn glucose properly and fat comes out of fat cells. Diabetic Ketoacidosis (DKA) – a condition brought on by inadequate insulin – is a life-threatening emergency usually affecting people with type 1 diabetes. Although less common, it also can happen when you have type 2 diabetes. DKA is usually, but not always, signaled by high blood sugar levels. The important fact to remember is that without enough insulin, the body cannot burn glucose properly and fat comes out of fat cells. As a consequence the excess fat goes to the liver and glucose builds up in the bloodstream. The liver makes ketoacids (also known as ketones) out of the fat. Before long, the body is literally poisoning itself with excess glucose and ketoacids. What causes DKA? A lack of insulin usually due to: Unknown or newly diagnosed cases of type 1 diabetes Missed or inadequate doses of insulin, or spoiled insulin Infection Steroid medications An extremely stressful medical condition DKA is rare in type 2 diabetes – but can develop if someone with type 2 diabetes gets another serious medical condition. Examples of medical conditions associated with DKA in type 2 diabetes are severe infections, acute pancreatitis (inflammation of the insulin producing organ, the pancreas), and treatment with steroids. Symptoms of DKA include: Nausea, vomiting Stomach pain Fruity breath – the smell of ketoacids Frequent urination Excessive thirst Weakness, fatigue Speech problems, confusion or unconsciousness Heavy, deep breathing How do you know if you have DKA? Check your blood or urine for ketones. And if the test is positive, you will need immediate medical care. Treatment includes agg Continue reading >>

Endocrine Disorders Of Pregnancy: Gestational Diabetes Mellitus, Diabetic Ketoacidosis In Pregnancy, Acute Adrenal Crisis In Pregnancy, Cushing's Syndrome In Pregnancy, Hypothyroidism In Pregnancy

Endocrine Disorders Of Pregnancy: Gestational Diabetes Mellitus, Diabetic Ketoacidosis In Pregnancy, Acute Adrenal Crisis In Pregnancy, Cushing's Syndrome In Pregnancy, Hypothyroidism In Pregnancy

Endocrine disorders of pregnancy: Gestational diabetes mellitus, Diabetic ketoacidosis in pregnancy, Acute adrenal crisis in pregnancy, Cushing's syndrome in pregnancy, Hypothyroidism in pregnancy Endocrine disorders of pregnancy: Gestational diabetes mellitus, Diabetic ketoacidosis in pregnancy, Acute adrenal crisis in pregnancy, Cushing's syndrome in pregnancy, Hypothyroidism in pregnancy Related conditions: Gestational diabetes mellitus Altered metabolic homeostasis in pregnancy allows for the natural growth and development of the fetus and placenta. However, these adaptive metabolic changes add a level of complexity to the diagnosis and management of diseases that are either inherent to pregnancy or complicated by pregnancy. The endocrine and metabolic alterations during pregnancy primarily affect the hypothalamus, pituitary, and adrenal glands. Tachycardia and hyperventilation (Kussmaul respirations) Nonspecific symptoms such as nausea, vomiting, diarrhea, fatique, muscle weakness, abdominal pain, lethargy, confusion, and coma Mental status changes ranging from irritability and depression to coma It is important to recognize that there are many physiologic changes that occur in pregnancy, such as mild tachycardia, tachypnea, respiratory alkalosis, fatigue, muscle weakness, and peripheral edema, as well as changes in specific laboratory values, such as decreased hemoglobin and creatinine levels, that potentially may confound the diagnosis of any of the endocrine processes that occur in pregnancy. Improve circulating blood volume with aggressive fluid resuscitation. Decrease serum glucose with insulin administration. Clear serum ketoacids (correcting acidosis) with fluid and insulin therapy. Initiate therapy with 0.1 U/kg bolus, then a continuous infusion of 0.1 U/k Continue reading >>

Diabetes Mellitus - Osmosis

Diabetes Mellitus - Osmosis

Anatomy and physiology of the female reproductive system Diabetes mellitus type 1 is a form of diabetes mellitus that results from the autoimmune destruction of the insulin-producing beta-cells in the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose. The classical symptoms are polyuria, polydipsia, polyphagia, and weight loss. Diabetes mellitus is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes. Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in people with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances. DKA results from a shortage of insulin; in response the body switches to burning fatty acids and producing acidic ketone bodies that cause most of the symptoms and complications. Vomiting,dehydration,deep gasping breathing,confusionand occasionallycomaare typical symptoms. It is distinguished from other, rarer forms ofketoacidosisby the presence of highblood sugarlevels. Diabetes mellitus type 2 is characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion. It is a common disorder with a prevalence that rises markedly with increasing degrees of obesity. The prevalence has risen alarmingly in the past decade, in large part linked to the trends in obesity and Continue reading >>

Diabetic Ketoacidosis. A Rare Complication Of Gestational Diabetes.

Diabetic Ketoacidosis. A Rare Complication Of Gestational Diabetes.

Diabetic ketoacidosis. A rare complication of gestational diabetes. Fraida Foundation Diabetes-Metabolism Service, Soroka Medical Center of Kupat Holim, Ben-Gurion University Faculty of Health Sciences, Beer-Sheva, Israel. OBJECTIVE: To describe a case of severe DKA in an otherwise healthy pregnant woman. RESEARCH DESIGN AND METHODS: We describe 2.5 yr of close follow-up of a Bedouin woman who was hospitalized for DKA while pregnant with her 11th child. Plasma glucose returned to normal levels immediately after delivery of a dead conceptus. Four months later, while normoglycemic, the patient became pregnant again. During the subsequent pregnancy, GDM was diagnosed at week 20 of gestation. Tight plasma glucose control was achieved with an insulin regimen, and the patient delivered a healthy girl at term. Plasma glucose again returned to normal and remained so to date, 18 mo postpartum. An OGTT and a euglycemic hyperinsulinemic clamp were performed between pregnancies; another OGTT was performed at week 14 of the last pregnancy. Plasma glucose, insulin, and C-peptide were measured in blood samples during these procedures. RESULTS: We established beyond doubt that the patient developed GDM and returned to essentially normal glucose tolerance after her last (12th) delivery. During the 11th pregnancy, gestational diabetes was complicated by severe DKA. CONCLUSIONS: GDM is a common abnormality of glucose metabolism during pregnancy, which affects fetal development and leads to peripartum complications. Our report stresses that under certain circumstances, gestational diabetes can be complicated by DKA and become life-threatening to the mother and fetus. Continue reading >>

Diabetes In Pregnancy: Management From Preconception To The Postnatal Period

Diabetes In Pregnancy: Management From Preconception To The Postnatal Period

If you have type 1 diabetes, you should be given ketone testing strips and a monitor. Your care team should advise you to test the ketone levels in your blood if your blood glucose is too high (known as hyperglycaemia) or if you are unwell. This is because you are at risk of a serious condition called diabetic ketoacidosis (DKA). People with type 1 diabetes are at higher risk of DKA (although anyone with diabetes can get it). If you have any form of diabetes, your care team should advise you to get urgent medical advice if you have hyperglycaemia or you are feeling unwell, to make sure you don't have DKA. Your ketone levels should be checked as soon as possible. If you are thought to have DKA you should be admitted straight away to a unit where you can get specialist care. Continue reading >>

Diabetic Ketoacidosis In Pregnancy

Diabetic Ketoacidosis In Pregnancy

Diabetic ketoacidosis is a serious metabolic complication of diabetes with high mortality if undetected. Its occurrence in pregnancy compromises both the fetus and the mother profoundly. Although predictably more common in patients with type 1 diabetes, it has been recognised in those with type 2 diabetes as well as gestational diabetes, especially with the use of corticosteroids for fetal lung maturity and β2-agonists for tocolysis.1–3 Diabetic ketoacidosis usually occurs in the second and third trimesters because of increased insulin resistance, and is also seen in newly presenting type 1 diabetes patients. With increasing practice of antepartum diabetes screening and the availability of early and frequent prenatal care/surveillance, the incidence and outcomes of diabetic ketoacidosis in pregnancy have vastly improved. However, it still remains a major clinical problem in pregnancy since it tends to occur at lower blood glucose levels and more rapidly than in non-pregnant patients often causing delay in the diagnosis. The purpose of this article is to illustrate a typical patient who may present with diabetic ketoacidosis in pregnancy and review the literature on this relatively uncommon condition and provide an insight into the pathophysiology and management. MAGNITUDE OF THE PROBLEM In non-pregnant patients with type 1 diabetes, the incidence of diabetic ketoacidosis is about 1–5 episodes per 100 per year with mortality averaging 5%–10%.4 The incidence rates of diabetic ketoacidosis in pregnancy and the corresponding fetal mortality rates from different retrospective studies5–8 are summarised in the table 1. As is evident from the table, both the incidence and rates of fetal loss in pregnancies have fallen in recent times compared with those before. In 1963 Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) happens when your blood sugar is high and your insulin level is low. This imbalance in the body causes a build-up of ketones. Ketones are toxic. If DKA isn’t treated, it can lead to diabetic coma and even death. DKA mainly affects people who have type 1 diabetes. But it can also happen with other types of diabetes, including type 2 diabetes and gestational diabetes (during pregnancy). DKA is a very serious condition. If you have diabetes and think you may have DKA, contact your doctor or get to a hospital right away. The first symptoms to appear are usually: frequent urination. The next stage of DKA symptoms include: vomiting (usually more than once) confusion or trouble concentrating a fruity odor on the breath. The main cause of DKA is not enough insulin. A lack of insulin means sugar can’t get into your cells. Your cells need sugar for energy. This causes your body’s glucose levels to rise. To get energy, the body starts to burn fat. This process causes ketones to build up. Ketones can poison the body. High blood glucose levels can also cause you to urinate often. This leads to a lack of fluids in the body (dehydration). DKA can be caused by missing an insulin dose, eating poorly, or feeling stressed. An infection or other illness (such as pneumonia or a urinary tract infection) can also lead to DKA. If you have signs of infection (fever, cough, or sore throat), contact your doctor. You will want to make sure you are getting the right treatment. For some people, DKA may be the first sign that they have diabetes. When you are sick, you need to watch your blood sugar level very closely so that it doesn’t get too high or too low. Ask your doctor what your critical blood sugar level is. Most patients should watch their glucose levels c Continue reading >>

Managing Severe Preeclampsia And Diabetic Ketoacidosis In Pregnancy

Managing Severe Preeclampsia And Diabetic Ketoacidosis In Pregnancy

US Pharm. 2010;35(9):HS-2-HS-8. Pregnancy is associated with increased levels of emotional and physical stress. Women with preexisting conditions such as hypertension and diabetes require intense prenatal monitoring by health care professionals. Pharmacists in direct contact with patients can play an integral role in identifying signs and symptoms that require immediate care. Two conditions that require emergent treatment in pregnant women are severe preeclampsia and diabetic ketoacidosis. SEVERE PREECLAMPSIA Hypertensive disorders can affect 6% to 8% of women and increase the risk of morbidity and mortality in both the expectant mother and the unborn child.1,2 Hypertension in pregnancy is divided into four categories: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. The focus in this article is on severe preeclampsia, but a brief discussion of preeclampsia is warranted. Preeclampsia, a pregnancy-specific syndrome of unknown etiology, is a multiorgan disease process characterized by the development of hypertension and proteinuria after 20 weeks' gestation.1,2 See TABLE 1 for diagnostic criteria.1,2 History of antiphospholipid antibody syndrome, chronic hypertension, chronic renal disease, elevated body-mass index, age 40 years or older, multiple gestation, nulliparity, preeclampsia in a previous pregnancy, and pregestational diabetes mellitus increase a woman's risk of preeclampsia.1 Preeclampsia is classified as mild or severe based on the degree of hypertension, the level of proteinuria, and the presence of symptoms resulting from the involvement of the kidneys, brain, liver, and cardiovascular system. The incidence of severe preeclampsia is 0.9% in the United States.3 Severe preeclampsia is associate Continue reading >>

What Are Ketones?

What Are Ketones?

Ketones are an acid remaining when the body burns its own fat. When the body has insufficient insulin (or cannot use sufficient insulin), it cannot get glucose (sugar) from the blood into the body's cells to use as energy and will instead begin to burn fat stores. When the body is burning too much fat, it may cause ketones to become present as by product shown in your urine. Burning fat instead of glucose can lead to a condition called ketosis. It can make you feel poorly, with lack of energy. If you have healthy or low BMI it can also be dangerous as you may also lose too much weight. Testing for ketones Your urine is usually tested for ketones during your diabetes clinic appointments. You may also be tested for ketones if you have been taken into hospital with high blood sugar levels. Ketones are detected by testing the urine with a dip stick. They are measured on a scale with 0 being lowest and 4++ being the highest. The test sticks can be purchased from a pharmacy or online and in some cases you may be prescribed test strips for home testing for if you get blood sugar levels over a certain level. Your diabetes midwife will usually complete ketone tests when you attend clinic appointments, so it is not necessary to purchase dip sticks for home use unless you're advised to by a medical professional. Blood ketones can also be tested and are much more accurate than the urine dip sticks. Type 1 diabetics may be given ketone blood testing monitors. Why are ketones common in ladies diagnosed with gestational diabetes? Ketones can be detected when you have not eaten for a long period of time and may be found in samples taken in the morning due to fasting overnight. It is common for mothers with gestational diabetes to develop ketones due to limiting too many carbohydrates f Continue reading >>

Gestational Diabetes In Primary Care

Gestational Diabetes In Primary Care

Diabetes mellitus (DM) can occur during pregnancy in 2 forms: pregestational and gestational diabetes. Pregestational diabetes is defined as Type I or Type II DM that existed before conception. Gestational diabetes (GDM) is defined as glucose intolerance that is first detected during the pregnancy and is associated with a probable resolution after the end of the pregnancy.[ 1 ] Despite the defining feature of glucose intolerance, pregestational diabetes and GDM and are very different entities. Pregestational diabetes represents very high-risk obstetrics. Poor glucose control before conception and during organogenesis places the fetus at high risk of congenital malformations, especially cardiac and neural tube defects.[ 2 ] Women with pregestational diabetes have a higher risk of diabetic ketoacidosis and require careful and frequent monitoring to manage their complex insulin needs. Intensive fetal monitoring to identify and anticipate complications is also necessary.[ 3 , 4 , 5 ] Extensive experience and training are required to feel comfortable managing the care of women with pregestational diabetes. By contrast, if good glucose control can be achieved with diet (and insulin, if necessary), GDM confers a much lower risk for both the mother and fetus. The remainder of this article focuses on the woman with GDM. Pregnancy is a diabetogenic state. The hormones that lead to fetal growth and development do so by mobilizing the woman's nutritional resources, primarily glucose, and making them available to the fetus. Figure 1 illustrates the plasma levels of the critical anabolic hormones present during pregnancy. All increase dramatically in the last 20 weeks of gestation. Human placental lactogen plays a pivotal role in triggering the changes that can lead to glucose intol Continue reading >>

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