Case Study: A 34-year-old Woman In Her Second Pregnancy At 24 Weeks Gestation
Case Study: A 34-Year-Old Woman in Her Second Pregnancy at 24 Weeks Gestation A 34-year-old Hispanic-American woman who is in her second pregnancy and has had one live birth and no abortions is seen for prenatal care at 24 weeks gestation. Her weight is 220 lb, and her blood pressure is 130/80 mmHg. Uterine size is appropriate for gestational age. The patient's past obstetric history includes the spontaneous vaginal delivery of a 9 lb, 8 oz. male infant at 40 weeks gestation, 8 years ago in Mexico. The patient reports that the child is doing well. Her family history reveals that her mother has type 2 diabetes mellitus. A urine dipstick shows 3+ glycosuria and negative ketones. 1. What tests should be done to evaluate the patient's glucose tolerance? 2. How is the diagnosis of gestational diabetes mellitus (GDM) established? 3. What would be the best treatment and follow-up strategy? This patient presents with several risk factors for GDM, defined as carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy, regardless of whether insulin is used for treatment or the condition persists after pregnancy. She is over 30 years of age, from an ethnic group at increased risk for type 2 diabetes mellitus, is obese, and has a first-degree relative with type 2 diabetes. The findings of significant glycosuria should prompt the performance of a glucose determination before the patient leaves the clinic. The usual approach to screening would be a 50-g oral glucose load administered to the patient between 24 and 28 weeks gestation when the "diabetigenic stress" of pregnancy is present. A positive test is a venous plasma glucose value 1 hour later of > 140 mg/dl. This would lead to a 100-gm oral glucose tolerance test (OGTT) with the diag Continue reading >>
Diabetes Complicating Pregnancy
Diabetes with Pregnancy Patient Encounter A 33-year old G2P1 female presented for her routine prenatal visit at 30 weeks gestation to see her obstetrician. With this pregnancy, her first prenatal visit was at 20 weeks and she has sporadically kept her appointments up to this visit. To note, her previous pregnancy two years ago was an uncomplicated vaginal delivery at 38 weeks gestation. The baby weighed 4.2kg at delivery and was complicated by shoulder dystocia. She had minimal general medical care between the pregnancies. At the patient’s 28 week visit, her prenatal surveillance included an abnormal 1-hr glucose challenge test. She returned for a follow up 3-hr OGTT, which revealed abnormal findings; these results were shared with the patient at the 30 week visit. Upon questioning, the patient admitted that there is a family history of diabetes in several of her relatives; however, she has never been tested for diabetes. The patient’s evaluation also demonstrated a body mass index (BMI) of 34, BP 130/78 and fetal heart tones at 148 BPM. Based on these results, the obstetrician diagnosed the patient with gestational diabetes mellitus (GDM) and established a plan of care for the duration of her pregnancy. This plan of care included nutritional counseling with monitoring of her blood glucose as well as possible medical intervention, if glycemic control could not be established. Additionally, the plan called for increased antenatal surveillance based on glycemic control Coding: ICD-9 to ICD-10 In ICD-9-CM, gestational diabetes mellitus codes to 648.83, Abnormal glucose tolerance of mother, antepartum condition or complication. In ICD-10, this condition maps to code O24.410, Gestational diabetes mellitus in pregnancy, diet controlled. Note the change in terminology betw Continue reading >>
Case Study: Eft In Diabetic And Non-diabetic Pregnancies
Case Study: EFT in Diabetic and Non-Diabetic Pregnancies Dr. Ravi Gunatilake published a recent article in Obesity: A Research Journal. The article provided extensive insight into the impact that gestational diabetes has on a babys weight. Below are the highlights of the case study. There has been evidence that the metabolic environment of a mother can affect fetal metabolism. In cases of mothers with diabetes, it has been found that babies are at risk of unhealthy weight, increased insulin resistance, inflammation, and low oxygen levels in the blood. In studies with adults, epicardial and visceral fat thickness have been used as tools for predicting these types of metabolic and cardiovascular risks. Fetal epicardial fat thickness (EFT) is a visceral fat deposit located between the heart and pericardium (the membrane enclosing the heart). Researchers have predicted that fetal EFT would be associated with fetal abdomen circumference, glycemia, and birth weight. In this retrospective cross-sectional study, the authors, including Dr. Gunatilake, reviewed charts of patients with fetal echocardiograms performed from 2008 to 2012. Participants were randomly selected in an effort to find 28 subjects with previous maternal history of diabetes and 28 non-diabetic pregnant patients. The echocardiograms within this study were all taken in the second trimester, between 20 and 28 weeks in the pregnancy. Measurement of the EFT was taken by two investigators that were blind to the medical history of the patient. Along with the EFT, other measurements were collected to determine altered fetal metabolism. These markers included: maternal BMI, estimated fetal weight, birth weight, fetal abdominal circumference, and subcutaneous fat thickness. As a result of this study, researchers found Continue reading >>
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Gestational Diabetes Infant Case Study 2 - Gestational...
Gestational Diabetes Infant Case Study 2 - Gestational Diabetes Mellitus(GDM Infant Case Study Use Chapters 5-9 to gather answers for this case study Gestational Diabetes Infant Case Study 2 - Gestational... 67% (6) 4 out of 6 people found this document helpful This preview shows page 1 - 3 out of 8 pages. Gestational Diabetes Mellitus (GDM) & Infant Case Study Use Chapters 5-9 to gather answers for this case study. GDM:Read the following case study and answer the multiple-choice questions. You may use your textbook, class power point slides, notes, or the Internet for help. Patient: Mrs. Lawrence A 37year-old Native American woman is 26weeks gestation. She is at her doctors office for a check-up and an oral glucose tolerance test (OGTT). Below is the patients history. Her weight before pregnancy was 177lbs. Ht:54 Wt:216lbs OGTT Results BP:140/90Overnight fast 110mg/dL Heart rate:751hour after 170mg/dL Smoker: No 2hours after 165mg/dL Meds:Prenatal vitamins 3hours after 130mg/dL Family Hx: Patients aunt had gestational diabetes. Patients latest baby weighed 10lbs- 9oz at birth. Patient is not feeling right. Food Allergies: Patient is allergic to fish and limes. 1. After looking at the OGTT results, you can conclude the following: a.Mrs. Lawrence has a low fiber diet. b.Mrs. Lawrence could have gestational diabetes; another test should be ordered. c.You cannot conclude anything from the test. d.Mrs. Lawrence has gestational diabetes. 2. Mrs. Lawrences BMI prior to pregnancy was: a.20.4b.30.3c.37.8d.21.53. Prior to pregnancy, Mrs. Lawrence would be considered: a.Underweight b.Normal weight c.Overweight d.Obese 4. With her pre-pregnancy BMI, it is recommended that she gain _____ during her pregnancy. a.28-40lbs b.25-35lbs c.15-25lbs d.11-20lbs 5. What risk factors does Mr Continue reading >>
Norwitz: Obstetrics And Gynaecology At A Glance
Correct answer: GDM refers to any form of glucose intolerance with the onset of pregnancy or first recognized during pregnancy, and complicates approximately 5% of all pregnancies. It likely includes some women who have undiagnosed pregestational diabetes. 2. Should everyone be screened for GDM? If so, at what gestational age should they be screened? Correct answer: Patients with GDM are typically asymptomatic. There is a small cohort of pregnant women in whom routine screening for GDM is not cost-effective. These are women under age 25 who have normal body mass index (BMI <25 kg/m2), no first-degree relatives with diabetes, no risk factors (such as a history of GDM, insulin resistance/PCOS [polycystic ovarian syndrome], a prior macrosomic infant, a prior unexplained late fetal demise, and women with persistent glycosuria), and who are not members of ethnic or racial groups with a high prevalence of diabetes (such as Hispanic, Native American, Asian, or AfricanAmerican). As such patients are rare, most experts and organizations recommend screening for GDM in all pregnant women. The ideal time to screen for GDM is 2428 weeks of gestation. For women at high risk of developing GDM (listed above), early screening for GDM is recommended at the first prenatal visit. If the early screen is negative, it should be repeated at 2428 weeks. 3. Her 1-hour GLT is 182 mg/dL. Does she have GDM? 4. All four values of her 3-hour GTT are elevated and her fasting glucose level is 127 mg/dL. How would you manage her GDM? How long would you allow her to try dietary restriction before adding a hypoglycemic agent? Correct answer: GDM poses little risk to the mother. Such women are not at risk of diabetic ketoacidosis (DKA), which is primarily a disease of absolute insulin deficiency. However, Continue reading >>
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Gestational Diabetes Nursing Case Study
The Finnish Gestational Diabetes Prevention Study (RADIEL khardori, md, phd, facp is a member of the following medical societies: american association of clinical endocrinologists, american college of physicians, american diabetes association, and the endocrine society.-trimester testing for women with diabetes includes a repeat spot urine protein-to-creatinine study in women with elevated value in first trimester, a repeat hba1c, and capillary blood sugar levels 4-7 times daily. study by stuebe et al found that gestational diabetes mellitus and impaired glucose tolerance during pregnancy are associated with persistent metabolic dysfunction at 3 years after delivery, separate from other clinical risk factors. women with gestational diabetes, weight gain during pregnancy that exceeds institute of medicine (iom) weight-gain guidelines increases the risk of preterm delivery, of having a newborn who is lga, and of requiring a cesarean delivery. initiated, participated in the design of, and coordinated the study and helped in the drafting and editing of the article. obstetric and perinatal outcomes in pregnancies complicated by type 1 and type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. this kind of study setting would need a bigger sample size to reveal the effect of a lifestyle intervention. both study groups visited antenatal clinics four times before the second-trimester ogtt (intervention group mean 4. is a term used to distinguish people who are at increased risk of developing diabetes.(your name) thought you would like to see this page from the diabetes care web site. international association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. participated in the Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study
- Diabetes Mellitus Case Study
Case Study For Nursing - Gestational Diabetes Mellitus - Medicine Bibliographies - In Harvard Style
Not logged in. Log in or create an account These are the sources and citations used to research Case Study for nursing - Gestational Diabetes Mellitus. This bibliography was generated on Cite This For Me on Introduction to maternity & pediatric nursing Your Bibliography: Leifer, G. (2011). Introduction to maternity & pediatric nursing. 6th ed. St. Louis, Mo.: Mosby/Elsevier. Your Bibliography: Marieb, E. and Hoehn, K. (2013). Human Anatomy & Physiology. 9th ed. Illinois: Pearson. Child and family health nursing in Australia and New Zealand 2012 - Lippincott Williams & Wilkins - Sydney Your Bibliography: Haley, C. (2012). Child and family health nursing in Australia and New Zealand. Sydney: Lippincott Williams & Wilkins. The Baby Friendly Initiative | Research | Interventions that promote breastfeeding | Review of skin-to-skin contact Your Bibliography: Unicef.org.uk. (2015). The Baby Friendly Initiative | Research | Interventions that promote breastfeeding | Review of skin-to-skin contact. [online] Available at: [Accessed 24 May 2015]. Your Bibliography: National women's health. (2010). Maternity Services induction of labour. [online] Available at: [Accessed 23 May 2015]. In-text: (National Womens Health, ADHB, 2013) Your Bibliography: National Womens Health, ADHB. (2013). Gestational Diabetes Mellitus. [online] Available at: [Accessed 24 May 2015]. Your Bibliography: Southern cross. (2012). Diabetes (symptoms diagnosis treatment). [online] Available at: [Accessed 23 May 2015]. Your Bibliography: Aotea pathology. (2014). Complete Blood Count. [online] Available at: [Accessed 24 May 2015]. Your Bibliography: Taranaki med lab. (2015). Taranaki Med Lab | Test Guide. [online] Available at: [Accessed 24 May 2015]. Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
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Exclusion Of Married Adolescents In A Study Of Gestational Diabetes Mellitus: A Case Study
Exclusion of married adolescents in a study of gestational diabetes mellitus: a case study A study on gestational diabetes mellitus (GDM) among 200 married women in Malappruam, Kerala, India, chose to exclude married women below the age of 18 from participation. Marriages before age 18 are not considered legally valid and persons below age 18 do not have the status of an adult. Parents are considered the legal guardians of married women under age 18, but because marriages are patrilocal, obtaining consent from parents would have time costs. Further, obtaining parental consent may also be considered disrespectful of the in-laws. The inclusion of married adolescents in this study was considered difficult for these reasons. This exclusion can also result in wrongly estimating the levels of GDM among all women at risk. We argue that such exclusion is also unethical; it unfair to exclude women who stand to benefit from participation by enabling them to identify the enhanced life time risk for diabetes mellitus and monitor their future health status better. Recognizing married adolescents as emancipated minors would enable their participating without violating confidentiality regarding their GDM status to parents and in-laws. Gestational diabetes mellitusAdolescent womenUnfair exclusionConfidentialityMature minors According to the District Level Household Surveys 4, which provide reproductive and child health-related data up to the district level in India, 24.7% of adult women aged 18 in Kerala reported blood sugar levels > 140mg/dl and 13.5% reported blood sugar levels > 160mg/dl [ 1 ]. For the district of Malappuram (within the state of Kerala), 14% of the women aged 18 reported blood sugar levels > 140mg/dl and 7.1% reported levels > 160mg/dl [ 2 ]. The burden of diabetes Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Diabetes Mellitus Case Study
- Excessive fruit consumption during the second trimester is associated with increased likelihood of gestational diabetes mellitus: a prospective study
Type 2 Diabetes Case Study Examples
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Putting Prevention Into Practice
Screening for Gestational Diabetes Mellitus KENNETH W. LIN, MD, Medical Officer, U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality CECILI K. SESSIONS, MD, MPH, General Preventive Medicine Residency, Uniformed Services University of the Health Sciences Am Fam Physician.2009Jul15;80(2):185-186. A 29-year-old woman at 20 weeks' gestation visits your office for a routine prenatal examination. This is her second pregnancy, and she has gained 15 lb (6.8 kg). According to her medical record, the patient's prepregnancy body mass index (BMI) was 27 kg per m2. She mentions that her father was recently diagnosed with diabetes, and she asks whether she should be tested for diabetes. Based on the U.S. Preventive Services Task Force (USPSTF) recommendation on screening for gestational diabetes mellitus, what is the most appropriate approach to this patient? A. Screen for gestational diabetes at this visit with a one-hour oral glucose challenge test. B. Schedule a three-hour oral glucose tolerance test at her 24-week visit. C. Explain the risk factors for gestational diabetes, and discuss potential benefits and harms of screening. D. Do not screen for gestational diabetes because she did not have gestational diabetes with her first pregnancy or pregestational diabetes. E. Do not screen for gestational diabetes because a false-positive test could cause prolonged psychological harm. Which one of the following statements is the best assessment of the patient's risk of gestational diabetes? A. She is at increased risk if she is white. B. Her age puts her at lower risk of gestational diabetes. C. She is not at increased risk because she did not have gestational diabetes in her previous pregnancy. D. Her age and prepregnancy BMI increase her risk of ge Continue reading >>
An Unusual Case Of Gestational Diabetes Mellitus
A 29 year old Asian woman, a nurse by profession, presented to our diabetes clinic at six weeks in her first pregnancy in June 2000. Her body mass index was 23 and blood pressure was 130/80 mm Hg. There was no relevant past medical history. There was a strong family history of type 2 diabetes as both her parents were diabetic and one sister had gestational diabetes and later developed type 2 diabetes. Our patient was worried about her glycaemic status and to allay her fears, a 75 g oral glucose tolerance test (OGTT) was performed. The fasting plasma glucose was 6.3 mmol/l and two hour value was 8.1 mmol/l. On the basis of the World Health Organisation 1999 diagnostic criteria, gestational diabetes mellitus was diagnosed and necessary dietary advice given.1 Unfortunately, the pregnancy terminated in abortion at 10 weeks. Eight weeks after the abortion a 75 g OGTT was repeated, which was normal. She was advised to follow a normal diet and to undergo an OGTT as soon as the next pregnancy was detected. She conceived again in February 2001 and underwent a 75 g OGTT at six weeks’ gestation. The fasting value was 5.7 mmol/l and two hour value was 10 mmol/l. Glycated haemoglobin (HbA1c) done at the same time was 6.6% (reference range 6.6%–8.3%). The diagnosis of gestational diabetes mellitus was made and insulin therapy in the form of twice daily injections of human biphasic isophane insulin (Huminsulin 30/70, Eli Lilly) was started. Follow ups were done at intervals of 2–4 weeks depending on the glycaemic control achieved. Her average fasting and two hour plasma glucose values were 4.3 mmol/l and 6.8 mmol/l respectively with average HbA1c being less than 6.5%. The insulin doses needed increasing with advancing pregnancy. At the end of the pregnancy, the daily insulin dos Continue reading >>
Case Study: Gestational Diabetes
With diabetes reaching epidemic proportions, the evidence suggests that early treatment to maintain optimum glucose levels will reduce the future burden of complications. This is especially so for diabetes in pregnancy, which can affect both mother and child. This case study is examining how to help pregnant women with diabetes, in partnership with their health practitioners, to use clinical decision-systems in conjunction with self-testing of blood glucose to manage both lifestyle and appropriate pharmacotherapy. During pregnancy, the body produces hormones and some of these hormones can have a blocking effect on insulin. Gestational diabetes is a condition in which a hormone produced by the placenta prevents the body from using insulin effectively. As a consequence, the level of glucose in the blood remains high. To compensate the increased amount of glucose in the blood, the body should produce more insulin. Occasionally, the amount of insulin produced is not enough to transport the glucose into the cells, or the body cells become more resistant to insulin. This condition is known as gestational diabetes mellitus and it can be defined as carbohydrate intolerance. Although any woman can develop GDM during pregnancy, some of the factors that may increase the risk include: being overweight or obese, sedentary lifestyle, poor diet, family history of diabetes or having given birth previously to infants who are large for gestational age (LGA), age (women who are older than 25 are at a greater risk of developing gestational diabetes than younger women) and prediabetes (impaired glucose tolerance). Besides these factors, specific ethnicities of women have long been considered as a risk factor for developing GDM, women of South Asian heritage are disproportionately affected. Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study
- Diabetes Mellitus Case Study
Managing Clinical Problems In Diabetes, Case Study #13: Gestational Diabetes
Home / Conditions / Gestational Diabetes / Managing Clinical Problems in Diabetes, Case Study #13: Gestational Diabetes Managing Clinical Problems in Diabetes, Case Study #13: Gestational Diabetes Edited by Trisha Dunning AM, RN, MEd, PhD, CDE, FRCNA and Glenn Ward MBBS, BSc, DPhil (Oxon), FRACP, FRCPath Mrs. ORA was referred to a diabetes educator when she developed diabetes at 29.5 weeks gestation. Mrs. ORA is a 30-year-old primigravida and is 29.5 weeks pregnant.She was referred to the diabetes educator from the antenatal clinic because her oral glucose tolerance test showed her BG was elevated at 8.7 mmol/L 2 hours after a 75-g glucose load. Gestational diabetes occurs in 2-9% of all pregnancies. Women who develop gestational diabetes are at increased risk of developing type 2 diabetes. If diet and exercise do not control blood glucose, insulin will be required. Gestational diabetes mellitus (GDM) occurs in 29% of all pregnancies (Hoffman et al. 1998). Evidence suggests that the use of insulin in treating high blood glucose levels in GDM reduces serious perinatal morbidity (Crowther et al. 2005). Pregnancy is an exciting time in a womans life. However, once the diagnosis of GDM is made, the pregnancy will be managed at a more intensive level of care. GDM is managed using diet and exercise but one in six women (or 16%) with GDM requires insulin. The care is usually transferred from the general practitioner to a multidisciplinary team that consists of an obstetrician, endocrinologist, diabetes educator and dietitian.Experts face the dilemma of managing GDM on a regular basis in diabetes centres. The potential need for insulin should be addressed promptly to improve fetal and maternal outcomes, and reduce maternal anxiety about the blood glucose levels and the impact Continue reading >>
Gestational Diabetes Mellitus Case Study
Home Case Study Gestational Diabetes Mellitus Case Study Gestational diabetes mellitus (GDM), also known as type III diabetes mellitus, is one of the most common type of diabetes mellitus and considered the most common complications of pregnancy. This health problem is like pregnancy-induced hypertension (PIH) that develops during pregnancy and disappears after the delivery of the fetus, or as maternal body returns to its pre-pregnant state. Gestational diabetes mellitus may or may not with co-existing maternal diabetes. It heightens the level of diabetes (if with previous diabetes) by a notch in response to the rise in fetal carbohydrate demand. 40% of pregnant mothers who develops GDM will eventually develop non-insulin-dependent diabetes mellitus (NIDDM or type II DM) within 5 years. Knowing the facts about insulin facilitates the understanding of gestational diabetes mellitus. Or any form of diabetes for that matter. This creates/develop ideas on how and why such health problems occur. The insulin is a normal body hormone that is produced by the beta cells of the Islets of Langerhans in the pancreas. The release of insulin is regulated by a negative feedback in response to high glucose level. The high glucose level may come from excessive glucagon action or through high carbohydrate intake. The insulin secretion of the pancreas and its action on the liver makes it maintain a normal value of 80-120 mg/dL. Insulin is essential in the following actions: Carbohydratesutilization of glucose by the cells Proteinsconversion of amino acids to replace muscle tissues Fatsconversion of excess glucose to fatty acids and store them to adipose tissues Endothelial and nerve cells are the only cells/tissues that can use glucose even without insulin. Low insulin level causes the ri Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Diabetes Mellitus Case Study
- Excessive fruit consumption during the second trimester is associated with increased likelihood of gestational diabetes mellitus: a prospective study
"using Smartphones For Accountable Care And Evidence-based Decision Mak" By Nilmini Wickramasinghe, Say Yen Teoh Et Al.
Better managing diabetes has become a global priority, especially given the exponential increase in the number of diabetes patients and the financial implications of treating this silent epidemic. In this paper, we focus on how it might be possible to use a mobile technology solution to support and enable superior diabetes monitoring and management. To test this solution, we examined the context of gestational diabetes and adopted a non-blinded randomized control trial with two-arm cross over applied to a private hospital in Victoria, Australia. Further, we use an accountable care system as the theoretical lens and, from this, develop a conceptual framework to bridge evidence-based management with technologies. Theoretically, we unpack McCleallan, McKethan, Lewis, Roski, and Fishers (2010) study with our conceptual framework that comprises providers for information (evidence-based management) and technology (smartphone). We enhance Muhlestein, Croshaw, Merrill, Pena, and James (2013) accountable care paradigm with three concepts: 1) quality of life, 2) evidence-based management, and 3) affordable care. From the perspective of practice, far-reaching implications have arisen particularly for hospital management pertaining to the cost and quality of care issues. In particular, it appears that adapting mobile technology solutions such as smartphones to support various aspects of care and patient-clinician interactions is a prudent choice to minimize costs and yet provide high-quality care. Wickramasinghe, Nilmini; Teoh, Say Yen; and Mercieca, Paul (2015) "Using Smartphones for Accountable Care and Evidence-based Decision Making in Managing Gestational Diabetes: An Australian Case Study," Communications of the Association for Information Systems: Vol. 37 , Article 33. Avail Continue reading >>
