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Gestational diabetes myelitis : GDM โรคเบาหวานขณะตั้งครรภ์, นายทัชธกรณ์…
Gestational diabetes myelitis : GDM
โรคเบาหวานขณะตั้งครรภ์
Carbohydrate metabolism insulin is incompletely created or used . Cause high blood sugar levels
Risk group
Elderly pregnancy
Obesity
PIH
Habitual abotion
Type of diabetes
IDDM Type I
Insulin-dependent melitus
Diabetes caused by insulin deficiency
It is diabetes that occurs in young people
IDDM Type II
I have diabetes that does not require insulin
Normal/low insulin production but has insulin resistance
Often occurs in the eldery
Lab screening
Urine dipstick test
Fruit+at 125 mg/deciliter glucose
Should be checked twice
Fasting blood sugar
Result + at >= 140 mg/d.I.
Should be checked twice
Oral Glucose Tolerance test
One step screening
Screening 75 g OGTT
Interpret + = 2 hr. >= 140
Two step screening
50 g glucose
NPO 6-8 no more than 14 hrs.
Take 75 g of glucose mixed whit 250-300 ml of water
Blood draw after taking glucose 1 hr. and 2 hr
Interprent
= 1 hr. >= 140 ส่งตรวจ100 g ต่อ
Re - screened when GA 24-28 wk.
100 g oral glucose
NPO 8-14 hr.
Pierced FHS before a wallowing
Eat 100 g of glucose mix with 300-400 ml of water in 5 min
Blood draw 1,2,3 hr. after eating
Interpret 100g. OGTT positive
1 hr > 190
2 hr > 165
3 hr > 145
1 wrong = normal
2 wrong = abnormal + GDM
HbA1c
Normal = 6-8.8
Pathology
Progesterone + Estrogen from the placenta
Pancreas that the pancreas secretes beta cells
Make insulin increase
Placenta creates h PL break down the stored fat for energy prolactin, cortisol Estrogen progesterone insulinase
Blood increases flows slowly tissues get insufficient oxygen
Lactic acid acidic blood
Ketoancidosis
Symtom
Polyuria
Polydipsia
Polyphagia
Weight loss
Fatigue
Itchy easily infected
Effect on mother
Hypoglycemia may occur during pregnancy after child birth
Hyperglycemia
N/V
Infection , abortion
Polyhydramnios
Effect on fetal
Abortion, ICD ,DEIU
An adult (macrosomia)> 4,000g from tat
NTD
RDS
Hypo-hyper glycemai
Cardiomyopathy
Take care
Gestation period
Control energy diet 30-35 kilocalories/kk/date
Prevention hypoglycemia Exercise should be done after meals
Drug
Long acting 3-4 hr. RI = shot
NPH Long acting 4-12 hr.
Take sugar levels
Check before breakfast , followed by 3 meal 1or 2 hours after meals
assess the health of the baby
NST should be done 1-2 time a wk.
GA 28-32
FMC
GA28 ทุก 4 wk.
GA 29-31 ทุก 2 wk.
GA 32 ขึ้นไป ทุก 1 wk.
Postpartum period
GDM A1 should repeat the OGTT test 6 wk. after delivery
With the way 75 g. OGTT
-ถ้า FBS > 126 mg/dl
และ 2 hr.pp>200 mg/dl
= interpreted as diabeted
Drink a glass of milk or water before breastfeeding
-Avoid taking oral contraceptives that are high in estrogen
-Low hormonal contraceptives should be given
นายทัชธกรณ์ วงศ์คำจันทร์
621410072-1