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HYPOGLYCEMIA AND HYPERGLYCEMIA
1. Presented by: Excalibur Group
Daphney Jacques, Bridgette Jenkins, Opal Jobson-Cudjoe , Kelly Miller
BY
HASHIM SYED ALI ABBAS H
PHARM.D VI YEAR
170312882029
MESCO COLLEGE OF PHARMACY
2. Objectives
Distinguish between normal and abnormal blood glucose
levels based on patient population
Classify the different diagnosis associated with
hypoglycemia/hyperglycemia based on patient age
Compare the common causes of
hypoglycemia/hyperglycemia based on patient population
3. Objectives
Formulate the appropriate interventions for
hypoglycemia/hyperglycemia management based on patient
population
Differentiate between the different medications used to manage
the hypoglycemic/hyperglycemic patient.
Predict immediate complications of
hypoglycemia/hyperglycemia
4. Objectives
State potential long term complications of uncontrolled
blood sugar levels
Determine the appropriate educational strategies to
prevent hypoglycemia/hyperglycemia
5. NORMAL BLOOD GLUCOSE for
PREGNANT WOMEN
65mg/dl (fasting)
<140 mg/dl (2 hr pp)
6. CLASSIFICATION OF DIABETES IN
PREGNANT WOMEN (cdc.gov)
Pregestational Diabetes
Type I: primarily due to pancreatic islet beta cell destruction.
Type II: most common type of diabetes that is a result of
insulin resistance or insufficiency.
Gestational Diabetes
Any degree of glucose intolerance with the onset or first
recognition occurring during pregnancy.
7. SCREENING FOR GESTATIONAL
DIABETES (Lowdermilk, Perry, &
Bobak)
Screening should be done between
24-28 weeks gestation.
Glucose Tolerance Test (GTT): 50
grams of glucose is consumed, blood
is taken after 1 hour and sent to a
laboratory for evaluation.
140mg/dl or greater is considered as
positive
Oral Glucose Tolerance Test (OGTT)
is done if the GTT is positive.
After a overnight fast, a fasting blood
glucose level is drawn. Then 100
grams of glucose is consumed and
blood is drawn at 1, 2 and 3 hour
intervals.
The patient is diagnosed with
gestational diabetes if 2 or more
values are met or exceeded:
Fasting 105mg/dl
1 hr 190mg/dl
2 hr 165mg/dl
3 hr 145mg/dl
8. HYPOGLYCEMIA IN PREGNACY
Blood glucose: < 60mg/dl
Causes: excess insulin, insufficient food, excessive exercise or
work, vomiting or diarrhea.
10. MANAGEMENT OF HYPOGLYCEMIA
Check blood sugar when symptoms first appear (fingerstick)
Eat 10-15 grams of simple carbs
Recheck blood glucose 15 minutes after intake
Notify healthcare provider if blood glucose remains low
If patient is unconscious call 911
If in hospital administer 50% dextrose or glucagon as ordered.
Recheck blood sugar, send urine/blood to lab
11. HYPERGLYCEMIA IN PREGNACY
Blood glucose > 200 mg/dl
Causes: Insufficient insulin, excess or wrong kinds of food,
infection, illness, injuries, emotional stress or insufficient
exercise
13. MANAGEMENT OF
HYPERGLYCEMIA
Notify healthcare provider
Administer insulin in
accordance with blood
glucose level (sliding scale)
Give IV fluids (NS or 0.45
NS)
Monitor blood & urine
laboratory testing
14. MANAGEMENT OF DIABETES IN
PREGNACY
Diet
2000-2500 daily, less if overweight or morbidly obese
Exercise
Active women are encouraged to continue physical activity,
sedentary are encouraged to get active. Walking is
recommended
Monitoring of blood glucose levels
Findersticks are done at home. Usually done upon waking
(fasting) and after meals (postprandial)
Insulin therapy: done on a individual basis to maintain normal
blood glucose levels
Close monitoring of fetus after 40 weeks until delivery
15. COMPLICATIONS OF DIABETES IN
PREGNACY
Congenital malformations
Macrosomia: infant weight
of 4,000-4,500 grams
Intrauterine growth
retardation (IUGR)
Stillbirth
Respiratory Distress
Syndrome (RDS)
Spontaneous abortion in
early pregnancy
Shoulder Dystocia
Pregnancy induced
hypertension (PIH)
Infections (UTI’s, yeast
infection)
Ketoacidosis
16. PREVENTION
Seek counseling before getting pregnancy
Maintain a healthy weight
Exercise regularly
Eat healthy and balanced meals
Seek prenatal care early in pregnancy
Keep all prenatal appointments
Follow regime prescribed by physician
17. REFERENCES
CDC.GOV (2009). Information on gestational diabetes.
Retrieved July 9, 2009, from: http://diabetes.niddk.nih.gov/dm/pubs/gestational/
Lowdermilk, D., Perry, S., & Bobak, I. (1999). Maternity
Nursing (5th
. Ed). St. Louis: Mosby.
18. CASE STUDY
Maria, a 40 y/o G4P3 at 29 weeks present to Labor &
Delivery with c/o dizziness, headache, nausea and
vomiting for 3 days. After interviewing Maria, you note
that she has not had any prenatal care, has a h/o diabetes
Her past obstetrical history includes delivery of a 4500
gram male complicated by shoulder dystocia. She weighs
312 pound. Her Bp 129/83, HR 82, RR 26 and Temp 98.8.
A UA shows 3+ glucose, and negative ketones. Her
accucheck is 179mg/dl.
19. CASE STUDY
DISCISSION
Questions
1. What tests, if any, should be done to evaluate the Maria’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 for Maria?
Discussion
This patient has several risk factors for GDM. She is over the age of 30, has
a history of GDM and is obese. All these place her at a greater risk for
developing GDM. She needs to be referred to a dietician or diabetic
counselor. She needs to continue prenatal care and started on insulin
therapy. Maria should be followed closely for the remainder of the
pregnancy. Birthing options (vaginal vs caesarean section) should be
discussed with the patient. Maria should also be followed closely after
delivering to assess for the development of Type II diabetes.