Gestational Diabetes
Patient presentation
C.G., a 32 y/o female pregnant with her second baby (gravida 2 para 1) presents to her CNM for her 24 week appointment. Pt's height is 5ft 7in, weight is 180lbs, pulse 84, temp 97.3, and BP is 126/82. C.G.'s hx reveals a normal spontaneous vaginal delivery in May 2009 at 42 weeks gestation to a 9lb 4oz female infant. Pt reports increased hunger and craving of sugary substances even after eating, as well as increased lethargy and fatigue. The results of the Pt's OGTT were 182mg/dL at one-hour, 158mg/dL at two-hour, and 143mg/dL after three-hours. Pt did not report any increase in urination or thirst, or any weight loss. Pt denies hx of DM or FHx of DM and reports recent travel to France at which point she stopped her exercise routine and was eating lots of highly fatty and sugary foods.
Diagnosis
Dx: Gestational Diabetes (GDM)
Tests: Next day overnight fasting blood glucose followed by a second 50g oral glucose load to confirm the diagnosis of GDM.
Results: Fasting blood glucose taken the following AM revealed a finger stick blood glucose (FSBG) of 105mg/dL. The results of the second oral glucose tolerance test (OGTT) were one-hour 180mg/dL, two-hour 157 mg/dL, and three-hour 142mg/dL which confirmed the dx of GDM.
Treatment
Pt was encouraged to decrease caloric intake and to eliminate refined carbohydrates and sugars such as sweets, white flour pastas, and white breads, and to increase her daily intake of fruits, vegetables, and fiber. Pt was explained the importance of regular exercise (at least 20-30 minutes per day) and taught how to perform FSBG 4-5x daily including in the morning and after meals to closely monitor blood glucose levels. Pt was scheduled for follow-up appointment the next week and was instructed that her blood glucose would be monitored closely throughout her pregnancy.
Outcome
Pt strictly adhered to the nutritional/exercise recommendations and eliminated all sugars and refined carbohydrates from her diet, began taking pre-natal yoga classes 3x per week and went on 20 minute walks every evening. Pt reported improved energy level, decreased fatigue and diminished craving of sugary foods. Pt kept a log of FSBG which demonstrated well controlled blood glucose levels within one week of adopting the new diet.
The Basics about GDM
1) GDM typically resolves after pregnancy.
2) Women with a prior hx of GDM are at greater risk in subsequent pregnancies and are at greater risk for type 2 diabetes both in the postpartum period and later in life.
3) Women are typically screened between weeks 24-28.
4) GDM can be controlled with diet, exercise, and careful monitoring.
5) Risk factors include: age >25yo, non-white race, overweight/obesity, FHx diabetes.