GDM DIAGNOSIS AND MANAGEMENT

1. GDM DIAGNOSIS AND MANAGEMENT DR.V.SEKAR COIMBATORE DIABETES FOUNDATION COIMBATORE,TAMIL NADU,INDIA

2. PREVALANCE 2007 WDF GDM PROJECT TAMILNADU • RURAL 10.9 % • URBAN 18.7 %

3. SCREENING • SELECTIVE SCREENING OR • UNIVERSAL SCREENING UNIVERSAL SCREENING BECAUSE OF HIGH PREVALANCE

4. ONE STEP OR TWO STEP ONE STEP APPROACH OGTT IN 100 GRAM GLUCOSE DIRECTLY TWO STEP APPROACH IT’S A SCREENING BY 100 GRAM GLUCOSE CUT OFF – 140MG/DL IDENTIFY 80 % GDM IF CUT OFF – 130MG/DL IDENTIFY 90 % GDM

5. PROFESSOR DR.V.SESHIAH • ONE STEP 75GRAM GLUCOSE LOAD 1HR BLOOD SUGAR TESTING CUT OFF 140MG/DL • HIGH RISK INDIVIDUAL SCREENING SHOULD BE DONE IN ALL TRIMESTERS – 1ST, 2ND & 3RD

6. SCREENING - HBA1C NO ROLE IN DIAGNOSIS

7. DIAGNOSIS OF GDM WITH A 100GRAM OR 75 GRAM GLUCOSE LOAD

8. CONT’ • 2 OR MORE OF THE VENOUS PLASM CONCENTRATION MUST BE MET OR EXCEEDED FOR A POSITIVE DIAGNOSIS • THE TEST SHOULD BE DONE IN THE MORNING AFTER AN OVER NIGHT FAST OF BETWEEN 8 & 14 HR & AFTER ATLEAST 3 DAYS OF UNRESTRICTED DIET (> 150G CHO / DAY) & UNLIMITED PHYSICAL ACTIVITY • THE SUBJECT SHOULD REMAIN SEATED

9. INDICATION FOR SCREENING • FAMILY HISTORY OF DIABETES • OBESITY • BOH • INFERTILITY • PCO • RAPID INCREASE IN WEIGHT • INCREASED MATERNAL AGE • AC > 95% • HYPERTENSION

10. MANAGEMENT • TARGET BLOOD SUGAR • FASTING 70 – 90 MG/DL • POST PRANDIAL 90 – 120 MG/DL

11. ROLE OF SMBG • 7 POINT BLOOD SUGAR PROFILE IN IDENTIFYING THE GLUCOSE INTOLERANCE DURING PREGNANCY

12. CLINICAL CASE STUDY MRS.E.KRISHNAVENI 26YRS WITH NORMAL GTT - FASTING 88 1HR 142 2HR 122 3HR 109, HBA1C 5.9%.IVF CONCEIVED,WT GAINED 9KGS IN 6 MONTH AMENHORREA, SCAN REPORT SHOWS POLYHYDRAMNIOSIS PATIENT IS ADVICED TO TAKE NORMAL DIET WITH 7 PIONT BLOOD SUGAR PROFILE

13. CONT’

14. MEAL PLAN CALORIE DENSE DIET VS NUTRIENT DENSE DIET

15. GLYCEMIC LOAD PUFFED RICE RICE

16. CONT’

17. REDUCE AND REPLACE WITH VEGETABLES

18. GLYCEMIC LOAD NO FIBER

19. REDUCE THE QUANTITY OF RICE REPLACE WITH VEGETABLES

20. GLYCEMIC INDEX RICE / RAGI KANJI FRUIT JUICES

21. STANDARDIZATION OF FOOD MEASURING SPOONS MEASURING CUPS WEIGHING SCALE PRATICALLY HOW MUCH IT IS POSSIBLE

22. WEIGHING SCALE

23. WHY WEIGHING MACHINE ? DURING PREGNANCY CALORIE REQUIREMENT HAS TO BE MAINTAINED SIZE MAY VARY

24. HOW TO CALCULATE THE CALORIE REQUIREMENT ? 1ST TRIMESTER – PRE PREGNANCY WT * 30 CALS Eg: 60*30 = 1800 CALS + 100 CALS =1900 CALS /DAY 2ND TRIMESTER- PRE PREGNANCY WT * 30 CALS Eg: 60*30 = 1800 CALS + 200 CALS =2000 CALS /DAY 3RD TRIMESTER- PRE PREGNANCY WT * 30 CALS Eg: 60*30 = 1800 CALS + 300 CALS =2100 CALS /DAY

25. ROLE OF SMBG IN THE MEAL PLAN

26. INSULIN THERAPY INDICATION – MORE THAN TWO OCCASION THE CONTROL IS NOT ACHIEVED • FASTING > 90MG/DL ,POST PRANDIAL >120MG/DL • ABNORMAL SCAN REPORT - AC 95% - INCREASED FETAL GROWTH - POLYHYDRAMNIOSIS

27. PRE MIX – BASAL BOLUS • PRE MIX – ADJUSTING THE DOSE ACCORDING TO THE NEED MAY NOT BE POSSIBLE • BASAL BOLUS – PRECIOUS ADJUSTMENT OF FASTING,POST PRANDIAL CONTROL IS POSSIBLE

28. SHORT ACTING ANALOGUE • LISPRO OR • ASPART

29. MONITORING • REGULAR SMBG

30. THANK YOU