diabetesasia

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Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms. The WDF mission:

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Post Partum:

Post Partum 1

Objectives:

Objectives Discuss the immediate care of the infant Discuss the importance of breast feeding Discuss follow up screening of the mother Discuss risk of IGT or diabetes in future Discuss follow up education for mother 2

After delivery – the infant:

After delivery – the infant Watch for signs of hypoglycemia Check blood glucose – heel prick Within 1 st hour after delivery After each of 1 st 4 feeds Less than 2.6 mmol /L or 44 mg/dl defined as hypoglycemia Treatment of hypoglycemia Topfeeding /glucose in water/ IV dextrose Seshiah , Balaji , 2006 3

After delivery – the infant:

After delivery – the infant Usual care Vital signs Apgar scores Pre-warmed incubator Start breast feeding within 30 minutes for better latching Watch for jaundice – check bilirubin If macrosomic , check calcium and magnesium on day 2 Seshiah , Balaji , 2006 4

After delivery - mother:

After delivery - mother Exogenous insulin not required after placenta is delivered Blood glucose usually returns to normal Check fasting within 48 hours to rule out type 1 or type 2 diabetes 5

Breast feeding:

Breast feeding Encourage for all Protects infant from over or undernutrition during early childhood May lower risk of Obesity Hypertension Cardiovascular disease Diabetes Gunderson, 2007 6

Post partum period:

Post partum period Encourage mother to achieve healthy weight. Healthy eating Adequate intake to sustain breast feeding Regular activity 7

Future pregnancies:

Future pregnancies Should be planned Education regarding birth control is needed Encourage achieving healthy weight prior to conceiving again Check blood glucose levels well ahead of conception allowing time to normalize if necessary 8

Contraception :

Contraception Any method of contraception can be safely used in a woman with history of GDM Intrauterine devices are commonly used Progesterone-only oral contraceptives are the best choice within the first 6 weeks post partum T hey have the lowest risk of thrombosis Preferred during breastfeeding 9

Glucose tolerance testing:

Glucose tolerance testing Should be done 6-12 weeks post partum Fasting glucose testing is not sufficient to identify all who have IGT or type 2 diabetes Only 34% of women with IGT or type 2 had elevated fasting glucose levels 44% of those with type 2 had fasting less than 5.5 mmol /L (100 mg/ dL ) OGTT should be done Metzger, Buchanan, Coustan et al. 2007 10

CVD risk:

CVD risk Women with GDM may have many of characteristics of metabolic syndrome Hypertension, dyslipidemia , obesity, IGT should all be evaluated and treated Metzger, Buchanan, Coustan et al. 2007 11

Postpartum education is key:

Postpartum education is key OGTT at 6-12 weeks Managing risk factors Obesity Hypertension Dyslipidemia Birth control Preconception screening Annual screening for diabetes – 35-60% risk of type 2 within 10 years Metzger, Buchanan, Coustan et al. 2007 12

References:

References Gunderson EP. Breastfeeding after gestational diabetes pregnancy. Diabetes Care. 2007;30( suppl 2):S161-168 . Metzger BE, Buchanan TA, Coustan DR, De Leiva A, Hadden DR, Hod M. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus, Diabetes Care. 2007; 30( suppl 2):S251-260. Seshiah V, Balaji V, et al. Gestational Diabetes Mellitus – Guidelines. J Assoc Physic of India 2006;54:622-28. 13

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