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Sunday, June 26, 2016

GESTATIONAL DIABETES : INFO WE GET FROM THE #ACOG 2013 GUIDELINES


✔️Increased blood sugars 4-6 h prior to delivery leads to increased rates of hypoglycemia in the neonate. A maternal blood glucose value of more than 180 mg/dl has been conclusively proven to be associated with high risk of neonatal hypoglycemia.

✔️The American College of Obstetrics and Gynecology and the American College of Endocrinology recommends maintenance of blood glucose between 70 and 110 mg/dl during labor (3.9-6.1 mmol/L) this goal is the same irrespective of whether the women has type 1 diabetes, type 2 diabetes or GDM. 

✔️The hepatic glucose supply is sufficient during the latent phase of labor, but during the active phase of labor the hepatic glucose supply is depleted so calorie supplementation is required. 

✔️During labor in a case with GDM controlled only on life-style modification it is not compulsory to monitor blood sugars periodically and monitoring once in every 4-6 h is sufficient during labor 

✔️In patients on insulin it is mandatory to monitor the blood sugar every 2-4 h during the latent phase, every 1-2 h during the active phase 

✔️In patients for whom cesarean is planned, it always preferred to do the procedure early morning. 

✔️Patient needs to take her usual night dose of intermediate-acting insulin and the morning dose of insulin has to be withheld and patient needs to be kept nil by mouth. 

✔️If surgery is delayed it is needed to start basal and corrective regimen (DNS with short acting insulin) with one-third of the morning intermediate insulin dose with a 5% dextrose infusion to avoid ketosis. Blood glucose has to be monitored second hourly and if required subcutaneous dose of corrective dose of short acting insulin to be given. 

✔️After delivery, the requirement of insulin shows a sharp decline and in GDM it is advisable to continue the monitoring to see if the sugars have become normal in the postpartum period 

✔️In cases with type 1 and type 2 DM it is prudent to decrease the dose of insulin by 20-40% of the pregnancy dose as the requirement of insulin during lactation is less. During the breast-feeding, sometimes the requirement of insulin can fall drastically and these women may develop hypoglycemia, so the dose of insulin needs to be adjusted accordingly

Reference: ACOG Practice Bulletin, 137, 2013

Indian Journal of Endocrinology and Metabolism: Peripartum management of diabetes, Pramila Kalra and Manjunath Anakal

#anesthesia , #diabetes , #gdm , #insulin , #acog ,#labor ,

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