The steps of an oral glucose tolerance include (Pagana et al., 2018): 1. Obtain fasting blood and urine specimens. The patient should fast for 12 hours before the test. 2. Administer a prescribed oral glucose solution of 75-100 g for pregnant women. Note that the ADA recommends using 75 g solution. 3. Instruct patient to drink the entire glucose solution. 4. Instruct patient not to eat or drink anything except water during the testing period. 5. Obtain a venous blood sample at 30 and 60 minutes and then hourly. 6. Collect urine specimens hourly. 7. Monitor the patient for dizziness, sweating, and weakness. Screening tests may vary slightly depending on the patient’s healthcare provider. General results include (Mayo Clinic, 2020c; Pagana et al., 2019): ● Initial glucose challenge test: This challenge test is done first. It is a one-hour test that involves drinking a glucose solution and having blood glucose levels assessed. A blood sugar level of 10 mg per deciliter (mg/dL) or 10.6 millimoles per liter indicates gestational diabetes. A blood glucose level below 140 mg/dL is usually considered normal. A higher- than-normal blood glucose level means that the glucose tolerance test should be performed. ● Follow-up glucose tolerance testing: If at least two of the blood glucose readings are higher than normal, a diagnosis of gestational diabetes is made. Management of Gestational Diabetes The goal of treatment for gestational diabetes is to keep blood glucose levels equal to those of pregnant women who do not have gestational diabetes (ADA, 2021d). Management of gestational diabetes includes the following initiatives (ADA,2021d; Dansinger, 2019a; Mayo Clinic, 2020c; WebMD, 2017a): ● Teach patients and family members (as appropriate) how to monitor blood glucose levels. Monitoring should be done four times per day, before breakfast and two hours after meals. Some patients require checking glucose levels before meals as well. ● Teach patients and family members (as appropriate) how to monitor urine for ketones. ● Initiate a dietary consultation for the development of an appropriate diet. Explain to patients and family members the importance of following prescribed dietary plans. A healthy diet focuses on fruits, vegetables, whole grains, and lean proteins. ● Help patients to develop medically approved exercise regimens. ● Teach patients to monitor their weight. ● If needed, teach patients about any hypoglycemic medications, including insulin, that are prescribed. ● Monitor blood pressure and initiate prescribed actions such as exercise and reduction of salt intake. As appropriate, teach patient and family members how to monitor blood pressure. ● Teach patients to keep a careful written record of their blood glucose levels and results of urine monitoring—including the time readings were obtained and how readings relate to dietary intake, exercise, and stress—and blood pressure readings if monitoring blood pressure at home. Instruct Type 1 diabetes occurs when the beta cells of the pancreas are destroyed or suppressed. This results in failure of the pancreas to release insulin and inadequate transport of glucose (Rebar et al., 2019). The prevalence of diagnosed type 1 diabetes in 2016 was 0.55%, or 1.3 million adults. This is significantly less than the prevalence of diagnosed type 2 diabetes, which was 8.6%, or 21.0 million adults (Morr, 2018).
patients to bring a copy of these written records with them to all health care appointments. ● Teach patients stress reduction techniques such as meditation and deep breathing exercise as appropriate. Most pregnant women are concerned about the possible effects of gestational diabetes on their unborn children. Fortunately, gestational diabetes affects the mother relatively late in her pregnancy, when the majority of the baby’s organs have been formed, but while the baby is still growing. Gestational diabetes is not associated with the types of birth defects in infants whose mothers had diabetes mellitus before pregnancy (Dansinger, 2019a; Mayo Clinic, 2020c). Unfortunately, untreated, or inadequately controlled gestational diabetes can harm the fetus. The pancreas works “overtime” to produce insulin in the presence of gestational diabetes, but the insulin does not reduce blood glucose levels. Insulin does not cross the placenta, but glucose does. Thus, the unborn child is exposed to high blood glucose levels. In response to these elevated levels, the unborn baby produces additional insulin, receives more energy, and stores the “extra” energy as fat. Additional stores of fat can lead to macrosomia, a condition in which the baby is abnormally large before birth. Adverse effects of macrosomia include damage to the baby’s shoulders during birth, low blood glucose levels because of the extra insulin production, respiratory distress, and jaundice. These infants are also at higher risk for obesity as children and at risk for type 2 diabetes as adults. Thus, it is essential that all pregnant women be screened for gestational diabetes and, if a diagnosis of diabetes is found, treated appropriately and promptly (Dansinger, 2019a; Mayo Clinic, 2020c). About six weeks after delivery, the mother’s blood glucose levels usually return to normal because the placenta, which was responsible for producing the hormones that led to insulin resistance, is no longer in the body. Blood glucose levels will be monitored to ensure that they have returned to normal. Some health care providers recommend an oral glucose tolerance test 6 to 12 weeks after delivery to screen for diabetes mellitus (Dansinger, 2019a; Mayo Clinic, 2020c). Evidence-based practice! Women who have had gestational diabetes have a 50% chance of developing type 2 diabetes within 10 to 20 years of delivery (Dansinger, 2019a). Therefore, they should work to reduce this risk by maintaining an ideal body weight, following a healthy diet, and exercising regularly. Self-Assessment Quiz Question #3 ADA recommendations for gestational diabetes screening include all of the following EXCEPT: a. Pregnant women not previously found to have diabetes should be screened for gestational diabetes at the first prenatal visit. b. Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes at least every three years. c. A blood glucose level of 140 mg/dL is considered normal. d. The initial glucose challenge test is done before the glucose tolerance test. Immune mediated types of type 1 diabetes, an autoimmune attack on beta cells occurs. This results in an inflammatory response in the pancreas (insulitis). Antibodies may be present for considerable time before the development of symptoms. In fact, by the time the disease is symptomatic, 80% of the beta cells are deactivated. Some experts believe that the beta cells are not destroyed, but instead they are disabled and may be able to be reactivated (Rebar et al., 2019).
TYPE 1 DIABETES: ETIOLOGY AND PATHOPHYSIOLOGY
Book Code: ANCCUS2423
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