Cover image for: Gestational Diabetes Mellitus
Details
CPD1h 25m of CPD
Rating
4.7
Total Rating(s)35
Publish Date17 June 2018
Review Date13 March 2020
Expiry Date17 June 2020
Recorded InMelbourne, Australia

Course Overview

This Course is designed to provide up-to-date information on gestational diabetes (GDM) given several recent changes in management. It will discuss predisposing factors for GDM, changes to treatment and diagnostic criteria, and how a diagnosis of GDM impacts subsequent pregnancies and ongoing health.

Topics include:

  • Overview and risk factors
  • Treatment
  • Education and future

Target audience

Health professionals currently or intending to work with pregnant women with or at risk of developing gestational diabetes mellitus.

Purpose

Provide up-to-date information focusing on the pathophysiology of hyperglycaemia during pregnancy, contributing causes/risks of developing gestational diabetes mellitus (GDM), and diagnosis and treatment/management strategies during antenatal, labour and postpartum periods.

Need

Health professionals need to be aware of the prevalence of GDM and the symptoms of this disease in order to identify women who may be at risk. They must also be aware of the management of GDM, which aims to normalise maternal blood glucose levels as soon as possible, reduce foetal and maternal risks, and reduce the long-term risk of developing type 2 diabetes.

Education that addresses this is timely in order to improve maternal outcomes

Learning Outcomes

  • Explain the pathophysiology of gestational diabetes (GDM)
  • Describe the risk factors and diagnostic criteria
  • Identify clinical targets and general management principles for antenatal, labour and postpartum care

Disclosure

No conflict of interest exists for anyone in the position to control content for this activity. Wherever possible, generic or non-proprietary names of medications or products have been used.

Educator

Portrait of Michelle Robins
Michelle Robins

Michelle Robins is a credentialled diabetes educator with 23 years experience in many aspects of diabetes care and education. She is currently employed as a nurse practitioner by Northern Health. Her past employment, as a diabetes educator, has included major tertiary hospital settings – including St Vincent's Hospital Melbourne, Melbourne Division of General Practice, Melbourne Extended Care and Rehabilitation Service, and, in Queensland, Logan/Beaudesert Health Service. Michelle has served on more than 40 diabetes-related committees, written book chapters and is consistently highly evaluated in her teaching role.

Details
CPD1h 25m of CPD
Rating
4.7
Total Rating(s)35
Publish Date17 June 2018
Review Date13 March 2020
Expiry Date17 June 2020
Recorded InMelbourne, Australia
Topic Tags
Diabetes Mellitus
Pregnancy
Midwifery
Maternal and Child Health
Women's Health
Reproductive Health
Nutrition
Neonatal
Obstetrics
Endocrinology
Disclaimer

Further Learning

Learner Reviews

4.7

35 Total Rating(s)

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Maura Penn
17 Feb 2019

Informative but presentation quite boring

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Lisa Ajala
07 Feb 2019

I found this lecture/course very helpful for my role as an antenatal midwife. It strengthened the knowledge I already have and has given me more confidence to better educate my patients in relation to GDM. The presenter was easy to understand and clearly knowledgable in her field. Would highly recommend to others!

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Toni Hosking
24 Jan 2019

Well spoken. Did not know that drinking through a straw made it easier.

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Margrite Mary Behm
24 Jan 2019

Very well presented. Lots of relevant information given in an easy to understand manner.

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Hellene Heron
22 Jan 2019

Best one I have seen great presenter very knowledgeable recommend this to all midwives

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Samantha Bock
23 Dec 2018

I found this very informative and enjoyed it.

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Juanita Ricciardi
10 Dec 2018

Using the term Anglo Saxon is rather incorrect and isn’t helpful in terms of ethnicity and population. Does she mean Northern European or European? Many people do not have British isles ancestry and are also not part of the mentioned high risk populations. For example where does someone from a polish background or someone from an Italian background stand ..... many Australians from Europe are not descended from the British isles.

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Debbie Mitschuinig
01 Dec 2018

Risk factors affecting 1 in 6 lives. Hormones are produced during pregnancy through the placenta. Care of medication administration is needed as well as some medications such as cortisol and prednisone can increase blood glucose levels. Pregnancy females can be insulin resistant, insulin sensitive or impaired first phase insulin. Testing is performed by 75g oral glucose test, resulting in fasting >=5.1 to confirm a diagnosis. Risk factors include ethnicity, diet and weight of the female prior to early pregnancy. Biggest risk factor impacting is insulin resistance, caused by the placenta. Treatment can be diet control, however pregnancy females need to reduce or limit their carbohydrate intake, spread carbohydrates throughout the day, with 3 meals and 3 snacks and maximize physical activity. NDSS is a free registration for information, provision of cheaper BGL test strip and needles are free if insulin is required. There is no risk to the baby when injecting insulin, it does not cross the placenta. Babies are usually larger in size. Risk of foetal macrosomia, as babies can fracture their limbs during birth, dislocate shoulders during birth as well. Babies increase their own insulin and they can suddenly drop levels which can have an enormous impact in feeding and bonding, can also cause irreversible brain damage to the baby. Macrosomia can occur 40% if left untreated of the GDM. There is also an increased risk of preeclampsia especially if the blood glucose levels are poorly controlled. Metformin is used for Ts2DM if there is a decrease insulin resistance, therefore will reduce the risk of pre eclampsia. Poorly controlled with increase the rate of emergency caesers and induction rates, there can be an increase in post partum, depression and babies in neonate have reduced bonding and feeding problems. The female needs to control diabetes. Perinatal complications : decrease risk of stillborn, neonatal death, shoulder macrosomia and neonate surgerys when BGL are controlled. Insulin is needed in 50-80% of the time. Abdomen is preferred site of injection, cannot inject the baby as the needle is small and is injected at a 90 degree angle. Commence on small doses and women self titrate. Hormones from the placenta affect the mums therefore they will need to use insulin. They rarely have hypoglycaemia. Lantus is rarely used - unsure it is 100% safe to use during pregnancy. Metformin can be used - it is ok during breast feeding. Injection into the abdomen fat - hardly any nerves. No issues in the 1st trimester, 2nd and 3rd trimester they can use lateral (side) of the abdomen for injecting. Not suitable for the upper muscle in the thigh, best to inject into the outer thigh. During Ramadan with GDM prefer no fasting. Fasting carry's a risk, additional appointments for mum, more testing, monitor the types of eating at sunset and sunrise, may need additional fluid before sunrise. Increased fasting level the placenta pushed up the level overnight. Nightly Protophane is a good insulin to address fasting BGL. Amount to start depends on the level of BGL and test fortnightly. Discard insulin after one month, even if not all used. Use a new device. Macrosomia is baby birth weight over 4500g or greater than 90% of gestational age. More common in obese females with poorly controlled or unknown GDM. Increased risk of developing GDM in Polycystic Ovarian syndrome because its already insulin resistance, therefore increased risk of developing GDM. Fasting BGL results for a female diagnosed with GDM is >= 5.1mmol/L. Urine glucose no longer used to diagnose GDM as mum may be glucose in urine although BGL is normal. Education and future GDM: food use a healthy plate model weight gain during pregnancy. put into perspective the starting weight, mum looses weight if healthy diet is used. Post meal increased BGL on target - meal is good -may need a fast acting insulin eg Humalog or novarapid - peaks 1 hour out of the system 3-4 hrs Post dinner and fgasting is too high. Post breakfast and lunch is ok then the patient may need to change to a pre mix to reduce BGFL. May change insulins to suit the patient. Must do the testing 4 times per day Ongoing anti natal care - endocrinologist. Ultrasound 22weeks, 32 weeks and 36 weeks weight and BP to be monitored Increased BGL - salbutamol and corticosteroids Timely delivery - 41-40 induction optimal BGL normal foetal growth - no complications Induction 38-40 weeks Caeser 38-39/40 weeks is elective only Alarm bells and/or issues then induction be earlier.

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Jaydan greaves
30 Nov 2018

Very well done, would highly recommend

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Sheldon George
15 Nov 2018

Through knowledge and good teacher love it