In this lesson plan, my audience is pregnant women. Diabetes mellitus is a common complication in pregnancy with severe consequences for both mother and the fetus. After diagnosis, the patients with diabetes need to be enlightened about the importance of adherence to self-care guidelines for a better outcome of pregnancy. Self-care of diabetes mellitus in pregnancy is a useful modality of preventing both acute and chronic complications of the condition in mother and fetus. Indeed, self-care management of gestation diabetes helps in controlling the progress of the disease as well as the prevention of type 2 diabetes mellitus.
Definition of Gestational Diabetes and Its Complications
Gestational diabetes is any glucose intolerance which is recognized for the first time when a woman is pregnant (Mumtaz, 2000). It is the apparent cause endocrine disorder that complicates pregnancy and affects up to 5% of pregnancies. At the start of the second trimester, the patient develops resistance to insulin due to high levels of hormones such as cortisol and estrogen. GDM develops when the pregnant women are not able to produce enough insulin to compensate for the resistance. The result is maternal hyperglycemia which causes a fetal hyperinsulinemia in an attempt to counter the excess glucose being transferred across the placenta.
Some maternal complications that are attributed to GDM can also be due to pregnancy. Polyuria and lethargy are common occurrences in pregnancy and can also be due to GDM. However, some complications are due to diabetes exclusively.
Increased Hypoglycemia Attacks
The attacks occur when blood glucose level drops below the body requirements, usually below 60mg/dl. This is caused by the production of high levels of insulin. The signs and symptoms include sweating, tremors, confusion, dizziness, rapid heartbeat, hunger, headache, and fatigue.
Increased Ketoacidosis episodes
These episodes are due to high blood glucose levels as a result of lack of insulin or due to peripheral resistance to insulin. The signs and symptoms include increased urine production, increased thirst, drowsiness, and lethargy.
Preeclampsia
Increased blood glucose levels lead to hypertension during pregnancy. The high blood pressure may be accompanied by convulsions leading to eclampsia.
Other complications include polyhydramnios which the woman has more than reasonable amounts of amniotic fluid in the uterus. The patient will have increased urinary tract infection rates such as candidiasis. Delivery complication include increased cesarean rates and traumatic deliveries due to fetal macrosomia.
Fetal Complications
Congenital abnormalities such; anencephaly, myelocele, hydrocephalus in the nervous system; dextrocardia, ventricular septal defects in the heart; skeletal caudal regression and spina bifida in the vertebral and renal agenesis and hypoplasia (Kampmann, 2015). Fetal macrosomia due to hyperglycemia which causes increased fat deposition.
Respiratory distress syndrome
Neonatal metabolic abnormalities such as hypoglycemia and hyperbilirubinemia.
Increased neonatal and perinatal mortality due to birth trauma and complications.
The child has a long-term predisposition to childhood obesity and metabolic syndrome.
Risk Factors and Screening of Gestational Diabetes
Various Factors Contribute To The Development of Gestational Diabetes.
These include Maternal age >25yMaternal overweight or obesity- BMI > 25
Previous GDM
Family history of DM in 1st-degree relative
Previous macrosomic baby(4kg or more)
Previous unexplained stillbirth
Various Screening Methods Have Been Developed For Gestational DM. Two Methods Are Explained Below.
The glucose challenge test is done for patients with risk factors. The patient ingests 50g of glucose, and after one hour the blood glucose level is tested. A value higher than 140mg/dl is a positive screen, and the patient should proceed to the next step below.
Oral glucose tolerance test is done by the fasting patient taking 75g of glucose. The blood levels are monitored over two hours. The test is diagnostic for GDM if the fasting glucose is above 126mg/dl or the venous glucose level is above 140mg/dl after two hours.
Self-Care of Patients With Gestational Diabetes
Tight control of glucose in diabetes is crucial in preventing the progression of diabetes in pregnant patients. Strict glycemic control entails ensuring that the level of glucose is kept as close to the normal as possible.
Pregnant diabetic patients can accomplish tight glycemic control using several ways. The methods of maintaining strict glycemic control should be well known and followed.
Pregnant Diabetic Patients Need To Focus On Eating The Recommended Healthy Diet And Taking Exercises.
Measurement of the glucose level frequently helps in maintaining the level of glucose within the recommended ranges.
The prescribed medications are crucial in the management of diabetes in pregnancy, and the patient needs to take them in the recommended dosage without skipping. Proper intake of medications supplement the lifestyle modifications are necessary to achieve the recommended glucose target.
Insulin is the most important medication in the management of diabetes in pregnancy. Patients should inject the recommended dosages of insulin during the required intervals.
Oral antidiabetic medications, if prescribed, need to be taken as instructed by a qualified doctor (Negrato & Zajdenverg, 2012). Proper intake of medications supplement the lifestyle modifications are necessary to achieve the recommended glucose target. The safety of oral antidiabetic drugs should be determined by the physician.
Self-Monitoring of Blood Glucose Is An Essential Aspect Of Diabetic Management During Pregnancy.
Self-monitoring of the blood sugar allows the patients have an idea about the most critical method for optimizing the blood sugar. Self-monitoring of the glucose levels is also helpful as the patients can check the effectiveness of the modalities employed in controlling the glucose levels.
Self-monitoring of blood glucose is accomplished by taking daily tests of glucose and keeping a record of the noted value.
The frequency of the daily tests of blood glucose is individualized. Those women whose treatment is based on diet control can measure their glucose levels up to four times in a day. Those on both exercise and dietary therapy with adequately controlled blood glucose levels can lower the frequency to two times daily (Alfadhli, 2015).
Patient's Factors Such As The Level of HBA1c Influence The Frequency Of Glucose Self-Monitoring Tests.
Teaching Strategies and Evaluation
The lesson will involve the use of PowerPoint oral presentations. Other activities will include the use of prepared videos demonstrating how to self-inject insulin to various body parts. Recorded videos will demonstrate how to mix multiple insulin types. The combination of both audio and visual strategies has been proven by the dual coding theory and is useful for retention of information (Killian n.d).
Evaluation of understanding of the objectives will mainly be by answering a few questions based on the subject. In groups, the audience will provide answers to questions set from the taught topic to test for comprehension. They will be expected to demonstrate how to mix insulin and self-inject. The patients should be able to carry out those activities to show that the objectives have been met.
References
Alfadhli, E. M. (2015). Gestational diabetes mellitus. Saudi Medical Journal, 36(4), 399406. http://doi.org/10.15537/smj.2015.4.10307
Kampmann, U., Madsen, L. R., Skajaa, G. O., Iversen, D. S., Moeller, N., & Ovesen, P. (2015). Gestational diabetes: A clinical update. World Journal of Diabetes, 6(8), 10651072. http://doi.org/10.4239/wjd.v6.i8.1065
BIBLIOGRAPHY \l 1033 Killian, S. (n.d.). Top 10 Evidence-Based Teaching Strategies. Retrieved from The Australian Society for Evidence-Based Teaching: http://www.evidencebasedteaching.org.au/evidence-based-teaching-strategies/
Mumtaz, M. (2000). Gestational Diabetes Mellitus. The Malaysian Journal of Medical Sciences : MJMS, 7(1), 49.
Negrato, C. A., & Zajdenverg, L. (2012). Self-monitoring of blood glucose during pregnancy: indications and limitations. Diabetology & metabolic syndrome, 4(1), 1.
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