1. GDM DIAGNOSIS AND MANAGEMENT
DR.V.SEKAR
COIMBATORE DIABETES FOUNDATION
COIMBATORE,TAMIL NADU,INDIA

2. WDF GDM PROJECT TAMILNADU
PREVALANCE 2007
WDF GDM PROJECT TAMILNADU
RURAL 10.9 %
URBAN 18.7 %

3. UNIVERSAL SCREENING BECAUSE OF HIGH PREVALANCE
SELECTIVE SCREENING OR
UNIVERSAL SCREENING
UNIVERSAL SCREENING BECAUSE OF HIGH PREVALANCE

4. ONE STEP OR TWO STEP
ONE STEP APPROACH OGTT IN 100 GRAM GLUCOSE DIRECTLY TWO STEP APPROACH IT’S A SCREENING BY 100 GRAM GLUCOSE CUT OFF – 140MG/DL IDENTIFY 80 % GDM IF CUT OFF – 130MG/DL IDENTIFY 90 % GDM

5. PROFESSOR DR.V.SESHIAH
ONE STEP 75GRAM GLUCOSE LOAD 1HR BLOOD SUGAR TESTING CUT OFF 140MG/DL
HIGH RISK INDIVIDUAL SCREENING SHOULD BE DONE IN ALL TRIMESTERS – 1ST, 2ND & 3RD

6. SCREENING - HBA1C
NO ROLE IN DIAGNOSIS

7. DIAGNOSIS OF GDM WITH A 100GRAM OR 75 GRAM GLUCOSE LOAD
MG/DL
FASTING 95
1 HR
180
2 HR
155
3HR
140
75 GRAM GLUCOSE LOAD

8. CONT’ 2 OR MORE OF THE VENOUS PLASM
CONCENTRATION MUST BE MET OR EXCEEDED
FOR A POSITIVE DIAGNOSIS
THE TEST SHOULD BE DONE IN THE MORNING AFTER AN OVER NIGHT FAST OF BETWEEN 8 & 14 HR & AFTER ATLEAST 3 DAYS OF UNRESTRICTED DIET (> 150G CHO / DAY) & UNLIMITED PHYSICAL ACTIVITY
THE SUBJECT SHOULD REMAIN SEATED

9. INDICATION FOR SCREENING
FAMILY HISTORY OF DIABETES
OBESITY
BOH
INFERTILITY
PCO
RAPID INCREASE IN WEIGHT
INCREASED MATERNAL AGE
AC > 95%
HYPERTENSION

10. MANAGEMENT TARGET BLOOD SUGAR FASTING 70 – 90 MG/DL
POST PRANDIAL 90 – 120 MG/DL

11. ROLE OF SMBG
7 POINT BLOOD SUGAR PROFILE IN IDENTIFYING THE GLUCOSE INTOLERANCE DURING PREGNANCY

12. CLINICAL CASE STUDY
MRS.E.KRISHNAVENI 26YRS WITH NORMAL GTT - FASTING 88 1HR 142 2HR 122 3HR 109, HBA1C 5.9%.IVF CONCEIVED,WT GAINED 9KGS IN 6 MONTH AMENHORREA, SCAN REPORT SHOWS POLYHYDRAMNIOSIS PATIENT IS ADVICED TO TAKE NORMAL DIET WITH 7 PIONT BLOOD SUGAR PROFILE

13. CONT’ NAME DAY BBF ABF BL AL BD AD 3.AM E.KRISHNAVENI 1 ST 85 93 83
130 86
144 79
2 ND 75 98
134
136

14. MEAL PLAN
CALORIE DENSE DIET VS NUTRIENT DENSE DIET

15. GLYCEMIC LOAD
PUFFED RICE
RICE

16. CONT’

17. REDUCE AND REPLACE WITH VEGETABLES

18. GLYCEMIC LOAD NO FIBER

19. REDUCE THE QUANTITY OF RICE REPLACE WITH VEGETABLES

20. GLYCEMIC INDEX
RICE / RAGI KANJI
FRUIT JUICES

21. STANDARDIZATION OF FOOD
MEASURING SPOONS
MEASURING CUPS
WEIGHING SCALE
PRATICALLY HOW MUCH IT IS POSSIBLE

22. WEIGHING SCALE

23. DURING PREGNANCY CALORIE REQUIREMENT HAS TO BE MAINTAINED
WHY WEIGHING MACHINE ?
DURING PREGNANCY CALORIE REQUIREMENT HAS TO BE MAINTAINED
SIZE
MAY
VARY

24. HOW TO CALCULATE THE CALORIE REQUIREMENT ?
1ST TRIMESTER – PRE PREGNANCY WT * 30 CALS Eg: 60*30 = 1800 CALS CALS =1900 CALS /DAY 2ND TRIMESTER- PRE PREGNANCY WT * 30 CALS Eg: 60*30 = 1800 CALS CALS =2000 CALS /DAY 3RD TRIMESTER- PRE PREGNANCY WT * 30 CALS Eg: 60*30 = 1800 CALS CALS =2100 CALS /DAY

25. ROLE OF SMBG IN THE MEAL PLAN
NAME
DAY
BBF
ABF BL AL BD AD
3.00 AM
MRS .SANGEETHA
1ST 85
130 98 83 86
117 79
200 G IDLI
ADVISED SPLIT DIET
2 ND 72 94
105
111
150 G IDLI

26. INDICATION – MORE THAN TWO OCCASION THE CONTROL IS NOT ACHIEVED
INSULIN THERAPY
INDICATION – MORE THAN TWO
OCCASION THE CONTROL IS NOT ACHIEVED
FASTING > 90MG/DL ,POST PRANDIAL >120MG/DL
ABNORMAL SCAN REPORT
- AC 95%
- INCREASED FETAL GROWTH
- POLYHYDRAMNIOSIS

27. PRE MIX – BASAL BOLUS
PRE MIX – ADJUSTING THE DOSE ACCORDING TO THE NEED MAY NOT BE POSSIBLE
BASAL BOLUS – PRECIOUS ADJUSTMENT OF FASTING,POST PRANDIAL CONTROL IS POSSIBLE

28. SHORT ACTING ANALOGUE
LISPRO OR
ASPART

29. MONITORING
REGULAR SMBG

30. THANK YOU