EASY TO FOLLOW POWERPOINT PRESENTATION ON GDM USEFUL FOR HEALTH CARE PROVIDERS AND ALL WOMEN OF REPRODUCTIVE AGE GROUP

1. GESTATIONAL DIABETES DR.RISHIKESAN K.V VENNIYIL MEDICAL CENTRE

9. CHO Metabolism

17. Vad happens to the carbohydrates from the food? gdm Insulin from the pancreas - - - - - Fat/muscle cell Stored sugar in the liver (glycogen) Carbohydrates from food

43. Women with gestational diabetes typically have normal blood sugar levels during the first trimester, allowing the body and body Systems of the fetus to develop normally.

44. The fact that you have gestational diabetes will not cause diabetes in your baby. However, your child will be at a higher risk for developing type 2 diabetes in adulthood and may get it at a younger age (younger than 30).

45. As your child grows, taking steps such as: eating a healthy diet, maintaining a healthy weight, and getting regular, moderate physical activity can help to reduce his or her risk. Macrosomic, or large-bodied babies are at higher risk for childhood and adult obesity.

46. Magnetic Resonance Image of Pregnancy Complicated by Diabetes Normoglycmia Hyperglycmia Jovanovic L et al. Am J Perinatol . 1993;10:432-437

47. Macrosomia

48. Gestational Diabetes

63. Eating a healthy diet Meal Plans of 42 PBRC 2006 CHO counting With this meal plan, the number of grams of carbohydrates that is eaten at each meal or snack is counted to make sure that they are within a certain range. A meal plan may be very specific, allowing a specified amount at each meal or snack, or it may be more general, with a daily carbohydrate total. The exchange system The exchange system groups each food consumed into one of the following food groups: bread/starches, fruits, vegetables, proteins, milk, and fats. Each food within a group has very similar amounts of carbohydrate, fat, protein and calories, but the amounts of vitamins and minerals may vary. In this plan, the number of items from a food group that is eaten at each meal is counted. There is a designated amount for each group every day.

64. Eating a healthy diet to keep blood sugar in check: of 42 PBRC 2006 Eat meals and snacks on a regular schedule throughout the day Researchers recommend that women with gestational diabetes should eat at least three small-to-medium sized meals and two to four snacks every day. Eat smaller amounts of carbohydrates at each meal It is preferable to eat several small meals every day rather than one large meal. Carbohydrates will increase blood glucose level directly, therefore, eating a small amount of carbohydrates all through the day will help keep blood sugar from rising too high. Add a nighttime snack to your meal plan A snack of one or two servings of carbohydrates before bedtime will keep blood sugar at a healthy level during sleep. Some healthy examples could include: a piece of fruit, a handful of pretzels, or crackers.

70. Role of moderate physical activity General Guidelines For Physical Activity gdm Do Don’t Participate in moderate and regular physical activity unless prohibited by a health care provider Get too tired while working out or doing physical activity Choose activities like swimming, that don’t require a lot of standing or balance Do any activity while lying on your back when you are in your 2 nd or 3 rd trimester of pregnancy Wear loose, light clothing that won’t cause excessive sweating or increased body temperature Perform activities in very hot weather Drink a lot of water before, during, and after your activity Perform activities that may bump or hurt your belly, or that may cause you to lose your balance Eat a healthy diet and gain the right amount of weight Fast (skip meals) or do physical activity when you are hungry Watch your level of exertion (Can you talk easily?) Over-exert yourself

73. Maintain a healthy weight Weekly Rate Of Weight Gain gdm A weight gain of two pounds or more each week is considered high . Time Frame Expected Weight Gain In the first trimester of pregnancy (the first 3 months) Three to six pounds for the entire three months During the second and third trimester (the last 6 months) Between ½ and 1 pound each week If you gained too much weight early in the pregnancy Limit weight gain to ¾ of a pound each week (3 pounds each month) to help get your blood sugar level under control

85. Neonatal Malformations Are Not Related to Type of Insulin 0 2 4 6 8 10 12 14 16 GDM Preexisting diabetes Regular human insulin Insulin lispro Congenital malformation rate (%) Bhattacharyya A et al. Q J Med. 2001;94:255-260 7.9% 6.6% 15.8% 3.8% N=213 N=97 P =0.79 P =0.16

86. Malformations Are Related to Glucose Not Type of Insulin Wyatt JW, Frias JL, Hoyme HE, Jovanovic L, et al. Congenital anomaly rate in offspring of pre-gestational diabetic women treated with insulin lispro during pregnancy. Diabetic Medicine 21:2001-2007, 2004.

89. Before any physical activity is begun, you should test your blood sugar. If it is low, do not begin the activity. Eat something and test again to make sure it is higher before beginning

90. Why does low blood sugar occur? Too much exercise Skipping meals or snacks Delaying meals or snacks Not eating enough Too much insulin

93. Things to keep in mind about delivery gdm Blood Sugar and Insulin Balance Keeping blood sugar levels under control during labor and delivery is vital for both you and your baby’s health. If you did not have to take insulin during the pregnancy, then you won’t need it during labor or delivery; however, if you did have to take insulin during pregnancy, then you may receive an insulin shot when labor begins or during labor. Early Delivery Gestational diabetes puts women at higher risk for a condition known as preeclampsia late in pregnancy. Preeclampsia is a condition associated with sudden blood pressure increases, which can be quite serious. Unfortunately, the only cure to preeclampsia is delivery of the baby, but delivery may not be the best option for your health or for the health of your baby. Your health care provider will keep you under close watch if this condition develops, determining whether early delivery is safe and needed. Cesarean Delivery This is a type of delivery used to deliver the baby, as opposed to natural delivery through the vagina. Cesarean delivery is also referred to as a cesarean section, or “C” section. Simply having gestational diabetes is not reason alone to have a C section, but your health care provider may have other reasons for choosing this option, such as changes in your health or your baby’s health during delivery.

98. Breastfeeding is also believed to help lower fasting blood glucose levels in mothers.

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