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Diabetes in Pregnancy
MC Gupta, Nidhi Gupta
CHAPTER 1:
Overview of Diabetes Mellitus
INSULIN THERAPY
Indications
Amounts of Insulin
Insulin Initiation
Substitution
Supplement
Adjustment to Morning Injection
Adjustment to Evening Injection
CHAPTER 2:
Physiology of Fuel Metabolism
FUEL METABOLISM IN THE NORMAL NON-PREGNANT
In the Fed State
In the Fasted State
CARBOHYDRATE METABOLISM IN A NON-DIABETIC PREGNANT
In the Early Stages of Pregnancy
In Later Pregnancy
FUEL METABOLISM IN DIABETIC PREGNANCY AND GESTATIONAL DIABETES
CHAPTER 3:
Renal Glycosuria in Pregnancy
MANAGEMENT
CHAPTER 4:
Classification of Diabetes in Pregnancy
CHAPTER 5:
Gestational Diabetes Mellitus (GDM)
DEFINITION
DETECTION AND DIAGNOSIS
Risk Factors
Oral Glucose Tolerance Test for Screening GDM
One Hour 50 gm Glucose Load Challenge Test (O'Sullivan 1973)
3-hour 100 gm Glucose Load Challenge Test
Random Plasma Glucose Sampling (RPG)
Glycosylated Blood Proteins
Fructosamine Assay
Current Recommendations for Screening for GDM (Flow Chart 5.1)
PATHOGENESIS OF GDM
FETAL COMPLICATIONS OF GDM
Macrosomia
Neonatal Hypoglycaemia
MANAGEMENT OF GDM (Flow Chart 5.2)
Diet
Exercise
Insulin
Principles of Therapy
Oral Glucose Lowering Agents
Monitoring of Fetal Wellbeing
Obstetrical Management
Follow up Testing
Contraception
CHAPTER 6:
Pregestation Diabetes
INCIDENCE
EFFECT OF HYPERGLYCAEMIA IN PREGNANCY
Spontaneous Abortions
Polyhydramnios
Pre-Eclamptic Toxaemia and Hypertension
Infections
Postpartum Bleeding
Caesarean Section
Ketoacidosis
EFFECT OF HYPERGLYCAEMIA ON THE FETUS
Congenital Malformations
Respiratory Distress Syndrome (RDS)
Fetal Deaths
Macrosomia and Birth Trauma
Hyberbilirubinaemia
Hypoglycaemia
Hypocalcaemia
Predisposition to Diabetics
EFFECT OF PREGNANCY ON DIABETES
PROGNOSIS IN DIABETES COMPLICATING PREGNANCY
Maternal Mortality
Perinatal Mortality
MANAGEMENT
Metabolic Control
Recommended Plasma Glucose Levels
Blood Glucose Monitoring
Diet
Insulin Therapy
Insulin Requirement during Pregnancy
Role of Oral Hypoglycaemic Agents in Pregnant Diabetics
Treatment Aimed at reducing Perinatal Mortality (PNM)
Perinatal Mortality
Prevention of Macrosomia
Prevention of Congenital Malformations among Infants of Overt Diabetic Women
Prevention of Intrauterine Death
Antepartum Fetal Surveillance and Its Significance
Timing of Delivery in Diabetic Pregnancies
Glycaemic Control of Patient
Maternal Factors
Fetal Factors
Route of Delivery
Intrapartum Management
In Case of Spontaneous Labour
If Labour is to be Induced
In Case of Elective Caesarean
Postpartum Management of Diabetic Mother
Contraception
Care of the Infant
Hypoglycaemia
Hyperbilirubinaemia
Hypocalcaemia
Respiratory Distress Syndrome
Hyperviscosity
Poor Feeding
Congenital Anomalies
CHAPTER 7:
About Insulins
ABOUT INSULINS
Action
Regulation of Insulin Secretion
Chemical
Hormonal
Neural
CNS
Fate of Insulin
Conventional Preparations (Table 6.6)
Reactions to Insulin
Drug Interactions
More Purified Insulins
Single Peak Insulins
Monocomponent Insulins
Human Insulins
Advantages
Indications
Newer Insulin Delivery Devices
Storage of Insulin
CHAPTER 8:
Management of Special Situations of Diabetes in Pregnancy
MANAGEMENT OF UNSTABLE INSULIN DEPENDENT DIABETIC PATIENTS
Somogyi Phenomenon
Dawn Phenomenon
Hypoglycaemic Episodes
Change in Insulin Pharmacokinetics
Insulin Pumps
MANAGEMENT OF INSULIN DEPENDENT DIABETIC PATIENT WITH END ORGAN DAMAGE
Diabetic Nephropathy
Diabetic Retinopathy
Diabetic Cardiomyopathy
Diabetic Neuropathy
MANAGEMENT OF DIABETIC KETOACIDOSIS
MANAGEMENT OF PRETERM LABOUR IN DIABETICS
MANAGEMENT OF PREMATURE RUPTURE OF MEMBRANES IN PREGNANT DIABETICS
PROTEINURIC HYPERTENSION
POLYHYDRAMNIOS
RENAL GLYCOSURIA
CHAPTER 9:
Preconception Care Programme for Women with Diabetes (Based on American Diabetes Association Recommendations)
IMPORTANT ELEMENTS
SPECIFIC GOALS OF TREATMENT
INITIAL VISIT
Medical and Obstetrical History
Physical Examination
Laboratory Evaluation
Management Plan
CONTINUING CARE
Appendices
APPENDIX 1: DIABETES TREATMENT CHART
APPENDIX 2: DRUG INTERACTIONS
Drugs that may Alter the Glycaemic Control of Sulfonylureas
Enhance Hypoglycaemic Effect (Decrease Blood Glucose)
Decrease Hypoglycaemic Effect (Increase Blood Glucose)
Drugs that Interact with Insulin
Enhance Hypoglycaemic Effect (Decrease Blood Glucose)
Decrease Hypoglycaemic Effect (Increase Blood Glucose)
APPENDIX 3: MANAGEMENT PLAN OF GESTATIONAL DIABETES MELLITUS
APPENDIX 4: STEPWISE MANAGEMENT OF DIABETIC PATIENTS REQUIRING SURGERY
Preoperative Management
Perioperative (During Surgery) Management
Postoperative (After Surgery) Management
APPENDIX 5: PATIENT COUNSELLING
APPENDIX 6: EXAMPLE OF AN INSULIN REGIME DURING LABOUR FOR PATIENTS WITH TYPE I DIABETES
APPENDIX 7: VARYING CRITERIA FOR DIAGNOSIS OF GESTATIONAL DIABETES
Bibliography
INDEX
TOC
Index
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