Question

Case Study 26-1: New Onset of Type 2 Diabetes during Pregnancy rudy, 43 years old, was overjoyed to receive confirmation from her physician that she was indeed pregnant after three years of trying to conceive. After a prenatal exam that determined she was at 7 weeks gestation, blood was drawn as a routine part of the evaluation. Judy's physician told her she would have her nurse call Judy the next day with the laboratory results. Judy found it surprising to hear her physician's voice on the phone the next morning at 8:15 a.m. instead of that of the physician's nurse. Her physician asked her if she had eaten or drunk anything yet that morning. When Judy said no, her physician ordered her to return to the clinic immediately to repeat her lab work in a fasting state. Judy rushed to her physician's office where she was informed that her random plasma blood glucose was 348 at 4 p.m. yesterday and a glycated hemoglobin of 12.3% indicated her blood glucose has been high for at least the past few months. A fasting plasma blood glucose, done immediately upon Judy's arrival at the clinic, showed a value of 235 mg/dL, confirming a diagnosis of type 2 diabetes. Diabetes didn't run in Judy's family and she had been in good health up until that point, as far as she knew. She acknowledged she hadn't had any blood work done in the past two years as part of her annual physical exams with her former primary care physician. There were multiple questions swirling around in Judy's mind and she was extremely fearful of losing her baby. She begged her physician for help and her physician promptly introduced Judy to the diabetes management team at the clinic. 1. What type of diabetes does Judy have? 2. What dietary modifications might Judy need to make? 3. What is the likelihood that Judy will need to start on insulin to manage her diabetes during her pregnancy? 4. What are the risks to Judy and her unbom baby if she doesn't manage her blood sugar carefully 5. Could the results of Judy's elevated glycated hemoglobin be related to her three miscarriages in the past two years? MacBook Air

Answer 1

1.Type 2 diabetes

A type of diabetes in which the process of insulin utilisation of our body is destroyed causing insulin resistance.

2. Dietary modifications

• Eat regular meals including small and frequent feeds allowing 2 to 4 snacks a day to control glycemia.
• Eat a well balanced and nutritious diet including fruits and vegetables,whole grains and legumes and lean meats,low fat diary products.
• One serving of protein should be included in the diet. Protein rich foods are egg,nuts,beans etc.
• Include folic acid supplements like spinach,calcium supplements like milk and broccoli,vitamin D supplements like salmon and iron supplements like lean red meat in the diet.

3. Fasting plasma blood glucose level of 235 mg/dL.

4. Risk in judy include - Miscarriage,high blood pressure,pre-eclampsia,vision problems,heart disease.

Risk for unborn baby include-

Brain and spinal defects,increased risk of miscarriage, Macrosomia(larger than average size),heart problems,cleft palate,kidney and gastrointestinal tract disorders,jaundice,hypocalcemia, polycythemia.

5. Yes,poor control of blood glucose level leading to elevated glycolated hemoglobin causes miscarriage.

Glycated hemoglobin shows how properly the diabetes is controlled in an individual.It is less than 7% in a well controlled diabetes patient.