The role of nurses in gestational diabetes. (DIABETES CARE)(Brief Article)
Journal of Diabetes Nursing | May 1, 2003 |
Research studies, recently conducted in America, have found that diet and exercise play an important role in predisposing a woman for gestational diabetes (GD). This study compared the rate of insulin treatment and perinatal outcome in women with gestational diabetes under endocrinologist-based versus diabetes nurse-based metabolic management. A total of 244 participants received endocrinologist-based care and 283 participants received diabetes nurse-based care. A retrospective analysis was carried out comparing maternal characteristics, rate of insulin treatment and perinatal insulin requirements, in comparison with those who had used diet and exercise as a controlling factor for their diabetes. Pregnancy imposes a great amount of stress on most bodily functions and it is certain that glucose metabolism is no exception. Gestational Diabetes Mellitus is a type of diabetes, which occurs during pregnancy, distinct from the condition that already existed. It is defined as a glucose intolerance of variable degrees with onset or first recognition during pregnancy; it will generally develop in the latter half of the pregnancy and will improve after delivery (Colman, 2004). Gestational Diabetes is generally not dangerous to either mother or fetus. The disease itself is usually mild and even asymptotic; however there is an increased incidence of foetal and perinatal complications (Guthrie & Guthrie, 2004). In addition, if an unreasonable amount of sugar is allowed to circulate in the mother’s blood and then to enter the fetal circulation, potential problems for both mother and baby are serious. The mother’s pancreas work’s overtime to produce insulin, but it is not enough to lower blood sugar levels. Glucose will then cross the placental barrier, increasing work on the pancreas of the fetus, which uses insulin to convert the glucose into energy. The baby has more energy than is required so it converts this energy into fat stores, resulting in large birth weight babies and all the problems that can be associated with that (http://diabetes.org). At each visit to the doctor a sample of urine is taken, this is then tested for glucose levels. Sugar in the urine may be the first indications of Gestational Diabetes. Also, during the fifth month a glucose tolerance test is now a routine test for pregnant women. A Glucose Tolerance Test is when the women provide a blood sample taken before and after consuming a glucose drink, glucose levels >9.0mmol/l indicate Gestational Diabetes is present. However this may be performed earlier on someone who is considered as being at risk (Colman, 2004). The incidence of gestational Diabetes has increased a significant amount, between35% and 59%, over the past ten years (http://diabetes.org). Studies have found that the figures have shown an alarming incline in the amount of women being diagnosed with this gestational Diabetes. It is now believed that between 2 and 12% of pregnant women suffer from Gestational Diabetes (Guthrie & Guthrie, 2002). Testing has now become routine for pregnant mothers, so it is being discovered earlier in the pregnancy and as a result is now being treated much sooner. Because of this routine testing the chance of miscarriage and perinatal loss has been greatly reduced. The survival rate of these infants has increased from less than 70% a few years ago to nearly 98% now, a figure which has only come about through care specializing in diabetes in pregnancy, routine testing of all pregnant women and the best care available (Guthrie & Guthrie, 2002). Even though gestational Diabetes is now being discovered more often and being medically controlled a woman who has had Gestational Diabetes will have a much higher chance of developing diabetes later in life. If insulin was required as treatment, there is a 50% chance of diabetes...
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