Gestational Diabetes and Why YOU Should Know About It
What the heck is gestational diabetes? Why should it matter? It’s just diabetes…right? WRONG! We are here to make sure that you understand Gestational Diabetes before you hit the OB floor!
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I’m Marian and I am an ob nurse Sung. You might’ve been in my last session this morning where we talked about pregnancy planning, but right now we’re going to talk about gestational diabetes. Um, I’ve been an ob nurse for about 10 years. When I first graduated I did med surge in hospice, so have that experience also and then have just stuck with ob and loved it. Um, so I’m excited to talk to you guys about gestational diabetes and kind of what you need to know. The different, the testing that happens and the numbers that we’re looking for in that range. Um, at the end you guys have an opportunity to ask me any questions and it can be about gestation diabetes, it can be anything pregnancy related, um, communication related, anything you’ve seen in clinical that, um, is questionable or you’re unsure of and I’m happy to help or in class.
Um, all right, so let’s start. So gestational diabetes, um, so what this means is it is just diabetes that happens in pregnancy. Okay. So it’s different than our type one and our type two. So remember, type one, people are insulin dependent. People. And then type two are those that can take a pill, B, Diet control and that kind of thing. So we in gestational diabetes, these people were not pregnant or not, um, diabetic before pregnancy, they get tested, they become diabetic. And then once the pregnancy is done, it should be gone and they’re good. Um, that doesn’t always happen, but that’s supposed to be what happens. So in gestational diabetes it is just the pregnancy. So first let’s talk about what’s kind of happening with the body. So these women that are pregnant and if they are in their first trimester, so in their first trimester you have your insulin needs go way down. Okay?
So when that happens, you don’t need as much, um, your metabolism is faster, your body’s working hard to grow this baby. So these people actually, um, will any pregnant person will actually a lot of times have low blood sugar in the beginning of pregnancy because it hasn’t hit them yet. They haven’t gotten that, those extra hormones and all the extra stuff. So first trimester we’re typically going to decrease our insulin needs. Then we are going to hit the second and third trimester and that’s when things get crazy. Okay. So second and third trimester, and these women will have an increase in insulin resistance. So what does that mean? They’re going to need insulin or diet control, whatever it may be, um, to fix that. So we have an increase in insulin resistance. And the reason is because we have extra hormones. So remember hormones are kind of like steroids.
So think about, um, if you have your basic med surge patient, they get pre or that pregnant, they are not pregnant. They have steroids that are given to them in the hospital and sometimes they need insulin even if not diabetic, right? Because insulin or I’m sorry, hormones will increase blood sugar and steroids will increase that blood sugar. So in our second and third trimester, that’s when things get real. Um, we have an increase in insulin resistance and those hormones have increased. So we become diabetic, hopefully not, but they do. So let’s talk about this. This is going to be tested gestation IB at 28 weeks. So we are in that second and third trimester. Um, give or take a little bit. But this is when they typically on average we’ll do this screening and this is called the glucose screening.
So for any woman that is not already diabetic, we’ll have this screening done to see if she is being super resistant to insulin and needs to be seen for diabetes. So there’s two different tasks. So let’s talk about the first one. The first one is going to be a oral glucose tolerance test or OGT. So this patient comes in, she does not have to be fasting. Okay, we’ll compare the two. So not ha no fasting. She comes in and she is going to drink 50 grams of this oral glucose, just pure sugar, pretty much. Um, so she’s going to drink that and then at one hour, but drink at one hour, we are going to check her blood sugar. And based on that it’ll determine if she gets to have a further testing or if she’s good. So I will give you a number range, but remember, um, look at your book to see whatever your instructor’s telling you.
Because numbers sometimes vary between different labs and that kind of thing. But we would like to see this number less than 95 okay. So hopefully she has enough insulin can put out enough insulin to fix this after she drinks it and her blood sugar would be under 95 if it is less than that. So she has passed this test, then she doesn’t need any more screening. Okay. Let’s say her number was even just a hundred or higher. Um, she is going to need the three hour Glue Cola done. So let’s look at what that one is.
So our three hour we call a challenge three hour Glue Cola. All right? So these women, now they’ve failed that one hour and they come and they’re going to have this three hour glucose. These women must be fasting, okay? So hopefully they have an appointment early in the morning and they can be NPO after midnight. So they are fasting, they come in and they’re going to have a fasting blood sugar checked. Then they are going to drink 100 grams. So even more sugar, 100 gram pure sugar drink. Okay. And then she’s going to have a check done at one hour, two hours and three, um, after she has had that drink. So let’s look at our numbers for this. With the fasting, we are there again, we want it to be less than 95 bout. Now remember, just look at your notes and what your instructor says cause the numbers might vary and I don’t want you to get it wrong because of that.
Um, so she’ll drink the drink and then at one hour we want it to be less than one 80 at two hours, less than about one 55 in three hours, less than one 40 ish if she fails one of these numbers. So let’s say the fasting with like 80, um, the one hour was one 90 and these were are both under where they’re supposed to be. Then she’s okay if she fails to. So the key here is failing two of these, then she’s considered gestational diabetic and she will need to have followup with endocrinology. Um, maternal fetal medicine has high risk doctors sometimes to check on the baby’s growth and to get her a plan. So hopefully she can be diet controlled. Um, these women a lot of times can be if we just kind of helped direct them with what to eat. So Diet controlled, um, and then they might sometimes even need insulin.
So that will be with the three hour. Now the big thing here is after she delivers, so she goes on, she’s been diet controlled, she delivers her baby. Now typically we are good. So she’ll just see one more blood glucose checker with, typically we’ll do the next morning and just get a fasting and make sure it’s in a good range. If it is, then she’s good. If it’s not, then she will probably follow up with endocrinology to make sure these women that become gestational diabetic aren’t going to be more at risk later in life to get that type two diabetes. Um, and something else I want to tell you guys says we see here like what’s gonna Happen to the baby, right? That baby is going to be large cause that baby grows big and people don’t understand really the why behind us. So I want to make sure either mom’s sugar is high, right? We have um, increased glucose numbers because we’re gestational by that. So we have a placenta and glucose is going to cross that placenta and get to our baby. Okay, so sugar.
The Placenta Insulin,
Doesn’t that, it does not cross the placenta. So what’s happening, the baby’s getting all this extra sugar and the baby makes its own insulin. Insulin is a growth hormone, so the baby grows big because of the sugar or the extra sugar or not because sorry, because of the extra insulin they’re making secondary to the high blood sugars. So insulin does not cross the placenta, the baby, their own insulin. So let’s talk about this. These babies are born and we have to check their blood sugars after delivery. Right? Okay. So that’s something you’re going to want to make sure that that baby is being checked for a few blood sugars. The reason being is because the baby has been attached to that placenta. It’s gotten all this extra sugar and it’s made a ton of extra insulin to take care of that extra sugar. Well then the baby’s born and that lifeline is gone.
All that extra sugar is not there. So the baby has extra insulin and not enough sugar coming across the placenta because that baby’s getting a continuous flow of sugar and food from the mom, right? And nutrients until it’s born. And then it’s not getting as good of nutrition. So the extra sugar is not there to cross that placenta and the baby has extra insulin. If we have extra insulin, our blood sugars are going to drop, right? So we’ll check the baby’s blood sugars. Um, a lot of people want to know what the normal range for a baby. So totally different than an adult babies. And it’ll vary by hospital of course. But typically above 40, between 40 and 50 are going to be our numbers for blood sugar for a baby that we’ll watch for. So that’s actually the reason why maybe grows and why we’re doing that.
So I’ll give you guys a second if you have questions and write any questions down that you have. And while you’re doing that, all kind of put out some risk factors for the newborn that we might see. Um, cause I know it takes some time to take. So when these babies are born they are LGA or can be and that’s what we call large for gestational age. Right? So they’re bigger and we’re talking 4,000 rams, which is about like an eight and a half pound baby. So a good size baby guys we had two days ago and the 11 pound 12 ounce baby born was the biggest baby I have had. Um, anyways, so huge. The kid look like a toddler. All right, so were LGA and then they’re going to be at risk for things like um, injury at delivery, so shoulder to Socias, which this just means the baby got a little stuck, their shoulder, their head delivered and the shoulders are stuck cause they’re bigger. So shoulder dystocia, they could have a get a broken clavicle from delivery as they’re trying to be maneuvered out and that clavicle might break. Um, so just some of these injuries that they might have that might have more bruising occur all just from delivery, being bigger and trying to fit through a smaller space doesn’t always work. Um, so these large babies also will be more likely to be delivered by c-section. Also. What questions do you guys have?
no, I’ll get you guys the links. Alright, so I put our gestational diabetes lesson on NRSNG right here for ya and you should be able to click right in there. It’s also mentioned in the screening lesson, um, that I don’t have, but I can get for you all. Here is a link. This second one that I’m playing from NRSNG is just our lesson on diabetes. If you just want some review on that to compare with the gestational diabetes.
Samuel, let me see what you asked. Let’s see. Is anything below 4,000 considered LGA or 4,000 as a heart? Okay, so 4,000, something about 4,000 is going to be our hardest number. Um, so large for gestational age. If you think about and small for gestational age, it has to do with how old that baby is. So a baby that’s eight pounds and 36 weeks versus eight pounds and 40 weeks. Um, you know, the 36 week or that’s a very large for gestational age babies. So 4,000 is the hard number, but it also could just depend. Um, you know, if you have a baby that’s eight and a half pounds and she went to 42 weeks, then it might not be considered LGAs much because she was 42 weeks. Does that make sense? I’m before thousands. None of your typical number that you will see anything over 4,000 grams.
Yes. But the gestational age is what we’re talking about with that LGA large for gestational age. So kind of depends. But for testing purposes, 4,000 is really going to be that typical number that you’ll see. Um, so we would check blood sugars on any baby over 4,000 grams or that is large for gestational age. Um, and same thing, we check it on babies that are very small too because they’re not getting the same nutrition. Um, so we want to make sure that they come out and are doing okay. So those babies would also get checked.
Okay. And this other one is the link for, um, the Google doc forms. If you guys could feel that out cause it helps us or if you have any suggestions on topics that you’d like to see, I’m happy to take those down as well. And then let me get the any part on lesson for you all because that one has a lot of the testing in it and does also talk about the Glue Cola one. And so I want to get that link.
Bear with me
that 11 pound 13 ounces baby or 12, whatever it was. Now it’s all running together. Um, huge baby was born by c-section, thankfully, and I don’t think they had any idea that that baby was going to be that big.
Thighs were huge. Okay. And there is the Lincoln, it should take you right there in the NRSNG to the antepartum testing. Um, lesson. So that one goes through a ton of different of the testing, but gestational diabetes is also mentioned in there. But if you wanted more information on other testing as well, um, that’s there. So while I wait in case you guys have any other questions, I’ll kind of just recap everything. So, oh, and one thing I forgot to tell y’all. So when these women are getting ready to have their Nicola testing done, um, we want them to eat a regular dinner and regular food the day before. So remember that one hour, they don’t have to be fasting for, but so we want them to eat normal. If they don’t eat lettuce every day, um, then they shouldn’t just eat that before their test because they’re trying to have lower numbers, right?
We really want to see what the environment this baby’s living in. So a regular diet, um, is really important. So remember our one hour, they don’t have to be fasting. They come in, they drink that 50 grams of oral glucose, pure sugar, um, and then have a blood sugar checked an hour later. And that sugar should be less than ish 95 and then if it’s not, then they come back for three hour. If it is less than 95, then they are golden and good to go. Um, so they’ll come back and do their three hour. If it’s not and they’ll drink 100 grade, they’ll be fascinating this time. So they will get their fasting, which should be under 95 again, they’ll have the time to drink the 100 gram and once that’s done, they will get a one, two and three hour glucose. So that one hour we want to see less than one 80 and then it’s less than one 55 and less than one 40 are your key numbers around there.
Um, and remember they have to fail two of them. So if they fail to, then they will see endocrinology, um, get a referral out or maybe the doctor, the office has specialties that can do that. Um, and typically they will try to do diet controlled. Um, and they will have the women track their blood sugars. They’ll tell them when to test and keep a log of it. This is always really hard for these women because one, you’re pregnant and you want to eat whatever you can, right? And then also they have, um, you know, minimal knowledge about this probably, and then are all of a sudden are diabetic. It’s being thrown at them. Um, and so just trying to maneuver through, you know, it’s hard, you have a shorter amount of time to figure, okay, what foods can I eat, what should I eat and that kind of thing.
So they’ll meet with a dietician and talk about all the good stuff with that and then, um, be followed closely so they might have more any part on testings done, like non-stress tests and things like that to make sure that baby is living in a good, healthy environment. Um, think about your normal diabetic patient when it, that those vessels aren’t full of sugar, right? The bloods moving super slow. It can’t get through the weight, so it’s thick. Um, so when these women are pregnant, it’s the same thing going through that placenta, that blood is thick and not moving as well. So they need to make sure the baby’s in a good environment. Um, and remember, sugar crosses the placenta so the baby makes extra insulin and the insulin grows the baby big. Um, and then we’ll check blood sugars on that baby once it’s born. And maybe we’ll just one more fasting blood sugar on mom and then hopefully she’s good to go and doesn’t have any worries. Like I said, these women will be more at risk later in life to be adjusted or not gestational be I’m diabetic and they also, if they get pregnant again are going to be at rest of course again for gestation. Diabetes.
Any other questions? Make sure you guys do that. Google that form because it’s super helpful for us to make sure we get you what you need and that’s what we want. Give you guys another second just in case you have another question.
You’re welcome. You sometimes these babies are born and you can tell that mom was gestational diabetic and went undiagnosed. Sometimes they just, um, you know, make it just by a hair past that, um, oral glucose test in three hour and then the baby is huge. And that’s what happened with our 11 pound 12 ass. She failed her one hour past her three hour, and then clearly things went crazy in her body. All right, guys, go out and be your best selves today. And as always, happy nursing.