Maternity - Pregnancy, part 10: Complications: Gestational Diabetes Mellitus

Hi, I'm Meris, and in this video, we're going to be talking about gestational diabetes mellitus. This is super duper important for you to have a really good grasp of during your maternity course because there's a lot of important patient teaching for a patient with gestational diabetes. And also, there are important things to know about how it impacts the baby. So I'm going to be following along using our maternity flashcards. These are available on our website, leveluprn.com, if you want to get a set for yourself, and if you already have one, I would absolutely invite you to follow along with me. All right, let's get started.

Okay, so first of all, what is gestational diabetes? Well, it is diabetes during pregnancy, and this is in someone who is not diabetic to start with. So your patient with gestational diabetes is going to have impaired glucose tolerance during pregnancy.

So what are the risk factors? Well, kind of the same for diabetes mellitus otherwise. So for like type 2, for instance. So obesity, if your patient had gestational diabetes in a prior pregnancy, they're at risk, a strong family history of diabetes or gestational diabetes, hypertension, all of those things are going to put your patient more at risk.

Now, signs and symptoms, your patients are usually going to be asymptomatic. This is why we actually screen for this. But same signs and symptoms as with with diabetes otherwise. Polyuria and polydipsia - excessive urination, excessive thirst - those are going to be your most common findings in pregnancy. However, remember that pregnancy is going to cause us to urinate more frequently than normal anyway so that it can be really hard to distinguish.

Now what do we do? Well we actually screen for it. So you're going to see that your patients will have an oral glucose tolerance test, an OGTT, and it's a one hour test that is performed. And this is performed to screen for gestational diabetes. If they fail the one hour, they will do the three hour test, and then that is going to be the diagnostic test for gestational diabetes.

Now the treatment, of course, as with everything, we're going to talk about lifestyle modifications, increasing exercise, changing the diet to have fewer carbs in it, and we're going to teach our patients how to monitor their own blood glucose. Insulin may be required. Most oral diabetic medications are contraindicated in pregnancy, so for that reason insulin is typically the go to. Not everyone requires it, though. With lifestyle modifications, your patients may be able to keep their blood sugars in that goal range, and that would be great.

Now complications. So first and foremost is fetal macrosomia. So macro meaning large and soma meaning body. So a large body size in the newborn. So that is going to be a sign and symptom too that perhaps your patient had undiagnosed gestational diabetes if they came in and had a very large baby.
The other thing, and it's in here in bold red text because it's so important, is that your baby, the baby is at risk for hypoglycemia. So think about it. Why is the baby at risk for hypoglycemia once they're born? Well, they've been getting all of their nutrition from mom. Mom probably had elevated blood sugars even when it's controlled. Even when we're doing well, it's still elevated, right? We have impaired glucose tolerance. Baby was getting a lot of that sugar, and now they are born and no longer getting that sugar. What's going to happen? Their blood sugar will crash. So if you see a baby who is macrosomic, who has a large body size, they are at risk for hypoglycemia because of that, right. You need to make that connection in your brain. Large body size means that they were probably getting a lot of glucose from mom. Now they're born, now they're having extra uterine life, and their blood sugar might crash.

The other thing is that any patient with gestational diabetes is at risk for pre-eclampsia, birth trauma. Again, remember large baby, we could have trauma during birth because of the size of the baby, a C-section, again because of the large baby, and also diabetes following pregnancy. If your patient has gestational diabetes, they need to be monitored in the postpartum period to make sure that they return to their baseline. But they are still at higher risk for developing diabetes mellitus afterwards. So they do need to have a repeat oral glucose tolerance test once they are no longer pregnant to make sure that they return to their baseline.

All right, then we're going to talk about hypoglycemia and hyperglycemia in your patient with gestational diabetes. Now there's not really too much that's different from this just in any patient with diabetes, but we're just going to cover it again.

Remember hypoglycemia? That means low blood sugar, right? So low blood sugar. Your patient is going to have this really characteristic look to them. They are going to be diaphoretic. So sweaty, they're going to be really sweaty. They're going to have cold and clammy skin. And you'll know exactly what that feels like. If you've ever touched somebody with cold, clammy skin, it's a very unique feeling. They may have a headache. They may have shakiness, right? They may say, I feel really shaky. They could have blurred vision. And then, of course, hunger.

So the cool chicken way to remember this is "Cold and clammy, I need candy."

So that means if I see a patient with cold and clammy skin that I should be thinking hypoglycemia, I need to treat them with sugar.

So the treatment, of course, is going to be 15 grams of a quickly absorbed glucose, something like a juice or soda or milk, something that has that glucose in it. And then we want to give them a protein snack after that as well. If I just replace the glucose, it will go away and they will crash again. I need to give them protein to have that long sustained energy source.

Now hyperglycemia, my blood sugar is too high. The hallmark signs here are the three P's: polydipsia, polyphagia, and polyuria. So polydipsia is excessive thirst, polyphagia is excessive hunger, and polyuria is excessive urination. So that is going to be your classic three signs there. But remember, your patients will also have warm skin that is very dry. They may have a fruity odor to their breath. That's a really important finding - that means like we have seriously high blood sugar levels - and rapid breathing. Think about it. What is that rapid breathing called? What's the name for it? Pause it. Think about it. I hope you paused it. That rapid breathing is called Kussmaul's respirations, and it is a compensatory mechanism for metabolic acidosis. And of course, fatigue is going to be another finding as well.

We have a cool chicken way to remember the findings of hyperglycemia. It's, "If my skin is warm and dry, my sugar's high."

So warm and dry, sugar's high. That means if you find your patient with warm, dry skin, you should be thinking they have hyperglycemia. "Cold and clammy, I need candy." "Warm and dry, sugar's high." I hope that is helpful for you. I know that that has helped me extensively in nursing school and in clinical practice, because it really does help you to identify the findings of these conditions.

All right, I hope that review was nice and comprehensive for you. If you enjoyed it, please like this video so that I know, and if you have a great way to remember something, I want to hear it in the comments below. And I'm sure that everybody else watching this video does, too. Be sure to subscribe to the channel so that you can be the first to know when the next video comes out. Thanks so much, and happy studying.