Medic Info (GDM)

Name: Puan Norafiza Nordin
Age: 26
Gender: Female
Occupation: Admininistrative Assistant
Race: Malay
Gr. 02, P. 01, Week 32
Medical Problem : Gestational Diabetes Mellitus (GDM)

Family Medical History
Diabetes- Father

Diagnosis
MOGTT*
*Modified Oral GlucoseTolerance Test
= 4.5 / 7.5/ 8.5 mmol/L

Repeat Blood Glucose Test
= 5.2/9.7/5.6/6.2 mmol/L

Final Diagnosis
Result meets treatment goal (kui..kui..mandai2 niih)

*The commonly accepted treatment goal is to maintain a fasting capillary blood glucose level of less than 95 to 105 mg per dL (5.3 to 5.8 mmol per L); the ambiguity (i.e., the range) is due to imperfect data. The postprandial treatment goal should be a capillary blood glucose level of less than 140 mg per dL (7.8 mmol per L) at one hour and less than 120 mg per dL (6.7 mmol per L) at two hours. Patients not meeting these goals with dietary changes alone should begin insulin therapy (http://www.aafp.org/afp/20031101/1767.html)

Discussion
(cewahhh..mcm la terer..mintak laluan ye Doktor2 sumer.. org kebanyakan nak cerita pasal KENCING MANIS SEWAKTU MENGANDUNG dgn ayat2 org kebanyakan)

Gestational diabetes mellitus (GDM) is a common but controversial disorder. (cey..)

*The cause of gestational diabetes is unknown. It is thought that the hormones produced during pregnancy may block the action of insulin. Gestational diabetes can happen if the mother's body can't produce enough extra insulin to counteract this blocking effect. http://hcd2.bupa.co.uk/fact_sheets/html/diabetes_in_pregnancy.html

Kebanyakan patient yg ada GDM, mempunyai history ayah yg ada diabetes mellitus @ kencing manis.. (Dr, ada type2 dia ekk?)

Simptom2 GDM;

• kerap kencing, dahaga, cepat letih.
• High blood sugar (of course)
• Glucose level (paras gula) tinggi * akan memerlukan ibu mengandung melalui terapi insulin (kesan: Fetus akan menjadi besar apabila gula ibu disimpan dlm darah fetus lalu ditukar menjadi lemak dlm fetus)

GDM juga boleh membawa kepada polyhydramnios di mana amniotic liquid (air ketuban) menjadi terlalu byk. (Dr, kalau salah sila betulkan..hehe) Check this..

Bagi ibu yg mengambil terapi insulin, selepas melahirkan baby, kemungkinan baby akan mengalami hypoglycemia keadaan di mana kandungan gula dlm darah rendah. Any blood glucose value below 4.0mmol/L is considered hypoglycemia. Ini kerana hormon insulin dari ibu yg memasuki darah baby merendahkan tahap gula dlm darah baby. Namun begitu, paras gula akan kembali normal apabila hormon insulin dlm darah baby hilang. (sila refer keratan di bawah)

:D Oleh kerana tak reti dah nak explain (dah penat dah study), maka amik jelah dr website http://hcd2.bupa.co.uk/fact_sheets/html/diabetes_in_pregnancy.html

The effects of gestational diabetes

Effects on the fetus during pregnancy

• Having high blood sugar can cause the baby to grow larger, which can make delivery difficult and potentially cause injuries to both mother and baby during birth. In some cases a caesarean section is necessary.

Effects on the baby after birth

• The baby may have low blood sugar (hypoglycaemia) after birth. This is because the baby's pancreas makes extra insulin in response to the mother's high blood sugar levels. Shortly after birth, the baby may continue to make extra insulin even though high levels of blood sugar are no longer present. After a pregnancy affected by gestational diabetes, the newborn baby's blood sugar level is checked regularly. Sometimes babies are given an early feed of a sugar (glucose) solution through a drip (fed directly into a vein) to correct low blood sugar.
• It is more likely that the newborn baby will develop jaundice (yellowing of the skin and whites of the eyes). This is not serious and usually fades over a few weeks, without the need for medical treatment.
  There is an increased risk that the baby will be born with congenital problems, such as a heart defect. Sometimes, infants can be born with respiratory distress syndrome, in which the baby has problems breathing because his or her lungs have not matured as normal. This usually clears up with time.
  There is also a slightly higher chance of stillbirth or death as a newborn, but if detected and the glucose levels well managed, death is rare.
• There may be an increased risk of the baby developing type II diabetes or being overweight later in life.

Effects on the mother

• Gestational diabetes is not an immediate threat to the woman's health. Most women with gestational diabetes whose blood sugar levels stay within the safe range deliver their babies without complications. However, in some women it can result in high blood pressure.

Women who get gestational diabetes are more likely to develop gestational diabetes in future pregnancies, and are at a higher risk of developing type II diabetes later in life.

#:-S Banyak lg info..leh check di byk website http://www.aafp.org/afp/20031101/1767.html etc.