Maternal and Fetal Complications in Diabetes Pregnancy
|
|
- Lynette Wells
- 5 years ago
- Views:
Transcription
1 Maternal and Fetal Complications in Diabetes Pregnancy Helen R Murphy Professor of Medicine (Diabetes & Antenatal Care), UEA Professor of Women s Health, Kings College London hm386@medschl.cam.ac.uk 1
2 2018 ATDC Conference: Conflict of Interest I have the following Conflicts of Interest to report: Stock Shareholder None Speakers Bureau NovoNordisk, Eli Lilly, Sanofi, Abbott, Medtronic Grants/Research Johnson & Johnson, Medtronic, Abbott Diabetes Care Consultant Medtronic Employee None No Other I will not be speaking on off-label topics.
3 Fetal development at 5 weeks 5 week human fetus
4 Early Cardiac Development Srivastava D, Nature 2000
5 Early neural tube development
6 Pre-pregnancy care Diabetes and Pregnancy Project
7 400,00 singleton pregnancies, 1677 diabetes 9,488 1 malformation, 129 diabetes HbA1c % (mmol/mol) 1000 Pregnancy 6.5 (48) in (53) in (58) in (64) in (80) in /1,000 pregnancies, RR 3.8 OR 1.3 per 1% HbA1c >6.3% (11>45mmol/mol) Bell R Diabetologia 2012
8 Glycaemic control in T1D (NPID 2016) 240 (<15%) T1D mothers achieved target HbA1c There has been no improvement in antenatal glucose control in T1D since NPID 2016 First trimester HbA 1c vs CEMACH Type 1 diabetes Type 2 diabetes HbA 1c <48 mmol/mol 15% 38% HbA 1c >=86 mmol/mol 12% 7% NPID HbA 1c median (10-90 th centile) 61 (45-89) 51 (39 to 81) HbA1c median (IQR) 58 (48 69) 8
9 Preterm births (NPID 2016) 43% T1D and 21% T2D preterm < weeks Reduction in T1D births > 38 weeks since Gestation at delivery for singleton live births, 2016 percentage of pregnancies 40 Type 1 Type to to to to to and over gestation (weeks)
10 Birthweight centiles (NPID 2016) LGA 47% in T1D, 23% in T2D offspring Unchanged in T1D since Expected level 0 Birthweight >=90th centile Type 1 diabetes Type 2 diabetes Birthweight <10th centile a GROW centiles adjust birthweight for maternal ethnicity, height, weight and gestational age at delivery.
11 NICU admissions (NPID 2016) 40% T1D went to NICU 60% T1D preterm <37 weeks, ~ 90% <34 weeks Percentage of babies admitted to a neonatal unit a, 2016 Percentage of Type 1 diabetes Type 2 diabetes babies Born at <34 weeks Born at 34 to 36 weeks Born at 37 weeks and over a Neonatal unit includes special care and intensive care
12 What contributes to neonatal complications?
13 T1D Pregnancy summary Pre-pregnancy care associated with reduced rates of congenital anomaly, SB and NND Women T1D spend hrs/day with glucose levels outside the target range ( mmol/l) One in two babies of T1D mothers have complications associated with maternal hyperglycaemia in second and third trimester New technologies needed for consistent glucose control T1D?
14 Continuous Glucose Monitor (CGM)
15 Primary Outcome: Change in HbA1c from randomisation to 34 weeks gestation CGM Control mean difference -0.2% 95% CI -0.34, -0.03; p =
16 % Time in target range mg/dl Pregnant Baseline Week 34 CGM N=107 Control N=107 CGM N=77 Control N=77 P-value % CGM mmol/l 52% ± 13% 12.5hrs/day 52% ± 14% 12.5hrs/day 68% ± 13% 16.3hrs/day 61% ± 15% 14.6hrs/day Pregnancy Trial Yamamoto J CDR 2018
17 Newborn health outcomes LGA: 53% CGM vs 69% control OR 0.51; 95% CI p= NNT 6 Hypoglycaemia requiring dextrose infusion 15% CGM vs 28% control OR 0.45; 95%CI p= NNT 8 NICU admission >24h: 27% CGM vs 43% control OR 0.48; 95% CI ; p= NNT 6 Feig DS Lancet 2017
18 Infant length of hospital stay CGM Control P-value N=100 N=100 Total number of hospital admission days Median (IQR) infant hospital stay 3.1 ( ) 4.0 ( )
19 Food diaries Dietplan 6.0
20 Increased energy from protein & fat, less from carbs Energy or macronutrient Mean (95% CI) Mean as % total energy UK average for women 19-64y UK Dietary Recommended Values Total energy (kcal) 1630 ( ) 1613 (derived from food diaries) 2175 (derived from doubly labelled water) Protein 65 g (61-68) 16 % 65 g (17 %) 45 g Carbohydrate 184 g ( ) 42 % 197 g (48 %) 47 % of total energy Fat 69 g (64-75) 38 % 60 g (34.5 %) 33 % of total energy
21 Carbohydrate sources at main meals Cereal 32 % Bread 27.5 % Pastries, cakes 8 % Beverages 6 % Fruit 5.5 % Potatoes 19 % Vegetables 11 % Bread 10 % Pasta 10 % Rice 10 % Bread 30 % Pastry and Cake 10 % Crisps 8.5 % Vegetables 7.5 % Fruit 6 % Breakfast Lunch Dinner Vegetables includes beans, lentils, peas, salad, vegetable dishes but not potato (potato does not include crisps)
22 Carbohydrate sources at snack times Confectionery 32% Fruit 20% Biscuits 17% Beverages 12% Crisps 7% Confectionery 20 % Biscuits 15 % Pastry and cake 14 % Fruit 13 % Bread 9.5 % Confectionery 24 % Beverages 14.5 % Pastry and cake 14 % Biscuits 9 % Fruit 7 % Morning Tea Afternoon Tea Supper
23 Overall non-recommended sources contribute 50 % of average daily carb intake (92 g) ADA Dietary Guidelines: Recommended = vegetables (not potato), whole grains (incl bread), fruit, legumes, dairy Non-recommended = everything else
24 CLIP_04 Study devices
25 CLIP_04 Baseline maternal characteristics CLIP_04 N = 16 Age years; mean (SD) 32.8 (5.0) BMI kg/m 2 ; mean (SD) 26.6 (4.4) *HbA1c mmol/mol, %; mean (SD) 63.7 (12.1) 8.0 (1.1) Duration of diabetes years (SD) 19.4 (10.2) Pump (n) 8 (50%) TDD units; mean (SD) 0.51 (0.09) Gestation randomisation week; mean (SD) 16.4 (4.9) Primiparous (n) 6 (38%) * 9 women had booking HbA1c 58mmol/mol (7.5%) 6 women with previous pregnancy losses (6 miscarriages and 1 stillbirth), 2 had TOP for congenital anomaly.
26 CLIP_04 Overnight results ( hr) SAP therapy Closedloop Effect size (CI 95% ) P value Time in target (-0.8 to 15.2) (%; mmol/l) Time >7.8 mmol/l (-14.0 to 2.9) 0.18 Time > 10 mmol/l (-7.0 to 2.3) 0.29 Time <3.5 mmol/l (-2.8 to -0.4) Time < 2.8 mmol/l (-0.6 to 0.0) Mean glucose (mmol/l) (-0.5 to 0.4) 0.83
27 CLIP_04 results Day and night SAP therapy CLIP Effect (CI 95% ) P value Time in target ( mmol/l) (-4.1 to 8.3) 0.47 Time >7.8 mmol/l (-7.4 to 6.3) 0.86 Time <3.5 mmol/l (-0.2 to -2.1) 0.02 Time <2.8mmol/L (-0.0 to -0.5) 0.03 Number of hypo events (range) 12.5 (1-53) 8 (1-17) 0.04 Mean glucose (-0.3 to 0.4) 0.85
28 CLIP_04 antenatal feasibility weeks gestation (n = 8) weeks gestation (n = 16) 36+ weeks gestation (n = 9) 0-6 weeks postnatal (n = 12) % time in target ( mmol/l) 70.6 (64.2, 75.4) 71.5 (68.9,75.9) 72.3 (67.3, 80.3) 77.1 (75.1, 90.4) % time above target (>7.8 and >10 mmol/l) % time below target (<3.5 and 3.9mmol/L) 28.0 (23.0, 34.0) 24.4 (22.8, 29.3) 23.7 (17.7, 31.5) 22.1 (9.5, 24.4) 1.9 (1.7, 2.3) 2.0 (1.1, 3.9) 2.3 (1.0, 3.0) 2.4 (0.8, 3.7) Mean glucose (mmol/l) 6.9 (6.6, 7.2) 6.7 (6.4, 6.9) 6.6 (6.4, 6.9) 7.7 (7.1, 8.2) Women maintained >70% time in target throughout pregnancy Diab care 2018
29 Practical take-home Pearls Safe effective contraception/pre-pregnancy care is most important intervention in T1D pregnancy Use of CGM is associated with improved neonatal outcomes, attributed to reduced fetal exposure to maternal hyperglycemia More attention to maternal dietary intake is needed Preliminary data suggest that closed-loop may be beneficial, but larger trials needed
30 Pre-pregnancy care
31 Questions
Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial
Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial Dr Sandra Neoh on behalf of: Dr Denice Feig and Professor Helen Murphy Funders: JDRF (Juvenile Diabetes Research Foundation),
More informationDo women have to come off DAFNE when pregnant?
Do women have to come off DAFNE when pregnant? Dr Helen R Murphy hm386@medschl.cam.ac.uk DAFNE Manchester June 26 2015 Topics for discussion Current practice in T1D pregnancy Reflect on current DAFNE guidelines
More informationDiabetes in obstetric patients
Diabetes in obstetric patients Swedish Society of Obstetric Anaesthesia & Intensive Care Anita Banerjee Obstetric Physician Diabetes & Endocrinology Consultant Outline Scope of the problem Diabetes and
More informationPregnancy workshop. 25 th April 2014 Caroline Byrne
Pregnancy workshop 25 th April 2014 Caroline Byrne Topics for Discussion Need for good control, pre pregnancy counselling How good control changes outcomes Using CSII in routine care Practical aspects
More informationVishwanath Pattan Endocrinology Wyoming Medical Center
Vishwanath Pattan Endocrinology Wyoming Medical Center Disclosure Holdings in Tandem Non for this Training Introduction In the United States, 5 to 6 percent of pregnancies almost 250,000 women are affected
More informationUniversity Hospitals of Leicester NHS Trust. Carbohydrates. A guide to carbohydrate containing foods for people with diabetes
University Hospitals of Leicester NHS Trust Carbohydrates A guide to carbohydrate containing foods for people with diabetes A Healthy Diet This information is designed to help you to understand how carbohydrates
More informationNational Pregnancy in Diabetes Audit Report, England, Wales and the Isle of Man 12th October 2017
National Pregnancy in Diabetes Audit Report, 2016 England, Wales and the Isle of Man 12th October 2017 Prepared in collaboration with: The National Pregnancy in Diabetes (NPID) audit is part of the National
More informationDiabetes and Pregnancy
Diabetes and Pregnancy Dr Warren Gillibrand Deputy Director of Postgraduate Education Department of Nursing & Midwifery Department of AHP and Sports Science w.p.gillibrand@hud.ac.uk Aims of the session
More informationGDM. Gestational Diabetes Mellitus. Diabetes Clinic, Women s Health Auckland Hospital
GDM Gestational Diabetes Mellitus Diabetes Clinic, Women s Health Auckland Hospital Welcome Haere Mai Respect Manaaki Together Tūhono Aim High Angamua Gestational Diabetes If you have been diagnosed with
More informationDIABETES WITH PREGNANCY
DIABETES WITH PREGNANCY Prof. Aasem Saif MD,MRCP(UK),FRCP (Edinburgh) Maternal and Fetal Risks Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Maternal and Fetal
More informationGestational Diabetes Mellitus Dr. Fawaz Amin Saad
Gestational Diabetes Mellitus Dr. Fawaz Amin Saad Senior Consultant OB/GYN, Al-Hayat Medical Center, Doha, Qatar DISCLOSURE OF CONFLICT OF INTEREST I am a full-time Employee at Al-Hayat Medical Center.
More informationDiet & Diabetes. Cassie Ricchiuti Diabetes Dietitian. Lives In Our Communities. Improving
Diet & Diabetes Cassie Ricchiuti Diabetes Dietitian Improving www.shropscommunityhealth.nhs.uk Lives In Our Communities www.shropscommunityhealth.nhs.uk Dietary management of diabetes Type 1 Consistent
More informationManagement of Pregestational and Gestational Diabetes Mellitus
Background and Prevalence Management of Pregestational and Gestational Diabetes Mellitus Pregestational Diabetes - 8 million women in the US are affected, complicating 1% of all pregnancies. Type II is
More informationPregnancies complicated by diabetes. Marina Mickleson Nurse Practitioner Midwife CDE
Pregnancies complicated by diabetes Marina Mickleson Nurse Practitioner Midwife CDE Two types Pre gestational Gestational diabetes Both types are on the increase Pre conception work up is imperative for
More informationAchieving optimal glycemic control throughout pregnancy
DIABETES TECHNOLOGY & THERAPEUTICS Volume 20, Number 7, 2018 Mary Ann Liebert, Inc. DOI: 10.1089/dia.2018.0060 BRIEF REPORT Adaptability of Closed Loop During Labor, Delivery, and Postpartum: A Secondary
More informationThe New GDM Screening Guidelines. Jennifer Klinke MD, FRCPC Endocrinologist and Co director RCH Diabetes in Pregnancy Program
The New GDM Screening Guidelines Jennifer Klinke MD, FRCPC Endocrinologist and Co director RCH Diabetes in Pregnancy Program Disclosures Current participant (RCH site) for MiTy study Metformin in women
More informationDiabetes in Pregnancy Registrar Induction. Dr Anna Dover August 31 st 2015
Diabetes in Pregnancy Registrar Induction Dr Anna Dover August 31 st 2015 Outline Joint Antenatal Diabetes Service Pre-existing diabetes Pre-conception, antenatal management Gestational Diabetes Screening,
More informationLearning Objectives. At the conclusion of this module, participants should be better able to:
Learning Objectives At the conclusion of this module, participants should be better able to: Treat asymptomatic neonatal hypoglycemia with buccal dextrose gel Develop patient-specific approaches to intravenous
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Stewart ZA, Wilinska ME, Hartnell S, et al. Closed-loop insulin
More informationPregestational Diabetes in Pregnancy. An Update
Pregestational Diabetes in Pregnancy An Update Disclosures D. Ware Branch, MD Nothing to disclose Questions to Be Addressed What are risks factors for adverse pregnancy outcome in pregestational diabetes?
More informationFaculty Disclosure. No, nothing to disclose Yes, please specify: Novo-Nordisk. Roche. Abbott. Funded Research. Ownership/ Equity Position
Diabeloop Closed-Loop does better than sensor-augmented-pump on blood glucose during 3 days with intensive physical eercises: a randomized crossover trial. Sylvia Franc 1, MD, Sophie Borot, MD, PhD, Pierre-Yves
More informationCOMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA)
COMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA) Prof. Hayfaa Wahabi, King Saud University, Riyadh Saudi Arabia Hayfaa
More informationHow does my weight affect my fertility? Maternity Services
How does my weight affect my fertility? Maternity Services Why is it important that i lose weight? You may be aware that being overweight or obese can lead you to develop a number of diseases such as diabetes,
More informationDiabetes in Pregnancy
NY BGYN Diabetes in Pregnancy Diabetes occurs when the body cannot make enough of the hormone insulin or cannot use the insulin it makes. Insulin is a hormone that allows sugar to enter the cells where
More informationUnderstanding gestational diabetes
Understanding gestational diabetes Gestational diabetes is a form of diabetes that occurs in women during pregnancy. About 12 14% of pregnant women will develop gestational diabetes, usually around the
More informationWhy is my Blood Sugar Too High?
What is Gestational Diabetes? Gestational diabetes is a type of diabetes which can occur during pregnancy and usually goes away after the baby is delivered. Gestational means in pregnancy and Diabetes
More informationNutrition for Gestational Diabetes
Nutrition for Gestational Diabetes Kim Lombard, MS, RD, CDE Public Health Consultant Diabetes and Kidney Unit Michigan Department of Health and Human Services Objectives State the importance of good blood
More informationInformation Sheet. Diabetes. Accessible information about diabetes for adults with Learning Disabilities
Information Sheet Diabetes Accessible information about diabetes for adults with Learning Disabilities It is important to: Eat a healthy diet Keep active Take your medication Breakfast Cereals with bran,
More informationNote: for non-commercial purposes only. A collaboration between Abbott Nutrition and King s College London
Note: for non-commercial purposes only Women s Health Academic Centre A pilot study to evaluate the effects of a dietary supplement with slow digesting-low GI (SD-LGI) carbohydrates in obese pregnant women
More informationPatricia is Hispanic and was originally born in Mexico. She uses mostly pre-packaged and convenience foods.
Case Study #1 Patricia 29 years old Patricia is a housewife. She is married and has two children. Patricia is Hispanic and was originally born in Mexico. She uses mostly pre-packaged and convenience foods.
More informationWhat is gestational diabetes?
ESPEN Congress Cannes 2003 Organised by the Israel Society for Clinical Nutrition Education and Clinical Practice Programme Session: Dietitian Symposium: Nutrition throughout the woman life cycle An Update
More informationEffect of Gestational Diabetes mellitus Health Education Module on Pregnancy Outcomes
World Journal of Nursing Sciences 1 (3): 76-88, 2015 ISSN 2222-1352 IDOSI Publications, 2015 DOI: 10.5829/idosi.wjns.2015.76.88 Effect of Gestational Diabetes mellitus Health Education Module on Pregnancy
More informationDiabetes Related Disclosures
Diabetes Related Disclosures Speakers Bureau Amylin Boehringer Ingelheim Eli Lilly Takeda Classification of Diabetes Diabetes Care January 2011 vol. 34 no. Supplement 1 S11-S61 Type 1 Diabetes Mellitus
More informationExternal Examiner: Miss C Biggs Internal Examiner: Mrs S Ogilvie DURATION: 3 HOURS TOTAL MARKS: 150
External Examiner: Miss C Biggs Internal Examiner: Mrs S Ogilvie DURATION: 3 HOURS TOTAL MARKS: 150 NOTE THIS PAPER CONSISTS OF SEVEN (7) PAGES AND APPENDIX A ONE (1) PAGE AND APPENDIX B ONE (1) PAGE PLEASE
More informationGestational Diabetes in Resouce. Prof Satyan Rajbhandari (RAJ)
Gestational Diabetes in Resouce Limited Area Prof Satyan Rajbhandari (RAJ) Case History RP, 26F Nepali girl settled in the UK Primi Gravida BMI: 23 FH of type 2 DM 75 gm Glucose OGTT in week 25 0 Min
More informationCarbohydrate Counting
Carbohydrate Counting What is carbohydrate counting? All the food you eat is made up of carbohydrate, protein and fat or a mixture of these. The part that makes the biggest difference to you blood glucose
More informationEarly Intervention in Pregnancy
Early Intervention in Pregnancy Dr Lucy Mackillop Obstetric Physician Honorary Senior Clinical Lecturer Women s Centre Oxford University Hospitals NHS Foundation Trust TVSCN conference 17 th January 2017
More informationContinuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial
Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial Denice S Feig, Lois E Donovan, Rosa Corcoy, Kellie E Murphy, Stephanie
More informationNo. of products >=3.5 Health Star Rating ineligible to display health claim (%)
Table S1: Agreement between the number of products scoring >=3.5 stars using the Health Star Rating and the proportion of products eligible to display a health claim using the Nutrient Profiling Scoring
More informationDiabetes and your Periods The effect of periods on diabetes and things to consider
Diabetes and your Periods The effect of periods on diabetes and things to consider Exceptional healthcare, personally delivered What effect do periods have on diabetes? n Most women and girls notice an
More informationWhat Should I Eat to Help my Pressure Sore or Wound Heal?
What Should I Eat to Help my Pressure Sore or Wound Heal? Information for Patients i UHL Nutrition and Dietetic Service UHL Tissue Viability Team Introduction If you have a pressure sore or a large wound
More informationFunctions of Food. To provide us with energy and keep us active. For growth and repair of the. body. To stop us from feeling hungry.
Functions of Food To provide us with energy and keep us active. For growth and repair of the body. To stop us from feeling hungry. To keep us healthy and fight diseases. Nutrients Macro/Micro Nutrient
More informationPregnancy outcomes in Korean women with diabetes
Pregnancy outcomes in Korean women with diabetes Sung-Hoon Kim Department of Medicine, Cheil General Hospital & Women s Healthcare Center, Dankook University College of Medicine, Seoul, Korea Conflict
More informationContemporary Maternal-Newborn Nursing: 8 Edition Test Bank Ladewig
Contemporary Maternal-Newborn Nursing: 8 Edition Test Bank Ladewig Link full download: http://testbankair.com/download/test-bank-for-contemporarymaternal-newborn-nursing-care-8th-edition/ Chapter 12 Question
More informationType 1 diabetes accounts for 5e10% of diabetes diagnoses,
Contemporary type 1 diabetes pregnancy outcomes: impact of obesity and glycaemic control Sally K Abell 1,2, Jacqueline A Boyle 1,3, Barbora de Courten 1,2, Michelle Knight 3, Sanjeeva Ranasinha 1, John
More informationFaculty Disclosure. No, nothing to disclose Yes, please specify: Medtronic Johnson & Johnson. Ownership/ Equity Position.
Diabeloop Closed-Loop does better than Sensor-augmented Pump on blood glucose control during 3 days with gastronomic dinners: a randomized crossover trial in Patients with Type 1 Diabetes. Hélène Hanaire
More informationEffective Health Care Program
Comparative Effectiveness Review Number 57 Effective Health Care Program Methods for Insulin Delivery and Glucose Monitoring: Comparative Effectiveness Executive Summary Background Diabetes mellitus is
More informationMy Diabetic Meal Plan during Pregnancy
My Diabetic Meal Plan during Pregnancy When you have diabetes and are pregnant, you need to eat small meals and s throughout the day to help control your blood sugar. This also helps you get in enough
More informationThe artificial pancreas: the next step in connectivity and digital treatment of type 1 diabetes
The artificial pancreas: the next step in connectivity and digital treatment of type 1 diabetes Roman Hovorka PhD FMedSci University of Cambridge, UK Duality of interest declaration Advisory Panel: Research
More informationRev. date Kaiser Foundation Health Plan of Washington
PE3620000-01-17 Rev. date 2014013 2017 Kaiser Foundation Health Plan of Washington Gestational diabetes Information to help you stay healthy during your pregnancy What is gestational diabetes? How gestational
More informationA S Y N T H E S I Z E D H A N D B O O K ON G E S T A T I O N A L D I A B E T E S
A S Y N T H E S I Z E D H A N D B O O K ON G E S T A T I O N A L D I A B E T E S P R E F A C E Dear reader, This is a synthesized handbook conceived to serve as a tool to health personnel in the screening,
More informationInternal Examiner: Mrs S Ogilvie External Examiner: Dr N Wiles DURATION: 3 HOURS TOTAL MARKS: 150
Internal Examiner: Mrs S Ogilvie External Examiner: Dr N Wiles DURATION: 3 HOURS TOTAL MARKS: 150 NOTE: THIS PAPER CONSISTS OF SIX (6) PAGES AND APPENDIX A - TWO (2) PAGES AND APPENDIX B - ONE (1) PAGE.
More informationWhat is diabetes? INSULIN, WHAT DOES IT DO?
What is diabetes? Type 2 diabetes is when the body is unable to use insulin effectively due to resistance to insulin. The cells in the pancreas that make insulin still produce insulin but the insulin is
More informationThe Wheel of Life Exercise. What s Happening? Where to start the beginning. What's in a meter- are they all the same?
Wharfedale Hospital Otley Linda Clapham BSc Hons. RGN, SEN,Cert. Ed. The Wheel of Life Exercise An exercise to Encourage self management Work What s going on! Medication Helping patients succeed Diabetes
More informationElite Health & Fitness Training, Inc. FOOD HISTORY QUESTIONNAIRE
FOOD HISTORY QUESTIONNAIRE Name: Date: Height: Weight: Age: Sex: Weight History: Have you ever tried to lose weight before or are you currently trying to lose weight? If yes, explain: Do you currently
More informationWhat to do when you have Type 2 diabetes. An easy read guide
What to do when you have Type 2 diabetes An easy read guide What is diabetes?? Sometimes your body does not make enough insulin. Sometimes your body can t use insulin properly. Insulin helps you to use
More informationWhat is a CGM? (Continuous Glucose Monitor) The Bionic Pancreas Is Coming
The Bionic Pancreas Is Coming Montana Diabetes Professional Conference October 23, 2014 H. Peter Chase, MD Professor of Pediatrics University of Colorado Barbara Davis Center Stanford: Bruce Buckingham,
More informationCase Study: Competitive exercise
Case Study: Competitive exercise 32 year-old cyclist Type 1 diabetes since age 15 Last HbA1 54 No complications and hypo aware On Humalog 8/8/8 and Levemir 15 Complains about significant hypoglycaemia
More informationKidney Disease and Diabetes
Kidney Disease and Diabetes What is diabetes? Diabetes is a disease where your body cannot properly store and use food for energy. The energy that your body needs is called glucose (sugar). Glucose comes
More informationCounting the Carbs, Fat and Protein in Type 1 Diabetes Translating the Research into Clinical Practice
Welcome to Allied Health Telehealth Virtual Education Counting the Carbs, Fats and Protein in Type 1 Diabetes Translating the Research into Clinical Practice Dr Carmel Smart, PhD Senior Specialist Paediatric
More informationJIGSAW READING CARBOHYDRATES
Date: CARBOHYDRATES Carbohydrates provide an important source of energy for our bodies. There are two types of carbohydrates: Sugars are found in foods which taste sweet like candies, jams and desserts.
More informationGestational Diabetes. Benjamin Byers, D.O., FACOG Center for Maternal and Fetal Care Bryan Physician Network
Gestational Diabetes Benjamin Byers, D.O., FACOG Center for Maternal and Fetal Care Bryan Physician Network Outline Definition Prevalence Risk factors complications Diagnosis Management Nonpharmacologic
More informationWeight loss guide. Dietetics Service
Weight loss guide Dietetics Service Contents Section 1 - thinking about losing weight? Section 2 - Carbohydrate Section 3 - Fruit and vegetables Section 4 - Protein & Dairy Section 5 - Fatty foods Section
More informationGestational Diabetes. Gestational Diabetes:
Gestational Diabetes Detection and Management Steven Gabbe, MD The Ohio State University Medical Center Gestational Diabetes: Detection and Management Learning Objectives: At the conclusion of this presentation,
More informationWessex Strategic Clinical Networks. Wessex Guidance on supporting women with diabetes to prepare for pregnancy
Wessex Strategic Clinical Networks Wessex Guidance on supporting women with diabetes to prepare for pregnancy February 2016 Wessex Strategic Clinical Network (SCN) Project Group SCN Role Department Contact
More informationMultiple Daily Injection (MDI) & Carbohydrate (CHO) Counting Assessment Tool
Multiple Daily Injection (MDI) & Carbohydrate (CHO) Counting Assessment Tool (for patients using analogue insulin) The overall aim of this questionnaire is to ensure that you have the knowledge required
More informationDiabetes in Pregnancy. L.Sekhavat MD
Diabetes in Pregnancy L.Sekhavat MD Diabetes in Pregnancy Gestational Diabetes Pre-gestational diabetes (overt) Insulin dependent (type1) Non-insulin dependent (type 2) Definition Gestational diabetes
More informationGestational Diabetes Mellitus (GDM) and Diabetes in Pregnancy: Diagnostic Recommendations, NSLHD
Guideline Gestational Diabetes Mellitus (GDM) and Diabetes in Pregnancy: Diagnostic Document Number GE2017_003 Publication Date 31 January 2017 Intranet location/s Summary Author Department Contact (Details)
More informationGESTATIONAL DIABETES (DIET/INSULIN/ METFORMIN) CARE OF WOMEN IN BIRTHING SUITE
GESTATIONAL DIABETES (DIET/INSULIN/ METFORMIN) CARE OF WOMEN IN BIRTHING SUITE DEFINITION A disorder characterised by hyperglycaemia first recognised during pregnancy due to increased insulin resistance
More informationDIABETES MELLITUS. Date of last Revision: 2002
Nutrition Fact Sheet DIABETES MELLITUS This information is brought to you by many of the Australian nutrition professionals who regularly contribute to the Nutritionists Network ( Nut-Net'), a nutrition
More informationCASE SCENARIO Carbohydrate Counting
CASE SCENARIO Carbohydrate Counting Ms. Champa V P.G. (Food & Nutrition), P.G. Dip. In Dietetics A.I.I.H.& P.H. Kolkata, WB HOD : Dietetics Department Apollo Hospitals Bilaspur Carbohydrate Counting Estimate
More informationNutritional Recommendations for the Diabetes Managements
In the name of God Nutritional for the Diabetes Managements Zohreh Mazloom. PhD Shiraz University of Medical Sciences School of Nutrition and Food Sciences Department of Clinical Nutrition OVERVIEW Healthful
More informationSUPPLEMENTARY DATA. Supplementary Figure 1. Flow diagram of study selection
Supplementary Figure 1. Flow diagram of study selection Supplementary Table 1. Summary of included studies examining the effects of fat, protein and on postprandial glycemia in type 1 diabetes Evidence
More informationMiCMRC Educational Webinar Diabetes and Pregnancy
MiCMRC Educational Webinar Diabetes and Pregnancy MiCMRC Care Management Educational Webinar: Enhancing Recognition and Improving Outcomes Expert Presenter: Kim Lombard, MS, RD, CDE Public Health Consultant
More informationPRACTICAL METHODS AND APPLICATIONS OF CARB COUNTING IN THE SCHOOL SETTING
PRACTICAL METHODS AND APPLICATIONS OF CARB COUNTING IN THE SCHOOL SETTING Katelyn Yzquierdo, MS, RD, CSP, LD Diabetes Management of the School-Aged Child Provided by Texas Children s Hospital Provider
More informationMy Food Groups. My Physical Activity. Healthy Bodies. Protein Meat, Beans, Nuts. Dairy Milk, Yogurt, Cheese. Grains Breads, Cereals, Pasta.
My Food Groups Dairy Milk, Yogurt, Cheese Vegetables Fruits Grains Breads, Cereals, Pasta Meat, Beans, Nuts OATMEAL OATM EAL extras My Physical Activity Healthy Bodies Main Nutrients and Their Health Benefits
More informationFacts that you need to know
NUTRITION This article explores the basic concepts of nutrition and provides useful tips on healthy diet My neighbor walks up to me asking whether I am aware of the nutritional value of a new food product
More informationCreate your own diet Healthy eating with the Wheel of Five
Create your own diet Healthy eating with the Wheel of Five Go your own way with the Wheel of Five Your body is with you for life, so you should take proper care of it. But how? Following the Wheel of Five
More informationEarly life influences on adult chronic
Early life influences on adult chronic disease among aboriginal people Sandra Eades, Lina Gubhaju, Bridgette McNamara, Ibrahima Diouf, Catherine Chamberlain, Fiona Stanley University of Sydney October
More informationNICE guideline Published: 25 February 2015 nice.org.uk/guidance/ng3
Diabetes in pregnancy: management from preconception to the postnatal period NICE guideline Published: 25 February 2015 nice.org.uk/guidance/ng3 NICE 2017. All rights reserved. Subject to Notice of rights
More informationObstetrics and Gynaecology
Purpose Pregnancy is associated with changes to insulin sensitivity which can lead to elevated maternal blood glucose levels (BGLs). When elevated BGLs are first diagnosed during pregnancy the mother has
More informationPresented by Dr. Bruce Perkins, MD MPH Dr. Michael Riddell, PhD
Type 1 Diabetes and Exercise: Optimizing the Medtronic MiniMed Veo Insulin Pump and Continuous Glucose Monitoring (CGM) for Better Glucose Control 1,2 for Healthcare Professionals Presented by Dr. Bruce
More informationKEY INDICATORS OF NUTRITION RISK
NUTRITION TOOLS KEY INDICATORS OF Consumes fewer than 2 servings of fruit or fruit juice per day. Consumes fewer than 3 servings of vegetables per day. Food Choices Fruits and vegetables provide dietary
More informationPhase 2: Making Choices
Phase 2: Making Choices Please create your own menu using this template as a guideline, e-mail it back to me and I will review it with you and put in your file. General Menu Planning Considerations Aim
More informationDiabetes and pregnancy
Diabetes and pregnancy Elisabeth R. Mathiesen Professor, Chief Physician, Dr.sci Specialist in Endocrinology Centre for Pregnant Women with Diabetes Rigshospitalet, University of Copenhagen Denmark Gestational
More informationHealthy Eating with Gestational Diabetes
Healthy Eating with Gestational Diabetes What is gestational diabetes? Gestational diabetes is the name given to diabetes that can occur during pregnancy (Gestation). Diabetes is an inability of the body
More informationMedical Nutrition Therapy for Diabetes Mellitus. Raziyeh Shenavar MSc. of Nutrition
Medical Nutrition Therapy for Diabetes Mellitus Raziyeh Shenavar MSc. of Nutrition Diabetes Mellitus A group of diseases characterized by high blood glucose concentrations resulting from defects in insulin
More informationA Fact Sheet for Parents and Carers Healthy Eating for Diabetes
A Fact Sheet for Parents and Carers Healthy Eating for Diabetes Healthy eating is important for children of all ages, including those living with diabetes. Children and teenagers with diabetes have the
More informationGestational Diabetes Mellitus
Gestational Diabetes Mellitus Should GPs keep a register of everyone with GDM? Ross Lawrenson Waikato Clinical School University of Auckland Definition of GDM GDM is defined as carbohydrate intolerance
More informationHealthy Eating. Eating healthily is about eating the right amount of food for your energy needs. Based on the eatwell plate, you should try to eat:
Healthy Eating The eatwell plate shows the different types of food we need to eat and in what proportions to have a wellbalanced and healthy diet. It's a good idea to try to get this balance right every
More informationPRACTICE GUIDELINES WOMEN S HEALTH PROGRAM
C Title: NEWBORN: HYPOGLYCEMIA IN NEONATES BORN AT 35+0 WEEKS GESTATION AND GREATER: DIAGNOSIS AND MANAGEMENT IN THE FIRST 72 HOURS Authorization Section Head, Neonatology, Program Director, Women s Health
More informationDiabetes Management with Continuous Glucose Monitoring & Multiple Daily Injections. Aaron Michels MD
Diabetes Management with Continuous Glucose Monitoring & Multiple Daily Injections Aaron Michels MD Outline SMBG & CGM by age group JDRF CGM Trial Sensor Augmented Insulin Pump Therapy for A1c Reduction
More informationGlycemic Index. Mean Incremental Blood Glucose Responses in Healthy Subjects (65-70 years) Time (Minutes)
Glycemic Index How to use the glycemic index By making careful food choices, you can influence your hunger and energy as well as blood sugar levels, cholesterol and triglyceride levels. If you have problems
More informationOriginal Article. Keiko KOHNO 1), Kazuhiko HOSHI 1), Motoi TAKIZAWA 1), Takashi KANEKO 2), and Shuji HIRATA 1)
Yamanashi Med. J. 21(3), 53 ~ 58, 2006 Original Article Usefulness of the 50-g Glucose Challenge Test for Screening of Patients with Gestational Diabetes Mellitus and an Analysis of the Timing of Administration
More informationFBC, HbA1c, U/E, FT4, Blood Gas, Thyroid antibodies, TSH, Coeliac screen, GAD antibodies, Islet cell antibodies, and insulin antibodies.
1. DIAGNOSIS confirmed by doctor using below guidelines: (a) History of polyuria (usually nocturia ± enuresis) Polydipsia ± weight loss (b) Glycosuria (c) Blood Glucose (BG) > 11 mmol/l (confirm from a
More informationProve You Are Ready For Healthier Living - Kick the Fat, Sugar, and Salt Food Trifecta
Adult food challenge Prove You Are Ready For Healthier Living - Kick the Fat, Sugar, and Salt Food Trifecta If you are serious about improving your health and life span, you are ready to kick the treacherous
More informationCurrent issues in research on food marketing. StanMark. STANMARK, 9th MARCH Jason Halford & Emma Boyland. Liverpool Obesity Research Network
Current issues in research on food marketing STANMARK, 9th MARCH 2011 Jason Halford & Emma Boyland Liverpool Obesity Research Network BRAND RECOGNITION IN VERY YOUNG CHILDREN Children are very aware of
More informationDiet advice for gestational diabetes
Diet advice for gestational diabetes Background Gestational diabetes is a type of diabetes that develops during pregnancy and usually goes away after giving birth. It commonly occurs in the second or third
More informationPATIENT INSTRUCTION. Extensive myocardial metabolic PET/CT NUCLEAR MEDICINE. Appointment time. Preparation for examination
Extensive myocardial metabolic PET/CT Appointment time You have been scheduled for PET-CT scan. The appointment will take 2-4 hours, of which part will be spent in bed rest. Imaging time is about 30 minutes.
More information