Diabetes in Pregnancy
|
|
- Stephany Wheeler
- 5 years ago
- Views:
Transcription
1 Diabetes in Pregnancy Ebony Boyce Carter, MD, MPH Division of Maternal Fetal Medicine Washington University School of Medicine Disclosures I have no financial disclosures to report. Objectives Review the pathophysiology of diabetes Discuss the prevalence of diabetes in pregnancy Review Diabetes Screening and Diagnosis Discuss morbidity with diabetes in pregnancy Review recommendations for diabetes management Antepartum Intrapartum postpartum Discuss preconception counseling for diabetes 1
2 Objectives Review the pathophysiology of diabetes Discuss the prevalence of diabetes in pregnancy Review Diabetes Screening and Diagnosis Discuss morbidity with diabetes in pregnancy Review recommendations for diabetes management Antepartum Intrapartum postpartum Discuss preconception counseling for diabetes Pathophysiology of Diabetes Metabolic disease with defects in insulin secretion and/or action resulting in hyperglycemia ADA Diabees Care 2004 Jan: 27 (suppl 1) Pathophysiology: Types of Diabetes Pre-Diabetes Gestational Diabetes 2
3 Pathophysiology Associated with long term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. ADA Diabees Care 2004 Jan: 27 (suppl 1) Objectives Review the pathophysiology of diabetes Discuss the prevalence of diabetes in pregnancy Review Diabetes Screening and Diagnosis Discuss morbidity with diabetes in pregnancy Review recommendations for diabetes management Antepartum Intrapartum postpartum Discuss preconception counseling for diabetes Prevalence: Diabetes in the United States 3
4 Prevalence CDC reported in million Americans with Diabetes & PreDiabetes million diabetes 84.1 million with Pre-Diabetes 1.5 million new cases in < 20 years old in million (7.2 %) adults in US population have been diagnosed with Diabetes 11.7 million are women 7.2 million adults are undiagnosed. 3.1 million are women Leading cause of Maternal and Perinatal M & M. Complicates 1% of pregnancies Objectives Review the pathophysiology of diabetes Discuss the prevalence of diabetes in pregnancy Review Diabetes Screening and Diagnosis Discuss morbidity with diabetes in pregnancy Review recommendations for diabetes management Antepartum Intrapartum postpartum Discuss preconception counseling for diabetes Screening: 4
5 Diagnosis Diagnosis Objectives Review the pathophysiology of diabetes Discuss the prevalence of diabetes in pregnancy Review Diabetes Screening and Diagnosis Discuss morbidity with diabetes in pregnancy Review recommendations for diabetes management Antepartum Intrapartum postpartum Discuss preconception counseling for diabetes 5
6 Perinatal Morbidity: fetus and neonate RDS Congenital Anomalies Hypoglycemia SAB Fetus IUGR w/ Type I DM Newborn Hyperbilirubinemia LGA w/ Type II DM >90 th % Shoulder Dystocia Organomegaly Stillbirth Polycythemia Long term Health Risk: Obesity, metabolic syndrome, and Type II DM Perinatal Morbidity: fetus and neonate Perinatal Morbidity: Maternal Preterm Labor Preeclampsia (15-20% vs 50% with nephropathy) Increased risk of Cesarean Progressive retinopathy 6
7 Objectives Review the pathophysiology of diabetes Discuss the prevalence of diabetes in pregnancy Review Diabetes Screening and Diagnosis Discuss morbidity with diabetes in pregnancy Review recommendations for diabetes management Antepartum Intrapartum postpartum Discuss preconception counseling for diabetes Antepartum Management: Pre-Existing Achieve excellent glycemic control Monitor Blood glucose 4-7x/day Fasting blood glucose Premeals 1 or 2 hours postprandial Bedtime (10 pm) Antepartum Management: GDM 7
8 Antepartum Management: target blood glucose Antepartum Management: Diet Counseling from Registered Dietician or Certified Diabetes Educator on Medical Nutrition Therapy (MNT) MNT is an evidenced based lifestyle intervention to improve outcomes in Diabetes Mellitus. Prevent ketosis, excessive weight gain,? Fetal programming, teach sustainable food choices CHO counting vs fixed CHO per meals 40-50% Complex CHO 20% Protein 30-40% Fats Antepartum Management: Diet Increase by 300 kcal/day Normal Body Weight kcal/kg/day Less than normal body weight kcal/kg/day Greater than normal body weight 24 kcal/kg/day 8
9 Antepartum Management: Initial OB Appt. Obtain baseline labs A1C TSH Baseline preeclampsia labs 24 hour urine for total protein and Creatinine clearance or Urine protein Creatinine ratio Eye Exam EKG Early Anatomic Survey vs. Specialized Anatomic survey Fetal Echo Serial fetal growth Ultrasound Fetal testing at 32 weeks 2x/week Antepartum Management: Medications Insulin Oral agents Metformin Glyburide Insulin Only FDA approved medication for Diabetes in pregnancy. Does not readily cross the placenta No association with fetal anomalies First line treatment for Diabetes and Gestational Diabetes Risk of hypoglycemia and hypokalemia 9
10 Insulin Initiation Weight based Calculations Trimester Total Daily Dose (units/kg) 1 st Trimester nd Trimester rd Trimester Decrease total daily dose by 20% if insulin naïve. Insulin Preparations and Pharmacokinetics Insulin Onset of Action Peak Action (hours) Lispro (humalog), Aspart (novolog), Glulisine (Apidra) 1-15 mins Duration of Action (hours) Regular (Humulin mins R, Novolin R) NPH (Humulin N, 2-4 hours 4-10 hours hours Novolin N) Glargine (Lantus) 2 hours none 24 hours Detemir (Levemir) Insulin zinc suspension (Ultralente) 2 hours 3-9 hours hours 2-4 hours 8-14 hours hours 10
11 Insulin dose adjustment Adjust weekly No evidence to support an optimal algorithm to adjust doses Increase by 20% Antepartum Management: Blood Glucose goals Time Non Diabetic range mg/dl Diabetic range mg/dl Fasting Premeal hr Postprandial <140 (< 120) 2hr Postprandial <120 Bedtime
12 Oral Medications Recommended for Gestational Diabetes Metformin -> second line agent Glyburide -> third line agent Both cross the placenta and usually are not enough for control pregestational diabetes. Not Recommended (limited safety data) Glipizide Alpha glucosidase inhibitors (Acarbose) Thiazolidinedione ( Pioglitazone) Glucagon like peptide 1 Metformin Initiate 500mg bid Increase by 500 mg q 3-5 days Requires slow dose adjustments Maximum dose is 2500 mg daily Crosses placenta Insufficient glucose control Antepartum Management: Exercise Increases insulin sensitivity Increases glucose utilization May prevent excess weight gain ACOG recommendations based on 2008 US Department of Health and Human Services for Healthy pregnant women at least 150 minutes per week of moderate-intensity aerobic activity ( equivalent to brisk walking). This activity should be spread throughout the week and adjusted as medically indicated. 12
13 Hypoglycemia Hypoglycemia Hypoglycemia Treat with pure glucose correlates better with glucose response Avoid protein which may enhance insulin response to dietary carbohydrates\ Avoid ingesting fats which may delay and prolong acute glycemic response of treatment Patient should carry glucose tablets All patients should be prescribed glucagon pen 13
14 Diabetic Ketoacidosis (DKA) Triad: hyperglycemia, anion gap metabolic acidosis and ketonemia 1-3% of pregnancies complicated by Pregestational diabetes 9-35 % Fetal Mortality rate 5-15% Maternal Mortality rate More common in Type I Diabetes with rare occurrences in Type 2 and Gestational diabetes Teach women to recognize and report symptoms Instruct women to check for urine ketones if blood glucose is > 200 mg/dl DKA Symptoms Nausea Vomiting Thirst Polyuria Polydipsia Abdominal pain Mental status changes Renal dysfunction Signs Elevated glucose > 200 Anion gap > 12 meq/l Ketonemia Low serum bicarbonate 14
15 Fetal Heart Rate Tracing during DKA Sibai, B. Diabetic Ketoacidosis in Pregnancy. Obset Gynecol 2014; 123:167 Antepartum Management ACOG recommends visits 1-2 weeks < 28 weeks and weekly at weeks. Low Dose Aspirin Specialized Anatomic Survey weeks Serial Ultrasounds to monitor fetal growth ( Final scan 3 at least 3 weeks prior to delivery) Fetal Echo vs specialized heart views on Prenatal US Fetal testing at 32 weeks Twice Weekly Delivery at 39 weeks or earlier. Vasculopathy Nephropathy Poor glucose control Prior Stillbirth Objectives Review the pathophysiology of diabetes Discuss the prevalence of diabetes in pregnancy Review Diabetes Screening and Diagnosis Discuss morbidity with diabetes in pregnancy Review recommendations for diabetes management Antepartum Intrapartum postpartum Discuss preconception counseling for diabetes 15
16 Intrapartum Management Goal is to keep BG < 110 mg/dl Prevent maternal hyperglycemia Prevent fetal hyperglycemia Prevent Neonatal hypoglycemia Objectives Review the pathophysiology of diabetes Discuss the prevalence of diabetes in pregnancy Review Diabetes Screening and Diagnosis Discuss morbidity with diabetes in pregnancy Review recommendations for diabetes management Antepartum Intrapartum Postpartum Discuss preconception counseling for diabetes 16
17 Postpartum Management Increase 500 kcal/day if breastfeeding Decrease insulin requirement 50% reduction in pre-delivery Further reduction if breastfeeding Objectives Review the pathophysiology of diabetes Discuss the prevalence of diabetes in pregnancy Review Diabetes Screening and Diagnosis Discuss morbidity with diabetes in pregnancy Review recommendations for diabetes management Antepartum Intrapartum postpartum Discuss preconception counseling for diabetes Preconception Counseling Target A1C < 6.0 (6.5) prior to pregnancy Review medications to ensure safe for pregnancy Folic Acid prior to conception Testing for complications: Cardiovascular disease Thyroid disease Neuropathy Nephropathy 17
18 Summary Excellent glycemic control decreases risk of perinatal morbidity and mortality. Insulin provides the best control and decreases risk of perinatal morbidity Attempt to keep Blood glucose < 110 prior to delivery Decrease insulin after delivery of placenta by 50% Preconception counseling has been proven to improve outcomes and should be encouraged. QUESTIONS??? 18
Management 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 informationDiabetes in Pregnancy
Diabetes in Pregnancy Susan Drummond RN MSN C-EFM Objectives 1. Describe types of diabetes and diagnosis of gestational diabetes 2. Identify a management plan for diabetes during pregnancy 3. Describe
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 informationCurrent Trends in Diagnosis and Management of Gestational Diabetes
Current Trends in Diagnosis and Management of Gestational Diabetes Shreela Mishra, MD Assistant Clinical Professor UCSF Fresno Medical Education Program 2/2/2019 Disclosures No disclosures 2/2/19 Objectives
More information2/13/2018. Update on Gestational Diabetes. Disclosure. Objectives. I have no financial conflicts of interest.
Update on Gestational Diabetes Lorie M. Harper, MD, MSCI Department of Obstetrics & Gynecology Division of Maternal-Fetal Medicine 2/18/2018 Disclosure I have no financial conflicts of interest. Objectives
More informationDiabetes in Pregnancy
Disclosure Diabetes in Pregnancy I have no conflicts of interest to disclose Jennifer Krupp, MD Maternal Fetal Medicine St. Marys Hospital/SSM Health Madison, WI Objectives Classification of Diabetes Classifications
More information2018 Standard of Medical Care Diabetes and Pregnancy
2018 Standard of Medical Care Diabetes and Pregnancy 2018 Standard of Medical Care Diabetes and Pregnancy Marjorie Cypress does not have any relevant financial relationships with any commercial interests
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 informationAPEC Guidelines Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) is defined as insulin resistance of variable severity with onset or first recognition during pregnancy. The prevalence of diabetes mellitus (DM) in the US is growing
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 informationImproving Outcomes in Pregnancies Complicated by Diabetes Mellitus
Improving Outcomes in Pregnancies Complicated by Diabetes Mellitus Steven G. Gabbe, M.D. Emeritus Chief Executive Officer Professor, Obstetrics and Gynecology The Ohio State University Wexner Medical Center
More informationWayne Gravois, MD August 6, 2017
Wayne Gravois, MD August 6, 2017 Americans with Diabetes (Millions) 40 30 Source: National Diabetes Statistics Report, 2011, 2017 Millions 20 10 0 1980 2009 2015 2007 - $174 Billion 2015 - $245 Billion
More informationDiabetes: The Effects of Maternal Diabetes on Fetal Development and Outcomes Sherrie McElvy, MD May 18, 2016
Diabetes: The Effects of Maternal Diabetes on Fetal Development and Outcomes Sherrie McElvy, MD May 18, 2016 Medical Director Sweet Success Sutter Medical Center Sacramento Perinatal Associates of Sacramento
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 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 information第十五章. Diabetes Mellitus
Diabetes-1/9 第十五章 Diabetes Mellitus 陳曉蓮醫師 2/9 - Diabetes 羅東博愛醫院 Management of Diabetes mellitus A. DEFINITION OF DIABETES MELLITUS Diabetes Mellitus is characterized by chronic hyperglycemia with disturbances
More informationMaximizing the Role of WIC Nutritionists in Prevention of DM2 among High Risk Clients ESTHER G. SCHUSTER, MS,RD,CDE
Maximizing the Role of WIC Nutritionists in Prevention of DM2 among High Risk Clients ESTHER G. SCHUSTER, MS,RD,CDE Heavy Numbers Surgeon General report: 68% of adults in U. S. are overweight or obese
More informationAACN PCCN Review. Endocrine
AACN PCCN Review Endocrine Presenter: Carol A. Rauen, RN, MS, CCNS, CCRN, PCCN, CEN Independent Clinical Nurse Specialist & Education Consultant rauen.carol104@gmail.com Endocrine I. INTRODUCTION Disorders
More informationDIABETES AND PREGNANCY. CDE Exam Preparation March 22 & 27, 2018 Presented by Wendy Graham RD CDE Mentor
DIABETES AND PREGNANCY CDE Exam Preparation March 22 & 27, 2018 Presented by Wendy Graham RD CDE Mentor OBJECTIVES Describe targets for blood glucose in pregnancy Discuss the risks to baby if blood glucose
More informationPregestational and Gestational Diabetes
Pregestational and Gestational Diabetes Francis S. Nuthalapaty, MD Greenville Health System University of South Carolina School of Medicine - Greenville Case History 30 year old black female presents to
More informationManagement of Gestational Diabetes
Management of Gestational Diabetes A Diabetes risk assessment should be ascertained at the First prenatal visit. Low Risk: Early blood glucose screening is NOT routinely required if most of the following
More informationCommUnityCare Women s Health Brackenridge Professional Office Building
Guidelines for Diabetes in Pregnancy Effective Date 7/1/11 *This document does not define a standard of care, nor is it intended to dictate an exclusive course of management. There are other accepted strategies
More informationObjectives. Diabetes and Obesity in Pregnancy. In Diabetes. Diabetes in Pregnancy
Objectives Diabetes and Obesity in Pregnancy. Health Impact for the mother and child Bresta Miranda, MD Assistant Professor of Clinical Medicine University of Miami, Miller School of Medicine Review physiologic
More informationDiabetes in Pregnancy
Diabetes in Pregnancy Resident School November 5 2014 Goals Be able to screen for gestational and preexisting diabetes Be able to counsel women on the diagnosis of gestational diabetes Understand glucose
More informationDiabetes & Pregnancy: Management Guide
Diabetes & Pregnancy: Management Guide This program is supported by an educational grant from Novo Nordisk Inc. Inc Diabetes & Pregnancy: Management Guide is supported by an educational grant from Novo
More informationDiabetes Mellitus. Raja Nursing Instructor. Acknowledgement: Badil 09/03/2016
Diabetes Mellitus Raja Nursing Instructor 09/03/2016 Acknowledgement: Badil Objective: Define Diabetes Mellitus (DM) & types of DM. Understand the pathophysiology of Type-I & II DM. List the clinical features
More informationDiabetes in Pregnancy: Detection, Intervention, Prevention. Diabetes in Pregnancy: Outline. Diabetes in Pregnancy
Diabetes in Pregnancy: Detection, Intervention, Prevention Michael Shannon, MD Chair, Providence Endocrinology/Diabetes CAT Diabetes in Pregnancy: Outline Prevalence, Pathophysiology and Complications
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 and Pregnancy
Diabetes and Pregnancy Eric L. Johnson, M.D. Associate Professor Department of Family and Community Medicine University of North Dakota School of Medicine And Health Sciences Assistant Medical Director
More informationThe Ever-Changing Approaches to Diabetes in Pregnancy
The Ever-Changing Approaches to Diabetes in Pregnancy Kirsten E. Salmeen, MD Assistant Professor Obstetrics, Gynecology & Reproductive Sciences Maternal-Fetal Medicine I have nothing to disclose. Approaches
More informationMixed Insulins Pick Me
Mixed Insulins Pick Me Alvin Goo, PharmD Clinical Associate Professor University of Washington School of Pharmacy and Department of Family Medicine Objectives Critically evaluate the evidence comparing
More informationI. General Considerations
1 2 3 I. General Considerations A. Type I ( Juvenile Onset or IDDM) IDDM results from autoimmune destruction of beta cells inability to secrete insulin --> ketone formation --> DKA 4 Diabetic Ketoacidosis
More informationSociety for Ambulatory Anesthesia Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery
Society for Ambulatory Anesthesia Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery Girish P. Joshi, MB BS, MD, FFARCSI Anesthesia & Analgesia
More informationType 1 Diabetes-Pathophysiology, Diagnosis, and Long-Term Complications. Alejandro J de la Torre Pediatric Endocrinology 10/17/2014
Type 1 Diabetes-Pathophysiology, Diagnosis, and Long-Term Complications Alejandro J de la Torre Pediatric Endocrinology 10/17/2014 Objectives Understand the pathophysiology of Type 1 diabetes. Be familiar
More informationInsulin Prior Authorization with optional Quantity Limit Program Summary
Insulin Prior Authorization with optional Quantity Limit Program Summary 1-13,16-19, 20 FDA LABELED INDICATIONS Rapid-Acting Insulins Humalog (insulin lispro) NovoLog (insulin aspart) Apidra (insulin glulisine)
More informationMANAGEMENT OF DIABETES IN PREGNANCY
MANAGEMENT OF DIABETES IN PREGNANCY Ministry of Health Malaysia Malaysian Endocrine & Metabolic Society Perinatal Society of Malaysia Family Medicine Specialists Association of Malaysia Academy of Medicine
More informationComprehensive Diabetes Treatment
Comprehensive Diabetes Treatment Joshua L. Cohen, M.D., F.A.C.P. Professor of Medicine Interim Director, Division of Endocrinology & Metabolism The George Washington University School of Medicine Diabetes
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 informationDiagnosis and Management of Gestational Diabetes Mellitus. Prof. Dr Md Faizul Islam Chowdhury Professor of Medicine, Department of Medicine, DMCH.
Diagnosis and Management of Gestational Diabetes Mellitus Prof. Dr Md Faizul Islam Chowdhury Professor of Medicine, Department of Medicine, DMCH. Gestational Diabetes Mellitus I, the Fetus I, the fetus
More informationassociated with serious complications, but reduce occurrences with preventive measures
Wk 9. Management of Clients with Diabetes Mellitus 1. Diabetes Mellitus body s inability to metabolize carbohydrates, fats, proteins hyperglycemia associated with serious complications, but reduce occurrences
More informationDIABETES. Mary Bruskewitz APNP, MS, BC-ADM Clinical Nurse Specialist Diabetes. November 2013
DIABETES Mary Bruskewitz APNP, MS, BC-ADM Clinical Nurse Specialist Diabetes November 2013 mbruskewitz@outlook.com Objectives Part 1 Overview of Endocrine Physiology Pathophysiology of Diabetes Diabetes
More informationManaging Gestational Diabetes. Definition of GDM
Managing Gestational Diabetes Definition of GDM Gestational diabetes is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy that excludes those with overt
More informationInsulin therapy in gestational diabetes mellitus
Insulin therapy in gestational diabetes mellitus October 15, 2015 Kyung-Soo Kim Division of Endocrinology & Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University Contents
More informationPHARMACISTS INTERACTIVE EDUCATION CASE STUDIES
PHARMACISTS INTERACTIVE EDUCATION CASE STUDIES Disclaimer: The information in this document is not a substitute for clinical judgment in the care of a particular patient. CADTH is not liable for any damages
More informationType 2 Diabetes Mellitus Insulin Therapy 2012
Type 2 Diabetes Mellitus Therapy 2012 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Preparations Onset Peak Duration
More informationDiabetes Mellitus II CPG
1 Diabetes Mellitus II CPG Candidates for Screening Integrated Complex Care Patients: Check Yearly Prediabetes: Check Yearly No Diabetes Mellitus (DM) Risk Factors: Check at Age 45, Repeat Every 3 Years
More informationManaging Diabetes Before, During, and After Pregnancy
Managing Diabetes Before, During, and After Pregnancy This program is supported by an educational grant from Novo Nordisk Inc. It has been accredited by AADE for pharmacists, nurses, and dietitians. This
More informationPregnancy confers a state of insulin resistance and hyperinsulinemia that. Gestational Diabetes Mellitus MANAGEMENT REVIEW
MANAGEMENT REVIEW Gestational Diabetes Mellitus Amanda Bird Hoffert Gilmartin, Serdar H. Ural, MD, John T. Repke, MD Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Penn State
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 informationClinical Practice Guidelines
Clinical Practice Guidelines Diabetes Objective The purpose is to guide the appropriate diagnosis and management of Diabetes. This guideline is designed to assist the clinician by providing a framework
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 informationObjectives 2/13/2013. Figuring out the dose. Sub Optimal Glycemic Control: Moving to the Appropriate Treatment
Sub Optimal Glycemic Control: Moving to the Appropriate Treatment Judy Thomas, MSN, FNP-BC Holt and Walton, Rheumatology and Endocrinology Objectives Upon completion of this session you will be better
More information9/14/2016. Diabetes from Antepartum to Postpartum: Disclosures. What the Bedside Nurse Needs to Know. Pre-Gestational Diabetes Mellitus.
Disclosures I have no financial relationships to disclose Department of Nursing: Perinatal Services Molly M. Killion, RNC-OB, MS, CNS-BC Perinatal Clinical Nurse Specialist Diabetes from Antepartum to
More informationAbbreviations DPP-IV dipeptidyl peptidase IV DREAM Diabetes REduction Assessment with ramipril and rosiglitazone
Index Abbreviations DPP-IV dipeptidyl peptidase IV DREAM Diabetes REduction Assessment with ramipril and rosiglitazone Medication GAD glutamic acid decarboxylase GLP-1 glucagon-like peptide 1 NPH neutral
More informationDiabetes: Definition Pathophysiology Treatment Goals. By Scott Magee, MD, FACE
Diabetes: Definition Pathophysiology Treatment Goals By Scott Magee, MD, FACE Disclosures No disclosures to report Definition of Diabetes Mellitus Diabetes Mellitus comprises a group of disorders characterized
More informationGestational Diabetes: Long Term Metabolic Consequences. Outline 5/27/2014
Gestational Diabetes: Long Term Metabolic Consequences Gladys (Sandy) Ramos, MD Associate Clinical Professor Maternal Fetal Medicine Outline Population rates of obesity and T2DM Obesity and metabolic syndrome
More informationDiabetes: Everything You Want to Know. LCDR Bernadine John, RN, BSN, CDE
Diabetes: Everything You Want to Know LCDR Bernadine John, RN, BSN, CDE I have no financial affiliation to disclose as a conflict of interest regarding this presentation. DM Standards of Care The IHS Division
More informationSignificant economic burden Conservative because focus on near-term medical costs, omitting increased long-term risks Insulin Resistance
What s New in Gestational Diabetes? Diane Reader RD, CDE International Diabetes Center Park Nicollet Health Services Minneapolis, MN GDM Statistics What s New? Proposed Changes to Diagnostic Criteria Treatment
More informationAntihyperglycemic Agents in Diabetes. Jamie Messenger, PharmD, CPP Department of Family Medicine East Carolina University August 18, 2014
Antihyperglycemic Agents in Diabetes Jamie Messenger, PharmD, CPP Department of Family Medicine East Carolina University August 18, 2014 Objectives Review 2014 ADA Standards of Medical Care in DM as they
More informationCurrent Approaches to Caring for the Woman with Diabetes During Pregnancy
CONTINUING EDUCATION Current Approaches to Caring for the Woman with Diabetes During Pregnancy Julie Daley, RN, MS, CDE Director, Diabetes in Pregnancy Program Women & Infants Hospital of Rhode Island
More informationGESTATIONAL DIABETES TESTING AND TREAMENT
Boston Medical Center Maternity Care Guideline: GESTATIONAL DIABETES TESTING AND TREAMENT Accepted: August 2015 Updated: December 2018 Contributors: Aviva Lee-Parritz, MD, Sara Alexanian, MD, Kari Radoff,
More informationNph insulin conversion to lantus
Nph insulin conversion to lantus Search 26-2-2003 RESPONSE FROM AVENTIS. We appreciate the opportunity to respond to Dr. Grajower s request for information regarding Lantus ( insulin glargine [rdna origin.
More informationPeripartum and Postpartum Management of Diabetes
Peripartum and Postpartum Management of Diabetes General Principles Glucose goal ~ 100 mg/dl (70-110 mg/dl) Labor is EXERCISE with increased metabolic demands. Insulin requirements decrease however the
More informationMedications for Diabetes
Medications for Diabetes Sweet, but not too sweet Colette Raymond, Pharm D June 15, 2011 Learning Objectives At the end of this presentation you should be able to: Understand the prevalence and types of
More informationPrevention and Management of Diabetes in Pregnancy
Prevention and Management of Diabetes in Pregnancy Sridhar Chitturi Consultant Endocrinologist Royal Darwin Hospital Outline of the talk Diabetes in Pregnancy Spectrum Diagnostic criteria Why bother about
More informationDiabetes is a chronic disease of impaired glucose intolerance caused by absolute or relative insulin deficiency.
June 2015 Diabetes is a chronic disease of impaired glucose intolerance caused by absolute or relative insulin deficiency. Types of Diabetes Type 1 Type 2 Gestational Diabetes and Pregnancy 0.3% of pregnancies
More informationStandards of Care in Diabetes What's New? Veronica Brady, FNP-BC, PhD, BC-ADM,CDE Karmella Thomas, RD, LD,CDE
Standards of Care in Diabetes 2016-- What's New? Veronica Brady, FNP-BC, PhD, BC-ADM,CDE Karmella Thomas, RD, LD,CDE Terminology No longer using the term diabetic. Diabetes does not define people. People
More informationThe Nurse s Guide to Understanding Gestational Diabetes
The Nurse s Guide to Understanding Gestational Diabetes 1 Contact Hours Copyright 2013 by RN.com. All Rights Reserved. Reproduction and distribution of these materials is prohibited without anrn.com content
More informationPHARMACISTS INTERACTIVE EDUCATION CASE STUDIES
PHARMACISTS INTERACTIVE EDUCATION CASE STUDIES Disclaimer: The information in this document is not a substitute for clinical judgment in the care of a particular patient. CADTH is not liable for any damages
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 informationBlood Glucose Monitoring
Blood Glucose Monitoring What is Glucose? A simple sugar that enters the diet as part of sucrose, lactose, or maltose Part of a polysaccharide called dietary starch Most of the body s energy comes from
More informationScreening and Diagnosis of Diabetes Mellitus in Taiwan
Screening and Diagnosis of Diabetes Mellitus in Taiwan Hung-Yuan Li, MD, MMSc, PhD Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Associate Professor,
More informationScreening & Management of Diabetes in Pregnancy: What s New?
Screening & Management of Diabetes in Pregnancy: What s New? Jerrie S. Refuerzo, M.D. Associate Professor Division of Maternal Fetal medicine Department of Obstetrics, Gynecology and Reproductive Sciences
More informationMANAGEMENT OF DIABETES
MANAGEMENT OF DIABETES Federal Bureau of Prisons Clinical Guidance MARCH 2017 Clinical guidance is made available to the public for informational purposes only. The Federal Bureau of Prisons (BOP) does
More informationMae Sheikh-Ali, M.D. Assistant Professor of Medicine Division of Endocrinology University of Florida College of Medicine- Jacksonville
Mae Sheikh-Ali, M.D. Assistant Professor of Medicine Division of Endocrinology University of Florida College of Medicine- Jacksonville Pathogenesis of Diabetes Mellitus (DM) Criteria for the diagnosis
More informationPharmacologic Agents for Treatment of Type 2 Diabetes
Pharmacologic Agents for Treatment of Type 2 Diabetes SCAN Drugs Medication Biguanides 1 1 er uncoated tabs 500 mg & 750 mg Sulfonylureas 1 1 500 850 mg QD - TID 500 2000 mg glimepiride 1 1 1 8 mg glipizide
More informationAre Novel Lifestyle Approaches to Management of Type 2 Diabetes Applicable to Prevention and Treatment of Women with Gestational Diabetes Mellitus?
Open Access Journal Volume: 1.1 Global Diabetes Open Access Journal Are Novel Lifestyle Approaches to Management of Type 2 Diabetes Applicable to Prevention and Treatment of Women with Gestational Diabetes
More information10/9/2017 OBJECTIVES DIABETES REVIEW
OBJECTIVES MECHANICAL MADNESS: TECHNOLOGY, DIABETES AND PREGNANCY ALYSON BLUM, PHARMD, CDE CLINICAL PHARMACIST IN OBSTETRICS SACRED HEART MEDICAL CENTER, CENTER FOR MATERNAL FETAL MEDICINE WASHINGTON STATE
More informationObjectives. Medical Complications of Pregnancy. Potential Conflicts: None. Common Complicating Medical Conditions that Precede Pregnancy
Medical Complications of Potential Conflicts: None Ellen W. Seely, M.D. Director of Clinical Research Endocrine-Hypertension Division Brigham and Women s Hospital Professor of Medicine Harvard Medical
More informationDiabetes in Pregnancy
JSAFOG Diabetes in Pregnancy CONTEMPORARY REVIEW ARTICLE Diabetes in Pregnancy Neeta Deshpande Consultant, Diabetologist and Bariatric Physician, Belgaum Diabetes Center, Belgaum, Karnataka, India Correspondence:
More informationWhat the Pill Looks Like. How it Works. Slows carbohydrate absorption. Reduces amount of sugar made by the liver. Increases release of insulin
Diabetes s Oral s - Pills These are some of the pills that are currently available in Canada to treat diabetes. Each medication has benefits and side effects you should be aware of. Your diabetes team
More informationGESTATIONAL DIABETES MELLITUS UPDATES AND OVERVIEW
GESTATIONAL DIABETES MELLITUS UPDATES AND OVERVIEW Kacy Herron MD R3 Idaho Perinatal Project Winter Conference 2018 DISCLOSURES NONE 1 LEARNING OBJECTIVES Gestational Diabetes Mellitus Pathophysiology
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 informationNew Guidelines for the Diagnosis of Diabetes Mellitus
New Guidelines for the Diagnosis of Diabetes Mellitus Joely Straseski, PhD, DABCC, FACB Assistant Professor and Medical Director Endocrinology and Automated Core Laboratory University of Utah and ARUP
More informationDiabetes in Pregnancy Dr. Hana
Diabetes in Pregnancy Dr. Hana Introduction Diabetes occurs in 2 5% of all UK pregnancies and its prevalence is rising. Forty years ago the majority of women with diabetes attending an antenatal clinic
More informationMedical Complications of Pregnancy
Medical Complications of Pregnancy Systems Cardiovascular Pulmonary Endocrine Gastrointestinal Urologic Neurologic Cardiovascular System Physiologic anemia 3:1 increase of plasma volume:rbc mass Treat
More informationBasal-Bolus Insulin Therapy. Veronica Brady, PhD, FNP-BC, BC-ADM, CDE ECHO January
Basal-Bolus Insulin Therapy Veronica Brady, PhD, FNP-BC, BC-ADM, CDE ECHO January 18 2018 Terminology No longer using the term diabetic. Diabetes does not define people. People with diabetes are individuals
More informationInitiating Injectable Therapy in Type 2 Diabetes
Initiating Injectable Therapy in Type 2 Diabetes David Doriguzzi, PA C Learning Objectives To understand current Diabetes treatment guidelines To understand how injectable medications fit into current
More informationManagement of Diabetes
Clinical Practice Guidelines November 2010 Clinical guidelines are made available to the public for informational purposes only. The (BOP) does not warrant these guidelines for any other purpose, and assumes
More informationHow to manage a pregnant patient with diabetes
How to manage a pregnant patient with diabetes EASD Postgraduate Course on Clinical Diabetes and its Complications, Shiraz, Iran Rasa Verkauskiene Lithuanian University of Health Sciences 2017 History
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 informationSCREENING FOR DIABETES IN THE FIRST TRIMESTER: WHY & HOW? Jillian Coolen, MD FRCSC DCPNS Spring Conference April 21, 2016
SCREENING FOR DIABETES IN THE FIRST TRIMESTER: WHY & HOW? Jillian Coolen, MD FRCSC DCPNS Spring Conference April 21, 2016 DISCLOSURE Site investigator for the CONCEPTT study funded by Juvenile Diabetes
More informationAs of June 2015 in the United
Insulin Use in Pregnancy: An Update Alyson K. Blum IN BRIEF Insulin remains the standard of care for the treatment of type 1 diabetes, type 2 diabetes, and uncontrolled gestational diabetes. Tight control
More informationIntrapartum and Postpartum Management of the Diabetic Mother and Infant
Intrapartum and Postpartum Management of the Diabetic Mother and Infant Intrapartum Management Women with gestational diabetes who maintain normal glucose levels during pregnancy on diet and exercise therapy
More informationBackground: Brief review of epidemiology, diagnosis, classification and pathophysiology of diabetes mellistus.
Insulin Therapy in Diabetes Mellitus Part 1 Lekshmi T. Nair, MD, MHS Assistant Professor Department of Internal Medicine Division of Endocrinology, Diabetes and Metabolism The Ohio State University Wexner
More informationGestational Diabetes Screening and Treatment Guideline
Gestational Diabetes Screening and Treatment Guideline Major Changes as of April 2018... 2 Screening Recommendations and Tests... 2 Diagnosis... 3 Treatment Goals... 3 Lifestyle modifications/non-pharmacologic
More informationHighlighting the Differences between Preexisting Type 1 and Type 2 Diabetes in Pregnancy and Gestational Diabetes
Highlighting the Differences between Preexisting Type 1 and Type 2 Diabetes in Pregnancy and Gestational Diabetes Elizabeth (Libby) Downs Quiroga, MS, RD, CDE Tandem Diabetes Care Clinical Specialist Grand
More informationInsulin Regimens: Hitting Glycemia Targets
Insulin Regimens: Hitting Glycemia Targets Grant Kelley MD March 1 st, 2018 Faculty Disclosure: Financial relationships with commercial interests None Overview Mortality and Morbidity Insulin and Insulin
More informationThe Pregnant Diabetic. Queenie G. Ngalob, MD, FPCP May 5, 2014
The Pregnant Diabetic Queenie G. Ngalob, MD, FPCP May 5, 2014 Outline Classification of diabetes in pregnancy Effect of diabetes and pregnancy on Conceptus Mother Treatment recommendations for pregnant
More informationRecent Advances in the Management of Diabetes
Recent Advances in the Management of Diabetes Raja Hanania, R.Ph,CDM,CDE,LDE,BCPS Clinical Pharmacy Specialist IU Health Bloomington Hospital Bloomington, Indiana Indiana Pharmacists Alliance Annual Convention
More information