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Treatments for Gestational diabetes
Treatment list for Gestational diabetes:
The list of treatments mentioned in various sources for Gestational diabetes includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
- Diet changes
- Exercise - with care and under medical advice; take extra care if using insulin.
- Diabetic blood sugar control
- Self monitored blood glucose testing
- Ketone testing
- Insulin
Treatments of Gestational diabetes: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Gestational diabetes.
Hyperglycemia:
Treatment
(In a Page: Signs and Symptoms)
- IV fluids
- Acute treatment includes insulin administration (IV or subcutaneous) or oral hypoglycemic medications
- Remove offending medications if possible
- Treat the underlying etiology
- Acute treatment of diabetic ketoacidosis involves fluid repletion, correction of electrolyte disturbances, insulin administration, and very frequent monitoring of glucose and electrolytes (intensive care admission is often necessary for initial stages of treatment)
- Long-term management includes regular testing of HbA1C, glucose (home readings), blood pressure, lipid profile, renal function, and regular podiatric and ophthalmology examinations
Hyperglycemia:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Initial management
–Fluid to correct dehydration
–Insulin to correct hyperglycemia and acidosis
–Intravenous therapy required if patient in DKA - Long-term management: Goal is to normalize blood glucose and HbA1c to decrease risk of acute and chronic complications
-
Type II diabetes
–Absolute daily insulin requirement
–Monitor blood glucose (metabolic control)
–Attention to dietary intake (carbohydrate counting) -
Type II diabetes
–Weight management via diet changes and exercise
–Most require medication (insulin and/or metformin)
-
Prognosis
–Chronic hyperglycemia increases long-term risk of microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (atherosclerosis and ischemic heart disease) complications
Polydipsia:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Insulin and/or oral medications for DM
-
Central DI
–Desmopressin treatment for older children
–Not in immediate post-op period
–Free water replacement
–Desmopressin may lead to hyponatremia in infants and in postoperative cases that may also involve SIADH -
Nephrogenic DI
–Thiazide diuretics
–Mild salt depletion
–Prostaglandin synthesis inhibitors - Behavioral modification for compulsive water drinking
- Surgical intervention for tumor
- Strict measurement of input and output
- Must assess presence or absence of intact thirst mechanism for central DI
Diabetes insipidus:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Mild cases require no treatment other than fluid intake to replace fluid lost. Until the cause of more severe cases of diabetes insipidus can be identified and eliminated, administration of various forms of vasopressin or of a vasopressin stimulant can control fluid balance and prevent dehydration. Vasopressin injection is an aqueous preparation that’s administered S.C. or I.M. several times a day because it’s effective for only 2 to 6 hours; this form of the drug is used in acute disease and as a diagnostic agent.
Desmopressin acetate can be given by nasal spray that’s absorbed through the mucous membranes, or by injection given S.C. or I.V.; this drug is effective for 8 to 20 hours, depending on the dosage. It’s also available in tablet form, to be given at bedtime or in divided doses. Hydrochlorothiazide can be used in both central and nephrogenic diabetes insipidus. Indomethacin and amiloride are also used for nephrogenic diabetes insipidus. If nephrogenic diabetes insipidus is caused by medication (such as lithium), stopping the medicine leads to kidney recovery.
Diabetes mellitus:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment normalizes blood glucose and decreases complications using insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump. Insulin may be rapid acting, intermediate acting, long acting, or a combination of rapid acting and intermediate acting; it may be standard or purified, and it may be derived from beef, pork, or human sources. Purified human insulin is used commonly today. Pancreas transplantation is experimental and requires chronic immunosuppression.
Successful treatment requires an extensive dietary education. The patient’s diet is specifically tailored to include the right amount and combination of foods. Almost all foods may be eaten occasionally. The diet should address dietary prescriptions as well as personal and cultural preferences to improve adherence and control. For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1 diabetes, the calorie allotment may be high, depending on growth stage and activity level.
Type 2 diabetes may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, and suppress hepatic gluconeogenesis.
Five types of drugs have been used to treat diabetes. Sulfonylureas stimulate pancreatic insulin release, increase tissue sensitivity to insulin, and require insulin’s presence to work. Meglitinides cause immediate, brief release of insulin and are taken immediately before meals. Biguanides decrease hepatic glucose production and increase tissue sensitivity to insulin. Alpha-glucosidase inhibitors slow the breakdown of glucose and decrease postprandial glucose peaks. The thiazolidinediones enhance the action of insulin; however, insulin must be present for them to work. These drugs also reduce insulin resistance by decreasing hepatic glucose production and increasing glucose uptake. They have also been shown to lower blood pressure in diabetic hypertensive patients. Cholesterol and triglyceride levels may also be reduced.
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
Keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy, nephropathy, and neuropathy. In type 2 diabetes, blood pressure control as well as smoking cessation reduces the onset and progression of complications, including cardiovascular disease.
Treatment of both the newly diagnosed and the established diabetic is designed to maintain blood glucose levels within acceptable limits through dietary management and insulin administration. Many females with overt diabetes mellitus require hospitalization at the beginning of pregnancy to assess physical status, check for cardiac and renal disease, and regulate diabetes.
For pregnant patients with diabetes, therapy includes:
❑ bimonthly visits to the obstetrician and the internist during the first 6 months of pregnancy; weekly visits may be necessary during the third trimester
❑ maintenance of fasting blood glucose levels at or below 100 mg/dl and 2-hour postprandial blood glucose levels at or below 120 mg/dl during the pregnancy
❑ frequent monitoring for glycosuria and ketonuria (ketosis presents a grave threat to the fetal central nervous system)
❑ weight control (gain not to exceed 3 to 3½ lb [1.4 to 1.6 kg] per month during the last 6 months of pregnancy)
❑ high-protein diet of 2 g/day/kg of body weight, or a minimum of 80 g/day during the second half of pregnancy; daily calorie intake of 30 to 40 calories/kg of body weight; daily carbohydrate intake of 200 g; and enough fat to provide 36% of total calories (however, vigorous calorie restriction can cause starvation ketosis)
❑ exogenous insulin if diet doesn’t control blood glucose levels. Be alert for changes in insulin requirements from one trimester to the next and immediately postpartum. Oral antidiabetic drugs are contraindicated during pregnancy because they may cause fetal hypoglycemia and congenital anomalies.
Generally, the optimal time for delivery is between 37 and 39 weeks’ gestation, although with reassuring antenatal testing and no evidence of macrosomia, 40 weeks or later is also feasible. The insulin-dependent diabetic may require hospitalization before delivery for frequent monitoring of blood glucose levels and prompt intervention if complications develop.
Depending on fetal status and maternal history, the obstetrician may induce labor or perform a cesarean delivery. During labor and delivery, the patient with diabetes should receive continuous I.V. infusion of dextrose with regular insulin in water. Maternal and fetal status must be monitored closely throughout labor. The patient may benefit from half her prepregnancy dosage of insulin before a cesarean delivery. Her insulin requirement will fall markedly after delivery.
Insulin, I.V. fluids, sodium bicarbonate
Treatment of hereditary fructose intolerance consists of exclusion of fructose and sucrose (cane sugar or table sugar) from the diet. Otherwise, treatment is supportive as the patient’s progress is monitored.
The pregnant adolescent requires the standard prenatal care that’s appropriate for an adult. However, she also needs psychological support and close observation for signs of complications.
The goal of antepartum management is to prevent complications and minimize the strain on the mother’s heart, primarily through rest. This may require periodic hospitalization for patients with moderate cardiac dysfunction or with symptoms of decompensation, toxemia, or infection. Older women or those with previous decompensation may require hospitalization and bed rest throughout the pregnancy.
Drug therapy is often necessary and should always include the safest possible drug in the lowest possible dosage to minimize harmful effects to the fetus. Diuretics and drugs that increase blood pressure, blood volume, or cardiac output should be used with extreme caution. If an anticoagulant is needed, heparin is the drug of choice. Cardiac glycosides and common antiarrhythmics, such as quinidine and procainamide, are often required. The prophylactic use of antibiotics is reserved for patients who are susceptible to endocarditis.
A therapeutic abortion should be considered for patients with severe cardiac dysfunction, especially if decompensation occurs during the first trimester. Patients hospitalized with heart failure usually follow a regimen of cardiac glycosides, oxygen, rest, sedation, diuretics, and restricted intake of sodium and fluids. Patients in whom symptoms of heart failure don’t improve after treatment with bed rest and cardiac glycosides may require cardiac surgery, such as valvotomy and commissurotomy. During labor, the patient may require oxygen and an analgesic, such as meperidine or morphine, for relief of pain and apprehension without undue depression of the fetus or herself. Depending on which procedure promises to be less stressful for the patient’s heart, delivery may be vaginal or by cesarean birth. Forceps may augment vaginal delivery to minimize the need to push, which strains the heart.
Bed rest and medications already instituted should continue for at least 1 week after delivery because of a high incidence of decompensation, cardiovascular collapse, and maternal death during the early puerperal period. These complications may result from the sudden release of intra-abdominal pressure at delivery and the mobilization of extracellular fluid for excretion, which increase the strain on the heart, especially if excessive interstitial fluid has accumulated. Breast-feeding is undesirable for patients with severely compromised cardiac dysfunction because it increases fluid and metabolic demands on the heart.
Until the cause of diabetes insipidus can be identified and eliminated, administration of various forms of vasopressin can control fluid balance and prevent dehydration.
This aqueous preparation is administered S.C. or I.M. several times a day because it’s effective for only 2 to 6 hours. This form of the drug is used as a diagnostic agent and, rarely, in acute disease.
This drug can be given orally, by nasal spray that’s absorbed through the mucous membranes or by S.C. or I.V. injection. Desmopressin acetate is effective for 8 to 20 hours, depending on the dosage.
Effective treatment for both types of diabetes normalizes blood glucose and decreases complications.
Treatment includes insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump.
Human insulin may be rapid-acting (Regular), intermediate-acting (NPH or Lente), long-acting (Ultralente, Lantus), or a combination of rapid-acting and intermediate-acting (70/30, 75/25, or 50/50 of NPH and Regular).
Clinical tip Insulin Lispro or Novalogue may be used in place of Regular insulin. It’s rapid in onset (15 minutes) and makes waiting to eat after injection unnecessary. It has a short duration of action (4 hours), which decreases between-meal and nocturnal hypoglycemia.
Islet cell or pancreas transplantation is available and requires chronic immunosuppression.
Patients may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis, and delay GI absorption of carbohydrates.
UNDER STUDY: Studies have shown that treatment with a lipase inhibitor (such as orlistat) combined with a low-calorie diet significantly decreases the weight of overweight patients with type 2 diabetes. Patients following this therapy also displayed improvements in glycemic control and cardiovascular risk profile; levels of glycosylated hemoglobin, fasting glucose, and postprandial glucose improved significantly.
Treatment of both types of diabetes requires a diet planned to meet nutritional needs, to control blood glucose levels, and to reach and maintain appropriate body weight.
For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1, the calorie allotment may be high, depending on growth stage and activity level. For success, the diet must be followed consistently and meals eaten at regular times.
UNDER STUDY: Vitamin E is under investigation for its cellular effects that can possibly reduce the risk of macrovascular disease in patients with type 2 diabetes mellitus. The antioxidant effects of vitamin E were supported, and it was found that, in high doses, vitamin E acts as an anti-inflammatory. It’s postulated that heart disease and stroke risk can be decreased because vitamin E reduces plaque formation at the endothelial level. Vitamin E may also have an effect on the metabolic syndrome that causes diabetes mellitus and may prevent the disease from occurring.
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
The Diabetes Control and Complications Trial has proved that intensive insulin therapy that focuses on keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy (up to 63%), nephropathy (up to 54%), and neuropathy (up to 60%).
Both the newly diagnosed and the established diabetic need dietary management and insulin administration to maintain blood glucose levels within acceptable limits. Most women with overt diabetes mellitus require hospitalization at the beginning of pregnancy to assess physical status, check for cardiac and renal disease, and regulate diabetes. For pregnant patients with diabetes, therapy includes:
❑ frequent visits to the obstetrician and the internist during the first 6 months of pregnancy; weekly visits may be necessary during the third trimester, an internist may be consulted as necessary.
❑ maintenance of blood glucose levels at or below 95 mg/dl during the third trimester
❑ frequent monitoring for glycosuria and ketonuria (Ketosis presents a grave threat to the fetal central nervous system.)
❑ a high-protein diet of 2 g/day/kg of body weight (a minimum of 80 g/day during the second half of pregnancy), a daily calorie intake of 30 to 40 calories/kg of body weight, a daily carbohydrate intake of 200 g, and enough fat to provide 36% of total calories (However, vigorous calorie restriction can cause starvation ketosis.)
❑ exogenous insulin if diet doesn’t control blood glucose levels. Oral antidiabetic agents are generally contraindicated during pregnancy because they may cause fetal hypoglycemia and congenital anomalies.
Generally, the optimal time for delivery is no different from a normal pregnancy, as long as blood sugars are controlled and no fetal compromise is present.
Depending on fetal status and maternal history, labor may be spontaneous induced or a cesarean section performed. During labor and delivery, the patient with diabetes should receive a continuous I.V. infusion of dextrose with regular insulin in water. Maternal and fetal status must be monitored closely throughout labor.
The patient may benefit from half her prepregnancy dosage of insulin before a cesarean delivery. Her insulin requirement will fall markedly after delivery.
Specific treatments vary before, during, and after delivery.
The goal of antepartum management is to prevent complications and minimize the strain on the mother’s heart, primarily through rest. This may require periodic hospitalization for patients with moderate cardiac dysfunction or with symptoms of decompensation, toxemia, or infection. Older women or those with previous decompensation may require hospitalization and bed rest throughout the pregnancy. Drug therapy is usually necessary and should include the safest drug in the lowest possible dose to minimize harmful effects to the fetus. Diuretics and drugs that increase blood pressure, blood volume, or cardiac output should be used with extreme caution.
If an anticoagulant is needed, heparin is the drug of choice. A cardiac glycoside and an antiarrhythmic are typically required. The prophylactic use of antibiotics is reserved for patients who are susceptible to endocarditis. A therapeutic abortion may be considered for patients with severe cardiac dysfunction, especially if decompensation occurs during the first trimester. Patients hospitalized with heart failure are usually treated with a cardiac glycoside, oxygen, rest, sedation, and a diuretic; intake of sodium and fluids is also restricted. Patients whose symptoms of heart failure don’t improve after treatment with bed rest and a cardiac glycoside may require cardiac surgery, such as valvotomy and commissurotomy.
The patient in labor may require oxygen and an analgesic, such as meperidine or morphine, for pain relief and apprehension without undue depression of the fetus or herself. Depending on which procedure promises to be less stressful for the patient’s heart, delivery may be vaginal or by cesarean section. Operative vaginal delivery (for example, with forceps) is usually preferable to avoid the blood pressure changes that occur with pushing.
Bed rest and medications already instituted should continue for at least 1 week after delivery because of a high incidence of decompensation, cardiovascular collapse, and maternal death during the early puerperal period. These complications may result from the sudden release of intra-abdominal pressure at delivery and the mobilization of extracellular fluid for excretion, which increase the strain on the heart, especially if excessive interstitial fluid has accumulated.
Teach the patient about his underlying disorder and its treatment. Discuss such self-care measures as diet, exercise, and home blood glucose monitoring. Explain the importance of reporting any significant weight gain or loss to his health care provider.
▪ Monitor the patient's intake and output.
▪ Weigh the patient daily.
▪ Check the patient's blood pressure and pulse in the supine and standing positions to detect orthostatic hypotension, which may indicate hypovolemia.
▪ Encourage adequate fluid intake, if appropriate.
▪ Explain the underlying disorder and its treatments.
▪ Teach the patient about diet, exercise, and home blood glucose monitoring, if indicated.
The following medical news items
are relevant to treatment of Gestational diabetes:
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Medical Articles:
Diabetic complications during pregnancy:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Diabetic ketoacidosis:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Hereditary fructose intolerance:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Adolescent pregnancy:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Cardiovascular disease in pregnancy:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Diabetes insipidus:
Treatment
(Handbook of Diseases)
Vasopressin injection
Desmopressin acetate
Diabetes mellitus:
Treatment
(Handbook of Diseases)
Type 1 diabetes
Type 2 diabetes
Both types
Complications
Diabetic complications during pregnancy:
Treatment
(Handbook of Diseases)
Delivery
Cardiovascular disease in pregnancy:
Treatment
(Handbook of Diseases)
Before delivery
During delivery
After delivery
Polydipsia:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Polydipsia:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
Patient teaching
Medical news summaries about treatments for Gestational diabetes:
Discussion of treatments for Gestational diabetes:
Although
a carefully balanced diet and/or insulin injections have been used to
control gestational diabetes, there is new evidence that high insulin
levels also can be damaging. Some doctors allow pregnant women with PCOS
to continue taking metformin in pregnancy, while others won’t prescribe it
to women trying to conceive. There is no evidence that it causes birth
defects, but the long-term effects on the baby are not known. Women and
their doctors should discuss the risks and benefits of medications. Women
taking medication usually are monitored more closely. (Source: excerpt from Polycystic Ovary Syndrome (PCOS): NWHIC)
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