Gestational Diabetes: Diagnosis to Delivery

Diabetes is an epidemic. One in three children born in 2000 will have diabetes in their lifetime. Gestational diabetes (GDM) is a silent epidemic affecting almost 1 in 10 pregnant women. If you work in a perinatal setting, you need to know how to manage GDM. Join Darcy J. Hostetter-Lewis, an expert in the field of gestational diabetes, as she shares insights garnered from years of high risk obstetrical nursing. Topics covered include:

• Self-Monitoring Guidelines
• Exercise and Nutrition
• The Latest in Medication Management
• Hyperglycemia and the 5 S's
• Hypoglycemia and the Rule of 15
• Glucose Control During Labor
• Postpartum Insulin Requirements
• Interconception and Preconception Care

This program is designed to enrich your knowledge of GDM and provide you with tools to care for your patients with confidence. Evidence-based practice recommendations will be combined with real-world applications and case studies throughout this engaging and information-packed day. We can all be a part of successfully managing gestational diabetes. Darcy's story-telling approach to imparting information makes her passion for diabetes and pregnancy contagious. Come hear her and catch the enthusiasm!

Objectives:
At the completion of this program, you should be able to:

1. Summarize current GDM screening and diagnosis recommendations, noting the impact of the Hyperglycemia and Adverse Pregnancy Outcome study (HAPO) on these recommendations.
2. Integrate perinatal practice strategies to counsel patients regarding the long- and short-term risks of hyperglycemia to the mother, fetus, and offspring.
3. Relate the use of the AADE 7 self-management skills when educating women with gestational diabetes.
4. State blood glucose targets and self-monitoring frequencies.
5. Describe the principles of a healthy eating plan.
6. Discuss the relationship between staying active and maintaining blood glucose targets.
7. Identify tools to assess coping with stress, readiness for change and level of motivation for women experiencing diabetes during pregnancy.
8. Explain how to use insulin and oral agents safely and accurately to achieve normoglycemia during antepartum, intrapartum and postpartum.

Program Outline:

1. Gestational Diabetes: Changing Lifestyles - 12 Carb Units and 30 Minutes of Exercise at a Time
2. Gestational Diabetes (GDM)
   1. The Silent Epidemic
   2. What it is and what it isn’t
   3. Who is at risk?
   4. Screening and diagnosis of GDM
      1. Current recommendations
      2. On the horizon (HAPO recommendations)
3. Effects of Hyperglycemia during Pregnancy
   1. Maternal
   2. Fetal
   3. Newborn
      1. In utero origins of chronic disease
4. Patient Education/the “Team” and the Plan of Care
   1. Framing diabetes education: Partnering for lifestyle change
   2. Teaching self-management skills: (AADE) 7 and GDM
5. Healthy Eating
   1. Weight management/Obesity
   2. Macronutrient distribution
   3. Timing of meals and snacks
   4. Breakfast
   5. Low carb foods
6. Staying Active
   1. How exercise lowers blood glucose
   2. Exercise recommendations
   3. Exercise precautions
7. Self-Monitoring Blood Glucose
   1. The saga of blood glucose targets during pregnancy
   2. Check blood glucose - don’t test
   3. How often, when and where
8. Healthy Coping
   1. How stress affects blood glucose
   2. Detecting healthy coping
   3. Diabetes, pregnancy and depression
   4. Using the Edinburgh Depression Screen
9. Taking Medications
   1. Insulin
      1. When to initiate
      2. What types of insulin
      3. When to give (regimen)
      4. How to administer
   2. Oral medications
      1. Metformin
      2. Glyburide and others
10. Problem Solving
    1. Hypoglycemia
       1. Numerology
       2. Rule of 15
    2. Hyperglycemia
       1. The 5 S’s
       2. What to do
11. Reducing Risks
    1. Tests of maternal well-being
    2. Tests of fetal well-being
    3. Timing of delivery
12. Labor & Delivery
    1. Effects of glucose control on outcomes
    2. Managing meds: insulin, Pitocin, magnesium, ephedrine and more
13. Newborn Care
    1. What is neonatal hypoglycemia?
    2. Management strategies that promote breastfeeding
14. Postpartum Care
    1. Decreased insulin requirements
    2. What can I eat now?
    3. Do I still have to check my blood sugar?
    4. How can I prevent future diabetes?
15. GDM - Not Just a Pregnancy Problem
    1. Pregnancy spacing
    2. Interconception and preconception care
    3. Getting tested for overt diabetes

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