HYPOGLYCEMIA AND HYPERGLYCEMIA

1. Presented by: Excalibur Group
Daphney Jacques, Bridgette Jenkins, Opal Jobson-Cudjoe , Kelly Miller
BY
HASHIM SYED ALI ABBAS H
PHARM.D VI YEAR
170312882029
MESCO COLLEGE OF PHARMACY

2. Objectives
 Distinguish between normal and abnormal blood glucose
levels based on patient population
 Classify the different diagnosis associated with
hypoglycemia/hyperglycemia based on patient age
 Compare the common causes of
hypoglycemia/hyperglycemia based on patient population

3. Objectives
 Formulate the appropriate interventions for
hypoglycemia/hyperglycemia management based on patient
population
 Differentiate between the different medications used to manage
the hypoglycemic/hyperglycemic patient.
 Predict immediate complications of
hypoglycemia/hyperglycemia

4. Objectives
 State potential long term complications of uncontrolled
blood sugar levels
 Determine the appropriate educational strategies to
prevent hypoglycemia/hyperglycemia

5. NORMAL BLOOD GLUCOSE for
PREGNANT WOMEN
 65mg/dl (fasting)
 <140 mg/dl (2 hr pp)

6. CLASSIFICATION OF DIABETES IN
PREGNANT WOMEN (cdc.gov)
Pregestational Diabetes
 Type I: primarily due to pancreatic islet beta cell destruction.
 Type II: most common type of diabetes that is a result of
insulin resistance or insufficiency.
Gestational Diabetes
 Any degree of glucose intolerance with the onset or first
recognition occurring during pregnancy.

7. SCREENING FOR GESTATIONAL
DIABETES (Lowdermilk, Perry, &
Bobak)
 Screening should be done between
24-28 weeks gestation.
 Glucose Tolerance Test (GTT): 50
grams of glucose is consumed, blood
is taken after 1 hour and sent to a
laboratory for evaluation.
 140mg/dl or greater is considered as
positive
 Oral Glucose Tolerance Test (OGTT)
is done if the GTT is positive.
 After a overnight fast, a fasting blood
glucose level is drawn. Then 100
grams of glucose is consumed and
blood is drawn at 1, 2 and 3 hour
intervals.
The patient is diagnosed with
gestational diabetes if 2 or more
values are met or exceeded:
 Fasting 105mg/dl
 1 hr 190mg/dl
 2 hr 165mg/dl
 3 hr 145mg/dl

8. HYPOGLYCEMIA IN PREGNACY
 Blood glucose: < 60mg/dl
 Causes: excess insulin, insufficient food, excessive exercise or
work, vomiting or diarrhea.

9. SIGNS & SYMPTOMS OF
HYPOGLYCEMIAIrritability
Hunger
Sweating
Nervousness
Dizziness
Weakness
Fatigue
Headache

10. MANAGEMENT OF HYPOGLYCEMIA
 Check blood sugar when symptoms first appear (fingerstick)
 Eat 10-15 grams of simple carbs
 Recheck blood glucose 15 minutes after intake
 Notify healthcare provider if blood glucose remains low
 If patient is unconscious call 911
 If in hospital administer 50% dextrose or glucagon as ordered.
 Recheck blood sugar, send urine/blood to lab

11. HYPERGLYCEMIA IN PREGNACY
 Blood glucose > 200 mg/dl
Causes: Insufficient insulin, excess or wrong kinds of food,
infection, illness, injuries, emotional stress or insufficient
exercise

12. SIGN & SYMPTOMS OF
HYPERGLYCEMIA
Thirst
Nausea/Vomiting
Abdominal pain
Constipation
Drowsiness
Dim vision
Increased urination
Fruity breath
Rapid, weak pulse
Rapid breathing

13. MANAGEMENT OF
HYPERGLYCEMIA
 Notify healthcare provider
 Administer insulin in
accordance with blood
glucose level (sliding scale)
 Give IV fluids (NS or 0.45
NS)
 Monitor blood & urine
laboratory testing

14. MANAGEMENT OF DIABETES IN
PREGNACY
 Diet
 2000-2500 daily, less if overweight or morbidly obese
 Exercise
 Active women are encouraged to continue physical activity,
sedentary are encouraged to get active. Walking is
recommended
 Monitoring of blood glucose levels
 Findersticks are done at home. Usually done upon waking
(fasting) and after meals (postprandial)
 Insulin therapy: done on a individual basis to maintain normal
blood glucose levels
 Close monitoring of fetus after 40 weeks until delivery

15. COMPLICATIONS OF DIABETES IN
PREGNACY
 Congenital malformations
 Macrosomia: infant weight
of 4,000-4,500 grams
 Intrauterine growth
retardation (IUGR)
 Stillbirth
 Respiratory Distress
Syndrome (RDS)
 Spontaneous abortion in
early pregnancy
 Shoulder Dystocia
 Pregnancy induced
hypertension (PIH)
 Infections (UTI’s, yeast
infection)
 Ketoacidosis

16. PREVENTION
 Seek counseling before getting pregnancy
 Maintain a healthy weight
 Exercise regularly
 Eat healthy and balanced meals
 Seek prenatal care early in pregnancy
 Keep all prenatal appointments
 Follow regime prescribed by physician

17. REFERENCES
 CDC.GOV (2009). Information on gestational diabetes.
Retrieved July 9, 2009, from: http://diabetes.niddk.nih.gov/dm/pubs/gestational/
 Lowdermilk, D., Perry, S., & Bobak, I. (1999). Maternity
Nursing (5th
. Ed). St. Louis: Mosby.

18. CASE STUDY
Maria, a 40 y/o G4P3 at 29 weeks present to Labor &
Delivery with c/o dizziness, headache, nausea and
vomiting for 3 days. After interviewing Maria, you note
that she has not had any prenatal care, has a h/o diabetes
Her past obstetrical history includes delivery of a 4500
gram male complicated by shoulder dystocia. She weighs
312 pound. Her Bp 129/83, HR 82, RR 26 and Temp 98.8.
A UA shows 3+ glucose, and negative ketones. Her
accucheck is 179mg/dl.

19. CASE STUDY
DISCISSION
Questions
 1. What tests, if any, should be done to evaluate the Maria’s glucose
tolerance?
2. How is the diagnosis of gestational diabetes mellitus (GDM) established?
3. What would be the best treatment and follow-up strategy for Maria?
Discussion
 This patient has several risk factors for GDM. She is over the age of 30, has
a history of GDM and is obese. All these place her at a greater risk for
developing GDM. She needs to be referred to a dietician or diabetic
counselor. She needs to continue prenatal care and started on insulin
therapy. Maria should be followed closely for the remainder of the
pregnancy. Birthing options (vaginal vs caesarean section) should be
discussed with the patient. Maria should also be followed closely after
delivering to assess for the development of Type II diabetes.