So, one of the number one reasons we're trying to keep the pregnant person's glucose at a steady state
and within normal limits, is because of that infant that's going to be coming out.
So let's talk for just a minute about the whole concept of infant hypoglycemia, so this is after delivery.
Now, anytime we know that a client has gestational diabetes the protocol
is going to dictate that we check the blood sugar.
But we should also be suspicious if we have a very large baby,
or if someone comes in and they're exhibiting symptoms of diabetes
and then we have a baby that comes out that's really jittery,
we may also need to check for hypoglycemia.
So we'll do a heel stick and we will check the glucose of that baby.
If it's greater than 40, so, 40 is lower than it would be for an adult,
but that's just fine for a baby, then that's normal and the baby can continue doing whatever it was going to do.
Hopefully, going to the breast for feeding.
Now, if we have a situation where the glucose reading is 20-40, so it's a little low.
If the baby is term, right, and if the baby is able to feed,
then that's going to be the time where we'll just put the baby to breast, okay?
So, we'll get that blood sugar value and then we will feed the baby.
So if the baby is not able to be put to breast and we're closer to the 20 mg,
then we may actually need to supplement with a bottle or with some sucralose,
so we can give a solution of sugar to get that blood sugar back up, and then after 20 minutes,
we will repeat the glucose testing and hopefully we will find that it is above 40.
So let's look at some different scenarios of what we can get on a glucometer and how that might look different.
So if we have a reading that's less than 20 mg/dL, we are always going to respond,
no matter what the situation is, what the gestation of the baby is,
what they're doing, if it's less than 20, it's an emergency, and we need to respond.
If it's less than 40, and let's say the baby hasn't really been eating or hasn't eaten anything,
or the baby is preterm, then we're going to again, need to respond to that blood sugar.
If the blood sugar is less than 40 after eating, so this is after the baby has had some glucose,
then that means there's some sort of impairment and then we're going to need to respond.
If it's less than 40 and the baby is symptomatic, so if the baby is jittery or fuzzy or lethargic,
or anything that indicates that actually this blood sugar might be 40 right now
and it's going to continue to drop, then we're going to need to respond to that.
So make sure when you're thinking about NCLEX and NCLEX questions,
that you can put it sort of in a frame of what's the baby's doing
and what's the gestation and therefore that's going to affect how the nurse should respond
and what the priority is going to be.
Now let's talk about the postpartum period.
So, I want to keep this sort of in your vision.
So women with gestational diabetes mellitus are at high risk for developing type 2 diabetes
so we want to make sure that the teaching and the instructions that we give postpartum
are going to be in such a way that they can make those modifications
and hopefully decrease those risk factors.
So I'm just putting that there as a side, but let's get back to business.
So, right after delivery, most of the time, the patient's glucose is going to return to normal,
and this is again a gestational diabetic, and it may take a few days for that to happen.
But, remember, immediately after delivery, what happens to that blood sugar?
Remember it dropped off the cliff? Exactly.
So we want to make sure that the client stays in the hospital.
This is not going to be a client that's a candidate for early discharge
because we want to make sure that that blood sugar is pretty stable before we send them home.
So, usually, they're going to be in the hospital a little bit longer.
Now, after three days or so, we can again check on the postprandial
and make sure that their blood sugar levels are leveling off and that they're pretty normal.
After six weeks, however, their risk for gestational diabetes is done,
but their risk for type 2 diabetes certainly begins and so at this point,
we're going to do a different sort of screening test to look for type 2 diabetes,
so we'll do the 75 gram oral glucose test, that's not the 100 or 50 that we did for gestational diabetes,
this is looking for regular type 2 diabetes.
So let's look at the postpartum testing for diabetes.
So we're here again, we have the chart and we're looking for the normal level,
what indicates impaired glucose tolerance and what indicates true diabetes.
So for looking at a fasting. So again we have that 75 g load,
which is not the 50 and the 100 we used for gestational diabetes.
So, the client is fasting, they come in, we draw their blood.
Normal will be 70-100 for a fasting.
If they have the beginning of impaired glucose, it will be a 100-125,
and if they're diabetic, their fasting blood sugar will be 126.
Now if their blood sugar is already 126 and they're fasting,
we probably don't have to go much further and actually give the 75 gram load
because we already know they have impaired glucose functioning
to the point that they are diagnostic for diabetes.
Now, let's say it's a little bit less than that and we give them the 75 g load,
then two hours later we wanna recheck that blood sugar.
If it's normal, it will be less than a 140.
If they're beginning the signs of diabetes,
it will be between a 140 and 199, and if it's greater than 200, diagnostic for type 2 diabetes.
So now we've covered a whole lot. Let's review that nutshell.