Write your response to each case study question on the lines provided. A female
ID: 74260 • Letter: W
Question
Write your response to each case study question on the lines provided. A female patient has a diet that is totally lacking in lipids. How does her diet affect hormone production in her body? A 35-year-old woman is pregnant with her first child. Her glucose tolerance test (GTT) is elevated ans she has been put on a diabetic diet. She is relieved that her diabetes is gestational and that she will return to normal blood sugar levels after her pregnancy. What information might you want to share with her?Explanation / Answer
59.
Lipids or fats include the sterols which are compounds with a multiple ring structure and among the sterols are hormones made from cholesterol. In female deprived of lipids, Estrogen, progesterone, Leutinizing hormone, active form of vitamin D, aldosterone and cortisol are all formed from cholesterol and are needed to maintain pregnancy, develop sex characteristics and regulate calcium levels in your body.
60.
Gestational diabetes is caused when insulin receptors do not function properly. This is likely due to pregnancy-related factors such as the presence of human placental lactogen that interferes with susceptible insulin receptors. This in turn causes inappropriately elevated blood sugar levels. The risks of maternal diabetes to the developing fetus include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), mild neurological deficits, polyhydramnios and birth defects. GD can be managed by:
Self-monitoring of blood glucose
Depending on the degree of hyperglycemic disorder in pregnancy, self-monitoring of blood glucose should be carried out by the patient at a frequency of 4–7 times per day. The target blood glucose levels are venous plasma glucose values of 100 mg/dl or lower before meals and of 120 mg/dl or lower 2 hours after meals.
Diet therapy
The key strategies for achieving strict control of blood glucose levels are first of all frequent self-monitoring of blood glucose, followed by appropriate diet therapy, which is extremely important. During pregnancy, as pregnant women patients need to consume adequate energy, protein, and minerals. Under the nutritional guidelines recommended by the Ministry of Health, Labour and Welfare the currently recommended calorie intake for pregnant women is 25–30 kcal/kg50 kcal, 25–30 kcal/kg250 kcal, and 25–30 kcal/kg450 kcal for the first, second, and third trimester, respectively. In the case that the target blood glucose levels described above cannot be achieved eating three meals a day, dividing each meal in a ratio of 2:1 or 1:1 and eating 4–6 meals per day can be effective.
Insulin therapy
In the case that target blood glucose levels cannot be achieved, insulin therapy should be actively implemented. Although there are RCTs indicating that the oral antidiabetic, glyburide, does not affect the fetus, its safety cannot be said to have been established, and so as a rule treatment is changed to insulin therapy. In the case of insulin therapy, due to the need for strict blood glucose control, it is important to keep blood insulin concentrations as close as possible to physiological insulin secretion patterns. That is to say, keeping in mind basal insulin secretion and after-meals insulin secretion, intensive insulin therapy is carried out by means of multiple injections of intermediate-acting and rapid-acting insulin or ultrarapid-acting insulin analog.
GDM management during labor and delivery
In the case of diabetes or GDM alone, caesarean section is not indicated. For example, it has been reported that in the case of a GDM patient undergoing insulin therapy where fetal development is thought to be within the normal range, there is no difference in the caesarean section rate between women for whom labor is induced at 38 weeks and those for whom labor is not induced. In the case that birth weight is estimated at 4, 000g or higher, an elective caesarean section is considered. However, in the case that the patient has poor blood glucose control, induced delivery at 38 weeks onward should be considered.
When carrying out insulin therapy, special care is needed as the amount of insulin required during pregnancy, during delivery, and after birth differs tremendously. Thus, insulin requirements at the end of pregnancy increase by approximately two-fold. During first-stage labor the required amount decreases, while in second-stage labor it increases slightly and after birth decreases rapidly.
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