OAR@UM

The aim of this Health Promotion Package is to find the optimal care management, and to bring the woman with diabetes through a pregnancy with good glucose-insulin control and how to protect her infant in utero from the
adverse effect of diabetes. In order to reduce the risk of any complications that might arise, the diabetic
pregnant woman should :-
1) Apply a diet of 1800-2200 calories daily as 3 meals and 3 snacks.
2) Exercise for at least 30 minutes daily.
3) Test urine for glucose and ketones by Tes-tape 4 times daily.
4) Check blood-glucose level before breakfast, 2 hours postprandial (after meals) and at bedtime.
5) Be able to inject insulin herself if blood-glucose level is high.peer-reviewe

Xuereb, Luciana

l r ·I ·[ [ f .l [ :[ [ .l REF l Pamphlet Box Insulin Dependent Diabetic Pregnant Women XUEREB LUCIANA 227612 The aim of this Health Promotion Package is to find the optimal care management, and to bring the woman with diabetes through a pregnancy with good glucose-insulin control and how to protect her infant in utero from the adverse effect of diabetes. In order to reduce the risk of any complications that might arise, the diabetic pregnant woman should :-- Apply a diet of 1800-2200 calories daily as 3 meals and 3 snacks. - Exercise for at least 30 minutes daily. -Test urine for glucose and ketones byTes-tape 4 times daily. - Check blood-glucose level before breakfast, 2 hours postprandial (after meals) and at bedtime. - Be able to inject insulin herself if blood-glucose level is high. . -;-------. ·. . •' -•' .) . DIET As diabetes is a disorder it is essential that the pregnant woman understands the need for a balanced diet and start the diet immediately as she finds out that she is pregnant. The regime a diabetic pregnant woman should take is a 1800-2200 calorie diet divided into 3 meals and 3 snacks. In early pregnancy due to nausea and vomiting, this could be e:\.iremely di±Iicult. However, keeping the calories distributed evenly in this way will help to keep the blood glucose constant. However, if the pregnant woman cannot eat because of nausea and vomiting during early pregnancy and heartburn later on, she must notify the obstetrician to help her. The diet should include a reduced amount of saturated tats and cholesterol and an increased amount of dietary fibre. protein and carbohydrate. Increasing the fibre in the diet will help to decrease the postprandial hyperglycaemia and thus lowers insulin requirements. Dietary calories should include 20% protein, 50% carbohydrate and 30% tat. Examples of food in which we find proteins are:-Meat Milk Eggs Fish Poultry Examples of foods in which we find refined carbohydrates are :-Jelly Preserved food Ice-Cream Pastries Cakes Sweetened Beverages (These types offood should be limited) Unrefined carbohydrates with fibre are found in :-Wholegrain bread Wholegrain cereals Fruit Vegetables (These should be included more in the diet) Examples of fatty toods are:-Meat fat Vegetable tats It is important tor the pregnant diabetic woman to be extremely diet conscious, to maintain good control and keep her weight gain to a suitable amount with the hope of limiting the size of her infant and making a vaginal delivery possible. Normal Diet Protein Fat CHO Brea~fast Bran:tlakes - 2 tbsp 2 10 Milk- 200 ml 6 10 10 Toast - 1 slice 2 10 Butter - thin spread 5 A-fid-moming Tea with milk 1.0 1.5 1.5 Digestive biscuits - 2 20 Lunch Bread - 3 slices 6 30 Butter 15 Cheese- 42g 10 13 Salad Fresh fruit- 1 2 10 Tea with milk 1.0 1.5 1.5 J'vfid-aftemoon Tea with milk 1.0 1.5 1.5 Digestive biscuit - 1 2 10 Dinner Lean meat 112g 28 20 Potatoes - 2 boiled 4 20 Vegetables Fresh fruit- 1 2 10 Ice cream- 1 2 4 10 Supper 1 glass milk 6 10 10 Toast - 1 slice 2 10 Butter 5 Digestive biscuit - 1 2 10 83 87 175 g Total 1816 kilo-calories 333 783 700 kcal 18 43 39 °o Suggested Dietary Requirements for a Pregnant Diabetic Protein Fat CHO Breakfast Weetabix- 2 4 20 Skimmed milk 200 ml 6 1.0 10 Wholemeal bread - 2 slices 4 20 Thin spread polycmsat. margarine 10 Afid-Jf orning Tea with skimmed milk 1.0 1.5 Digestive biscuit - 1 2 10 Fresh fruit- 1 2 10 Lunch 2 wholemeal rolls 8 40 Thin spread polyunsat. margarine 10 Lean meat - 56g 14 10 Salad Low fat plain yoghurt - 1 6 1.0 10 Fresh fruit- 1 2 10 .A.lid-afternoon Tea \Vith skimmed milk 1.0 1.5 Digestive biscuits - 2 4.0 20 Dinner Lean meat - 84g 21 15 Potatoes - 3 small 6 30 Vegetables Fresh fruit- 1 2 10 Ice cream- 1 2 4 10 Supper 1 glass skimmed milk - 200 ml 6 1.0 10 Vlholemea! bread - 2 4 20 Thin sQread golvunsat. margarine 10 95 62 233 g Total 1870 kilo-calories 380 558 932 kcal 20 30 50% fUiiiiVERSir Y -----·-l_'r.; LiBRARY i INSTITUTE OF HeALTH CARE ~ ,~-EYERCISE Exercise is another mechanism that lowers serum glucose and thereby the need for insulin. When the woman exercises she lowers her blood glucose level because of uptake of glucose by the muscle. This effect lasts for at least 12 hours following exercise. If the part of the body where the woman has injected insulin is actively exercised, the efiect will be greatly increased. Therefore the woman should eat a snack of protein or complex carbohydrate before exercise and she should maintain a consistent exercise program (not doing aerobic exercises one day and then nothing the next day, but rather 30 minutes of walking every day). The following are exercises which one can do just by sitting down:-1. Circles using the >Yrist. Make sure that your back is touching the back of the armchair. Put both feet flat on the floor and put your stomach in. Open your arms, keeping your elbows straight. Slowly make 4 circles with your wrist clockwise and the again anti-clockwise. After a few sessions you will be able to do 8 circles each way without tiring. 2. Touching the roof. Sit down straight and place one arm on your shoulder. Raise your other arm as if to touch the ceiling. Do the same using the other arm until you can do this 8 times with each arm. 3. Ballet sitting down As usual, start from the sitting position. Put your right arm on your head and bend towards the left. At the same time put your left arm in such a position as to be doing a t!gure S (like you are holding a baby in your arms). Repeat with the other arm. In a short \Vhile you should be able to do this 8 times on each side. 4. Walking on the spot. Open both legs so as to be able to touch the legs of the armchair. Raise your left toot 15 em above the tloor and put it back down slowly. Do the same with the right side and continue for not more than 3 minutes in the beginning. 5. Circles with your ankles. Sit down as straight as possible and raise one of your legs straight in front of you. With the ankle do 4 circles clockwise and then again anti-clc<·kwise. Repeat with the other leg. MONITORING FOR GLUCOSE AND KETONES I.i'i URINE In order to maintain an effective control of diabetes the pregnant woman must learn how to monitor glucose levels. One way of doing this is by urine testing. Urine testing provides a simple and convenient measurement for the concentration of blood glucose over the renal threshold level. Insulin-dependent diabetic pregnant women should test their urine 4 times per day (before every meal and at bedtime) to monitor the glucose and ketones present. How to do a Urine Glucose Test 1. Collect a urine specimen in a clean container. B1iefly dip the test strip into the urine. 2. Withdraw and wipe edge along the rim of the container in order to remove excess urine. 3. After 2 minutes compare the test areas with the colour scale on the label. 3UJ.io:a,pu0LU PO~IS JJ,fOlVITORLVG BLOOD GLUCOSE LEVELS The other way to maintain an effective control on the blood glucose levels is by doing a fingerprick blood test. The blood test for glucose is to be taken betore breakfast, 2 hours after each meal and at bedtime. However, the woman should keep a weekly chart and report a fasting level of more than 100 mg!dl and a 2 hour postprandial level of more than 138 mg!dl. r c;F-~ llfD ~JIIY }er--8~'''''''''''''~ 4,5 6.5 OSP. Gly , emia G ~~· l-oJ 1 C-.J •. s ·~~ How to check your Blood Glucose Level 1. Obtain a good sized drop of blood large enough to cover both test zones completely. 2. Place test strip on a flat clean surface. Apply sample- don't let skin touch test zones. Start timing. 3. Leave blood on test zone for one minute (never spread or smear the blood). 4. Hold test strip firmly against flat surface. Wipe with clean ball of cotton wool - repeat twice with clean area of wool. Leave test strip for one more minute. 5. The reaction colours remain stable giving you ample time to read or recheck your results. Compare test zone with colour blocks on label of vial. Record your result. 6. If your reading at 2 minutes is above 17 mmol/1, the reaction is not complete. Leave for a further minute and read again. Following these instructions \\ill enable you to obtain a dependable result ~~~ Good Technique 1. Ideal - a good sized drop of blood has covered both test areas. 2. The smallest coverage that will give a definite result. Bad Technique 3. Results are unreliable- smearing has produced uneven colours. 4. Reading is impossible- blood stains on strip are due to inadequate wiping. Reading results (interpretation) Important: Use the colour chart on the test strip vial itself when reading the reacted strip. When reading values below 9 mmoL'l give priority to the block which matches the colour on the lower light blue test zone. When reading values above 9 mmol!1 give priority to the block which matches the colour on the upper sage/deep green test zone. :J,U~LU:J,~~.I:a.:~~~~~~-UI· . . . .:~:_-.;::.--~~:=_:_<:_-·;_·:~ . ..: -~ ~'-.. ,_-INSULIN TREATMENT Types of insulin and duration of their action Short acting Intermediate Long Acting Palin/Soluble/ Actrapid *IV elosulin Lente*•Monotard Ultralente * denotes the type of insulin most commonly used in Malta. The amount of insulin needed by a woman depends on the result of the blood glucose level. Normal range= 3.5 mmol/1 (75 mg!dl)- 5.5 mmol/1 (90 mg/dl) Blood Glucose Result 10 (180) 13.3 (240) 17.7 (320) 22.2 (400) Units Reg_uired 4 units 8 units 12 units 16 units Tvpe o(Insulin Onset of Action Peak Action Duration ofAction Short Acting Intermediate Long acting It is important to :-1/2- 1 hour 1 -2 hours 4-6 hours 2-4 hours 6-8 hours 8- 12 hours 6- 8 hours 14- 16 hours 24-36 hours Keep to insulin regime prescribed or adjust to changes in blood glucose level. Keep insulin in a cool place Keep to the diet and exercise regime as ordered. How to prepare and inject a One Dose Insulin Injection ' 1. Wash your hands and dry them. 2. Check the label of the insulin bottle for any special instructions. 3. Clean the rubber cap of the bottle with cotton wool. 4. Gently tip the bottle to and tro to make sure that the insulin is properly mixed. This is especially important when using cloudy insulin. 5. Pull back the plunger of the syringe to measure approximately the same amount of air as the amount of insulin you use. 6. Insert the needle straight through the rubber cap of the insulin bottle and inject the air into the bottle. 7. Now turn the bottle upside dowq. Make ceiiain that the point of the needle inside the bottle is well beneath the surtace level of the insulin. 8. Continue holding the bottle and syringe upright with the point upwards and pull back the plunger until you have measured slightly more than your correct dose of insulin. 9. If any air bubbles have entered the syringe, tap the syringe barrel fairly gently with your finger and this will usually release them so that they rise to the tip of the syringe. Note that if the air bubbles persist, expel all of the insulin back into the bottle and start again. 10. Press the plunger slightly to expel the bubbles back into the bottle. Adjust the plunger to measure your exact insulin dose and take the needle out of the bottle. 11. Make absolutely certain that you have measured your insulin dose to the correct mark on the syringe. Always make sure your hands are clean. 12. Taking care not to touch the sterile needle, hold the syringe firmly near the top, as if you were going to write with it like a pencil. rUNIVERSlTY OF . LIBRARY f ,- • ......,Y- · .r · 1 -:-~ l /"""':.. - • INSTITUTe u~- h:::Au r-1 vAAl.: I - ~ 13. Now, using the other hand, pinch up a mound of clean skin and quickly push the needle straight into the mound as far as it will go. Some people prefer to insert the needle at a slight angle - almost vertical but not quite. 14. Release the mound of skin. Hold the syringe barrel comfortably in place with one hand so that your other hand is free to press the plunger. With your thumb on top of the plunger, quickly and smoothly inject all of the insulin in the syringe. 15. Withdraw the needle and quickly place a clean piece of tissue or cotton wool over the injection site. Hold it in place with firm pressure for just a few seconds. Your injection is complete. CONCLUSION Things to Remember -If you suft:er from diabetes wear an identity bracelet or an identii"ication badge stating this in case of emergency. -Do not smoke. Smokers require up to 20°.·o more insulin than non-smokers. - Stick to your diet. - Remember to do your exercises. - Attend the Ante-Natal clinic for regular visits. Here are some useful addresses for any further help that a diabetic pregnant woman might need. I . Diabetes Clinic St. I .uke's Hospital G'Mangia. 2. Ante-Natal Clinic Karen Grech Hospital G'Mangia 3. Family Support Group c/o Maltese Diabetic Association 41, South Street Valletta 4. Ghaqda Kontra d-Dijabete P.O. Box413 Valletta 

Insulin dependent diabetic pregnant women

Paper written in collaboration with the Department of obstetrics and gynaecology at Karin Grech Hospital MaltaThe collection and evaluation of obstetric data is essentia1 for measuring the adequacy and effectiveness of the health and social services in a country, rendering possible the reallocation of resources end long-term planning on the basis of changing health needs. Organization of a standard maternity and neonatal record on a regional or national level is difficult though ideal, but this is possible in a situation where the majority of deliveries are conducted under the supervision of one department. During 1986, Department of Health in conduction with the World Health Organisation introduced a computer-based Individual Health Profile aimed as a person-based record for all patients who encounter government medical services with the aim of providing readily available clinical information to medical practitioners on the patients they are treating, of scheduling appointments and follow-up procedures, of managing immunization and the preventive programmes, and of conducting surveys and research.peer-reviewe

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Insulin dependent diabetic pregnant women

The computerization of maternity information

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