Peripartum management of Gestational Diabetes - Dr. Shashi Agrawal
“Peripartum management of hyperglycemia most important aspect to avoid maternal hyperglycemia this depends lot on the control of sugars during pregnancy. If the sugar has been control well during pregnancy the requirement of insulin is usually very minimum or not required. A women with uncontrolled sugar during pregnancy may require higher dose of insulin, fetal outcome also varies according to the maternal control of sugar during pregnancy there is increased chance of fetal hypoglycemia and fetal Academia if the maternal sugar are high during lobar so the key is to keep our blood sugar within 70 to 110 milligram per liter. Tight glycerin control is important to avoid adverse fetal in maternal outcome during labor. This can be achieved by keeping the women if the induction is planned usually the woman is kept fasting overnight and early induction is planned and continuous glucose infusion started early in the day time and regular blood test are done usually hourly, we try to maintain the blood sugar between 70 and 110, if any 50 unit rise in the sugar level should maintain an introduction of insulin which is usually rapid acting insulin of about 4 units for every 50 unit rise. Throughout the labor tight cytoplasmic control is maintained and during the labor metabolic requirements of the mother increase suddenly so the insulin may come down caution is required in that period after the delivery the Postpartum period maternal insulin requirements are suddenly low because of the lactation so the blood Sugars should be treated. The peripartum management of veteran hypoglycemia is also dependent on what type of diabetes the mother has whether its Type 1 Diabetes in which the insulin requirements a little more because there is no inherent insulin in the lady, in type 2 diabetes there is some already some in insulin in the body so the
requirements are generally lesser or sometimes not required at all.