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Abstract: The patient had regular menstruation and abnormal blood glucose at 24 weeks of pregnancy, which was thought to be a normal reaction to pregnancy and therefore was not treated specifically. She was treated with daily diet and exercise only. This time, she came to the maternity checkup at 29 weeks of pregnancy and found that her blood glucose was still high and diagnosed as gestational diabetes mellitus. After a series of glucose-lowering treatment and daily diet and exercise guidance, the patient’s blood glucose control was more satisfactory.
Basic information】Female, 31 years old
Type of disease】Gestational diabetes mellitus
Hospital】Huangshi Central Hospital
Date of Consultation】May 2022
Treatment plan】Subcutaneous insulin hypoglycemia treatment (menthol insulin injection, detergent insulin injection) + daily diet and exercise guidance
Treatment period】7 days of inpatient treatment, regular follow-up
Treatment effect] Satisfactory blood glucose control
I. Initial consultation
The patient came to our hospital for maternity checkup accompanied by her family, and did not complain of any special discomfort. At 24 weeks of pregnancy, the patient performed glucose tolerance test with fasting glucose of 11.7 mmol/L, 1 hour postprandial glucose of 22.41 mmol/L and 2 hours postprandial glucose of 25.32 mmol/L. At that time, she did not take it seriously and thought it was a normal physiological phenomenon, and did not use drugs. I thought it was a normal physiological change during pregnancy, so I did not monitor the change of blood sugar. Now she is 29 weeks after menopause, she came to the hospital for maternity checkup and her random blood glucose was 13.9 mmol/L. Only then she started to worry about the effect on the fetus and came to our department.
Since the patient’s self-control of blood glucose was not satisfactory and she was currently in pregnancy, the patient was judged to have gestational diabetes after combining all indicators. However, considering that the patient was in pregnancy, we recommended hospitalization, insulin control and regular monitoring of blood glucose changes, and the patient and her family actively cooperated with the treatment.
II. Treatment history
After the patient was admitted to the hospital, the relevant examinations, namely physical examination, liver and kidney function, blood routine, urine routine, electrocardiogram, glycated hemoglobin, blood ketone body and other examinations were completed, which were consistent with the characteristics of gestational diabetes mellitus. She then communicated with the patient and her family about the situation, and informed them that the cause of the disease was due to a variety of hormones secreted by the placenta during pregnancy affecting the function of the pancreas, which usually leads to gestational diabetes if the reserve capacity of the pancreas is insufficient, and after hearing this, the family expressed that they would definitely cooperate with the treatment.
Since the patient’s current abnormal increase in blood glucose was obvious and the glycated protein was significantly elevated, after admission, she was given short-acting insulin menthol insulin injection and long-acting insulin detergent insulin injection for treatment, and was instructed to strictly control her diet and exercise appropriately. After 7 days of hospitalization, the patient’s blood glucose was well controlled and returned to normal standards, so he was discharged from the hospital. The patient was instructed to continue to monitor the change of blood sugar after discharge and to come to the hospital regularly to learn about the ultrasound of the fetus.
III. Treatment effect
After insulin hypoglycemic treatment, the patient’s blood sugar was well controlled, and the blood sugar before three meals was below 5.3mmol/L and 2 hours after meals was below 6.7mmol/L. With diet control and appropriate activities, the patient’s blood sugar remained stable. After the patient was discharged from the hospital, the changes of blood glucose were monitored regularly, while no abnormal fetal development or excessive amniotic fluid was found for the time being.
IV. Notes
We are glad that the patient has achieved stable blood glucose control after treatment. However, since gestational diabetes must be strictly controlled, otherwise it will be easy to recur, the patient still needs to pay attention to the following points after discharge.
1. Patients still need to pay attention to their diet after discharge, control sugar intake and avoid eating foods with too much sugar such as fruits, pastries and milk tea.
2. patients are advised to perform about 30 minutes of moderate intensity activity after each meal, which is conducive to increasing insulin sensitivity and lowering blood glucose.
3. With the development of pregnancy, the amount of insulin use may need to be adjusted, so regular monitoring of blood glucose is needed, and efforts will be made to control blood glucose at the target value, and if there is any discomfort, consult the doctor at any time.
V. Personal insights
Gestational diabetes has an impact on the safety of both mother and child, and needs to be taken seriously by physicians and patients, such as weight control during pregnancy, avoiding excessive sugar-rich foods such as fruits and pastries, and paying attention to blood glucose monitoring. The increase of blood glucose in this patient during pregnancy is related to the special hormone secretion and insufficient pancreatic reserve function during pregnancy. Therefore, timely blood glucose monitoring is needed for pregnant women with excessive body mass index, rapid weight gain during pregnancy, and a family history of diabetes.
In addition, in addition to insulin injection therapy, patients with gestational diabetes should be treated with diet control and exercise as the preferred treatment, such as exercising more, paying attention to the rate of weight gain, and using insulin to lower glucose under the guidance of physicians in a timely manner if the blood glucose is not well controlled, but to prevent the occurrence of hypoglycemia.