Patient+1-+Pregnant+Diabetic+Spring+2012

===**Patient Demographic Information: The patient is a 36 year old caucasian female of Irish descent who is a non-compliant Type I Diabetic. She is 5"6 and weighs 202 lbs. She is 21 weeks gestation, here for her initial OB/GYN visit. The patient has three children who she has recently lost custody of due to neglect. She is not married at this time and currently unemployed with no health insurance due to job loss. She currently resides with her mother in a 2 bedroom apartment.**===

===**Past Medical History: Patients childhood diseases include Chickenpox at six years old and mumps at age 9. Patient suffers from seasonal allergies. NKDA. Past injuries include fractured right tibia at age 12; and concussion due to car accident approximately age 19.**===
 * Patient was diagnosed with Type I Diabetes as a young adolescent. In the past, she had been compliant with her insulin regimin up until the subsequent loss of her health insurance 18 months ago. She was diagnosed with hypertension at age 32 and has been non-compliant with meds.**

**Past Surgical History: Patient had tonsilectomy as a young girl but does not remember her age. Past surgical history also includes three ceserean section births without complication.**
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 * Laboratory Data:**
 * **BMP:** ||  ||   ||
 * || Results: || Ref.Range ||
 * **Na+** || L 124 || 136-145 ||
 * **K+** || H 5.8 || 3.5-5.1 ||
 * **CO2** || 25 || 23-29 ||
 * **Cl** || 101 || 98-107 ||
 * **Glucose** || H 275 || 74-100 ||
 * **CA+** || 10.1 || 8.6-10.2 ||
 * **BUN** || 17 || 8-23 ||
 * **Creatinine** || 0.9 || 0.8-1.3 ||
 * **HGB** || 17 || 14.0-18.0 ||
 * **HCT** || 48 || 42.0-52.0 ||
 * **HBG A1c** || H 9 || 4.3-6.1 ||
 * **HIV-RNA** || <75 || <75 ||
 * **UR Microalbumin** || 1.9 || 0.0-1.9 ||
 * **Microalb/Creat Ratio** || 13.2 || 0.0-29.9 ||
 * **Hemoglobin A1C** || H 9 || 4.0-6.0 ||

__Interview Dr Dave Ores - NYC 3/23/2012__

Pregnant Diabetic

1. Maintenance of blood sugar levels at a stable level. This is challenging as there may be changes that require very regular testing. a) illness/fever b) dietary issues from morning sickness or restrictions due to weight gain or loss.

2. Appropriate weight gain. a) this depends on patient‘s initial weight b) patient’s attitude to weight gain during pregnancy.

The patient must understand (through education) the importance of stable blood sugars so there are no severe fluctuations in the hydration of the patient and fetus. Dehydration can lead to damage to the fetus – particularly in the first trimester.

The patient should be seen 2/3 X a week for first few weeks to ensure stability of the above.

The following article is well worth a quick read - I didn't read all of it but there's some good pointers. . ..



This article has some good real life story clips, there's a lot about gestational diabetes which isn't so relevant to our case study:

