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Ally Gargiulo

Dr. Ha
Case Study
March 30, 2015

Clair is a 36-year old Spanish-speaking Mexican American with a 2-year history of type 2
diabetes. She was seen in her primary physicians office because of a missed menstrual period; a
pregnancy test was positive.
Her past obstetrical history included 5 miscarriages and all of those occurred before the diagnosis
of diabetes. At the time of referral, she was 8 weeks pregnant and taking 10 mg of glyburide
daily, oral medication to increase insulin production. She was checking her blood glucose once a
day in the morning with typical readings between 180 and 220 mg/dL. Family history was
positive for diabetes in her mother.
Her height was 62 inches and her weight was 198lb. She had no retinopathy and no evidence of
neuropathy and her blood glucose level checked at the office 4 hours after lunch was 201mg/dL.
She was started on insulin immediately and her oral medication was discontinued. She began
monitoring her glucose before and after each meal, making daily adjustment in insulin.

1. Is there a relationship between Clairs diabetes and her adverse obstetrical history?
If yes, explain it. Yes, diabetes can be hereditary; her mom has type 2 diabetes. However,
all of her miscarriages occurred before she developed diabetes. Many women develop
preconception type 2 diabetes because they delay pregnancy until later in life. Also, the
number of minority groups developing type 2 diabetes is increasing. The existence of
diabetes in a pregnant woman is very difficult. Blood glucose regulation during the first
2 months of pregnancy is necessary for normal organ development. Unfortunately, many
women do not seek medical help until after this stage of pregnancy because they either do
not know they are pregnant yet or the pregnancy was unexpected. Because of this,
preconception counseling is an important part of pregnancy.

2. Calculate her body mass index and explain how it is related to her condition. Her
BMI is 36.2 which is considered obese. Her obesity can be related to her type 2 diabetes
because of the glucose buildup in her blood.

3. Identify her possible, adverse pregnancy outcome(s). Five miscarriages, type 2


Analyze her diet and make dietary recommendations to improve her pregnancy
outcomes. I recommend eating foods that will keep her blood sugar levels in check. This
includes eating high fiber foods and consuming lots of whole grains instead of starchy
foods. Also consume lots of fruits and vegetables and avoiding sweetened beverages. Its
also important to include folic acid in a pregnant womans diet.

5. What was the reason that she was put on insulin instead of oral medication? If the
readings are higher than 90 mg/dL before meals and higher than 120 mg/dL one hour
after meals, then the doctor may stop the oral medication and start insulin. Oral
medication can also cause the unborn baby to secrete too much insulin and suffer severe
hypoglycemia. Oral medications also arent strong enough for the insulin needs during
pregnancy; since insulin does not cross the placenta. Since pregnancy outcome is related
to controlling blood glucose, insulin is preferred over oral medications for a woman with
type 2 diabetes.