Clinical Case: Gestational Diabetes Mellitus

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CLINICAL CASE:
GESTATIONAL
DIABETES
MELLITUS
 Marília de Araújo Alves
INGLÊS INSTRUMENTAL EM
MEDICINA II 
Case Presentation
Female patient, 28 weeks pregnant, 40 years old, Brazilian, natural and resident of Alfenas -
Minas Gerais, housewife, married, black, Catholic, complete high school. The patient arrived at
the basic health unit where she performs prenatal care, reporting that, about a week ago, she
has excessive thirst (polydipsia), more frequent visits to the bathroom to urinate (polyuria) and
increased hunger (polyphagia). She presents herself with fear, saying that she seeks medical help
because she fears that something will happen to her baby. Her mother has type 2 diabetes
mellitus, but the patient has no history of diabetes diagnosis. She is overweight, does not
exercise routinely and has a history of miscarriage. When she was 20 years old, she presented
isolated hypercholesterolemia, which was resolved with the use of medications. Regarding her
diet, she remains with a high consumption of carbohydrates and fats. She denies comorbidities
such as systemic arterial hypertension, dyslipidemia, polycystic ovary syndrome and heart
disease.
Physical exam
On physical examination, a patient has good general condition. Normocardial
(heart rate is 68 bpm), eupneic (16 breaths per minute), normotensive (blood
pressure is 125/75 mmHg), afebrile (36.3°C). It is hydrated, nourished, acyanotic,
anicteric, overweight (BMI 26 kg/m²), stained, without alteration in speech,
language, gait and physical development.
The fetus has a heart rate of 140 bpm, cephalic position, uterine height of 25 cm.
Type 2 diabetes mellitus
Gestational diabetes mellitus
Diagnostic suspicions
The doctor then requests an oral glucose tolerance test with an overload of 75
grams. Three glucose measurements are analyzed: fasting, 1 hour and 2 hours. As
more than two measurements are altered, the diagnosis of gestational diabetes
mellitus is closed.
Complementary exams
G U I A D E P R I M E I R O S
S O C O R R O S | 2 0 2 0
Diagnosis
The patient has some classic symptoms of hyperglycemia: polyuria, polydipsia and
polyphagia. Therefore, an alteration in the complementary exam confirmed the
diagnosis of diabetes mellitus. As the symptoms started in the pregnancy period, the
diagnosis of gestational diabetes mellitus (GDM) is confirmed.
The risk factors for GDM are very suggestive in this case. The patient has advanced age
(over 35 years), overweight, family history of diabetes in first-degree relatives (mother)
and obstetric history of abortion.