Even though GDM usually is triggered and diagnosed in late pregnancy, mothers need to check their blood sugar levels at least four times daily and continue until they deliver. Patients should report their blood sugar levels to a perinatologist weekly for follow-up and treatment evaluation. In many cases, the RD also is a CDE and, as part of the perinatology team, is involved in all aspects of patient care, which includes providing instructions for self-monitoring blood sugar, medical nutrition therapy and exercise, and medication recommendations.
In addition to the lack of evidence to support sliding scale only as a preferred treatment modality, there are also data to show that sliding scale only can contribute to poor glycemic control . Studies have explored the use or basal or bolus insulin in direct comparison to sliding scale insulin only. The RABBIT-2 trial suggested that a basal-bolus regimen was superior to sliding scale insulin (SSI) in obtaining goal BG levels with no increase in hypoglycemia . Datta et al.  suggested that a once daily glargine dose was more effective in the post-operative control of bariatric patients with diabetes than sliding scale alone. The RABBIT-2-Surgery trial suggested that a glargine and glulisine treatment improved glycemic control and reduced hospital complications compared to SSI alone in a general surgical population .
A. Pathophysiology: diffuse hyperplasia of thyroid gland → overproduction of thyroid hormone and increased blood serum levels. Hormone stimulates mitochondria to increase energy for cellular activities and heat production. As metabolic rate increases, fat reserves are utilized, despite increased appetite and food intake. Cardiac output is increased to meet increased tissue metabolic needs, and peripheral vasodilation occurs in response to increased heat production. Neuromuscular hyperactivity →accentuation of reflexes, anxiety, and increased alimentary tract mobility. Graves’ disease is caused by stimulation of the gland by immunoglobulins of the IgG class.