I was making my rounds in the ward as the obstetrician-gynecologist resident physician on duty last September, 2009. I was called in the emergency room because there was thirty two year old in term pregnancy. When I went to her, I noticed that her abdomen was too enlarged to her body frame. She was of medium built even if she said she has big appetite. She said that she was always thirsty. She was always having frequent urination. I told the patient and her relatives that I was suspecting a large a baby. I told them that I was also thinking of diabetes. Big babies usually always come from diabetic mothers.

I asked the nurse to get the capillary blood sugar test. As I suspected, her blood sugar was very high. I told the woman that we would be doing the blood sugar test every hour till she delivered. I was thinking of the doing emergency cesarean section. I referred the woman to the internal medicine for the co-management of diabetes. The internal medicine resident on duty, however, ordered further work-ups such as electrocardiographs, chest x-ray with abdominal shield and fasting blood sugar.

I called the consultant on duty of the obstetrics-gynecology to tell her the condition and management of the patient. She said that she opted to do trial of labor because this was a first pregnancy. There was no indication of operation even if her baby appeared big. So, I induced the labor till her labor did not able to progress after six hours. Now, I have an indication for abdominal delivery which is difficult labor. I asked the permission of the consultant and I delivered the baby via emergency cesarean section.

After the operation, the internal medicine residents ordered to continue capillary blood sugar test every hour. Then, they ordered insulin if the sugar rose to 200mg/dl. When they saw that her sugar was rising up three times, they ordered long-acting and intermediate acting insulin while she could not yet tolerate oral medications. When she could already eat, the oral ant diabetic medication was started. I advised her to slim down and have exercises once able. I discharged her improved after five days. There are so many types of instruments that are available these days for helping people check their level of sugar in blood and keep that in check. So, this important thing can be done much easier than thought.

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