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Content
Diabetes
Diabetes Information
-Diabetes Facts
-History of Diabetes
-Causes of Diabetes
-Diabetes Complications
-Diabetes Education
-Diabetes Research
Diabetes Mellitus
-Diabetes Mellitus Symptoms
-Type 1 Diabetes Mellitus
-Type 2 Diabetes Mellitus
-Diabetes Mellitus Treatment
Types of Diabetes
Type 1 Diabetes
-Type 1 Diabetes Mellitus
-Type 1 Diabetes Symptoms
-Type 1 Diabetes Diet
-Type 1 Diabetes Cure
Type 2 Diabetes
-Type 2 Diabetes Mellitus
-Type 2 Diabetes Symptoms
-Type 2 Diabetes Causes
-Type 2 Diabetes Diet
-Treatment of Type 2 Diabetes
-Type 2 Diabetes Medications
Gestational Diabetes
-Gestational Diabetes Test
-Gestational Diabetes Symptoms
-Gestational Diabetes Diet Plan
-Gestational Diabetes Treatment
Juvenile Diabetes
-Juvenile Diabetes Symptoms
-Juvenile Diabetes Treatment
Diabetes Insipidus
-Nephrogenic Diabetes Insipidus
-Treatment for Diabetes Insipidus
Feline Diabetes
Diabetes Symptoms
-Signs of Diabetes
Also: Diabetes Sign Symptoms
-Type 2 Diabetes Symptoms
Also: Type II Diabetes Symptoms
-Gestational Diabetes Symptoms
-Symptoms, Juvenile Diabetes
Also: Diabetes Symptoms in Child
Glucose
(see also Blood Glucose)
-Glucose Level
Also: Blood Glucose Level
-Glucose Meter
Also: Blood Glucose Meter
-Glucose Monitor
Also: Blood Glucose Monitor
-Glucose Test
Also: Glucose Tolerance Test
-Glucose Intolerance
Diabetes Diet
-Diabetes Food
-Diabetes Nutrition
-Diabetes Diet Plan
-Type 2 Diabetes Diet
Diabetes Supply
-Diabetes Testing Supply
Diabetes Treatment
-Diabetes
Medications
-Alternative Treatment for Diabetes
Insulin
-Insulin Resistance
-Insulin Pump
-Lantus Insulin
Diabetes Care
-Diabetes Management
-Diabetes Associations
-Diabetes Prevention
-Diabetes Cure
Diabetes
is the No. 6 leading causes of deaths in the United States, according to 2001
data from the United States National Center for Health Statistics.
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Gestational Diabetes What is
gestational diabetes and what causes it?
Diabetes (actual name is diabetes mellitus) of any kind is a disorder that
prevents the body from using food properly. Normally, the body gets its major
source of energy from glucose, a simple sugar that comes from foods high in
simple carbohydrates (e.g., table sugar or other sweeteners such as honey,
molasses, jams, and jellies, soft drinks, and cookies), or from the breakdown of
complex carbohydrates such as starches (e.g., bread, potatoes, and pasta). After
sugars and starches are digested in the stomach, they enter the blood stream in
the form of glucose*. The glucose in the blood stream becomes a potential source
of energy for the entire body, similar to the way in which gasoline in a service
station pump is a potential source of energy for your car. But, just as someone
must pump the gas into the car, the body requires some assistance to get glucose
from the blood stream to the muscles and other tissues of the body. In the body,
that assistance comes from a hormone called insulin. Insulin is manufactured by
the pancreas, a gland that lies behind the stomach. Without insulin, glucose
cannot get into the cells of the body where it is used as fuel. Instead, glucose
accumulates in the blood to high levels and is excreted or ?spilled? into the
urine through the kidneys.
When the pancreas of a child or young adult produces little or no insulin we
call this condition juvenile?onset diabetes or Type I diabetes (insulin?dependent).
This is not the type of diabetes you have. Unlike women with Type I diabetes,
women with gestational diabetes have plenty of insulin. In fact, they usually
have more insulin in their blood than women who are not pregnant. However, the
effect of their insulin is partially blocked by a variety of other hormones made
in the placenta, a condition often called insulin resistance.
The placenta performs the task of supplying the growing fetus with nutrients
and water from the mother's circulation. It also produces a variety of hormones
vital to the preservation of the pregnancy. Ironically, several of these
hormones such as estrogen, cortisol, and human placental lactogen (HPL) have a
blocking effect on insulin, a ?contra?insulin? effect. This contra?insulin
effect usually begins about midway (20 to 24 weeks) through pregnancy. The
larger the placenta grows, the more these hormones are produced, and the greater
the insulin resistance becomes. In most women the pancreas is able to make
additional insulin to overcome the insulin resistance. When the pancreas makes
all the insulin it can and there still isn't enough to overcome the effect of
the placenta's hormones, gestational diabetes results. If we could somehow
remove all the placenta's hormones from the mother's blood, the condition would
be remedied. This, in fact, usually happens following delivery.
How does gestational diabetes differ from other types of diabetes?
There are several different types of diabetes. Gestational diabetes begins
during pregnancy and disappears following delivery. Another type is referred to
as juvenile?onset diabetes (in children) or Type I (in young adults). These
individuals usually develop their disease before age 20. People with Type I
diabetes must take insulin by injection every day. Approximately 10 percent of
all people with diabetes have Type I (also called insulin?dependent diabetes).
Type II diabetes or noninsulin?dependent diabetes (formerly called adult?onset
diabetes) is also characterized by high blood sugar levels, but these patients
are often obese and usually lack the classic symptoms (fatigue, thirst, frequent
urination, and sudden weight loss) associated with Type I diabetes. Many of
these individuals can control their blood sugar levels by following a careful
diet and exercise program, by losing excess weight, or by taking oral
medication. Some, but not all, need insulin. People with Type II diabetes
account for roughly 90 percent of all diabetics.
Who is at risk for developing gestational diabetes and how is it detected?
Any woman might develop gestational diabetes during pregnancy. Some of the
factors associated with women who have an increased risk are obesity; a family
history of diabetes; having given birth previously to a very large infant, a
stillbirth, or a child with a birth defect; or having too much amniotic fluid (polyhydramnios).
Also, women who are older than 25 are at greater risk than younger individuals.
Although a history of sugar in the urine is often included in the list of risk
factors, this is not a reliable indicator of who will develop diabetes during
pregnancy. Some pregnant women with perfectly normal blood sugar levels will
occasionally have sugar detected in their urine.
The Council on Diabetes in Pregnancy of the American Diabetes Association
strongly recommends that all pregnant women be screened for gestational
diabetes. Several methods of screening exist. The most common is the 50?gram
glucose screening test. No special preparation is necessary for this test, and
there is no need to fast before the test. The test is performed by giving 50
grams of a glucose drink and then measuring the blood sugar level l?hour later.
A woman with a blood sugar level of less than 140 milligrams per deciliter
(mg/dl) at l?hour is presumed not to have gestational diabetes and requires no
further testing. If the blood sugar level is greater than 140 mg/dl the test is
considered abnormal or ?positive:? Not all women with a positive screening test
have diabetes. Consequently, a 3?hour glucose tolerance test must be performed
to establish the diagnosis of gestational diabetes.
If your physician determines that you should take the complete 3?hour glucose
tolerance test, you will be asked to follow some special instructions in
preparation for the test. For 3 days before the test, eat a diet that contains
at least 150 grams of carbohydrates each day. This can be accomplished by
including one cup of pasta, two servings of fruit, four slices of bread, and
three glasses of milk every day. For 10 to 14 hours before the test you should
not eat and not drink anything but water. The test is usually done in the
morning in your physician's office or in a laboratory. First, a blood sample
will be drawn to measure your fasting blood sugar level. Then you will be asked
to drink a full bottle of a glucose drink (100 grams). This glucose drink is
extremely sweet and occasionally makes some people feel nauseated. Finally,
blood samples will be drawn every hour for 3 hours after the glucose drink has
been consumed. The normal values for this test are shown in table 1.
- TABLE 1. 3?Hour Glucose Tolerance Test for Gestational
Diabetes
|
Diagnostic Criteria |
Normal Mean Values* |
|
Blood Glucose Level |
Blood Glucose Level |
Fasting |
105 mg/dl |
80 mg/dl |
I hour |
190 mg/dl |
120 mg/dl |
2 hour |
165 mg/dl |
105 mg/dl |
3 hour |
145 mg/dl |
90mg/dl |
|
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From 752 Unselected Pregnancies
*O'Sullivan, J. B. Establishing Criteria for Gestational Diabetes. Diabetes Care
3: 437?439, 1980.
If two or more of your blood sugar levels are higher than the diagnostic
criteria, you have gestational diabetes. This testing is usually performed at
the end of the second or the beginning of the third trimester (between the 24th
and 28th weeks of pregnancy) when insulin resistance usually begins. If you had
gestational diabetes in a previous pregnancy or there is some reason why your
physician is unusually concerned about your risk of developing gestational
diabetes, you may be asked to take the 50?gram glucose screening test as early
as the first trimester (before the 13th week). Remember, merely having sugar in
your urine or even having an abnormal blood sugar on the 50?gram glucose
screening test does not necessarily mean you have gestational diabetes. The
3?hour glucose tolerance test must be abnormal before the diagnosis is made.
How does gestational diabetes affect pregnancy and will it hurt my baby?
The complications of gestational diabetes are manageable and preventable. The
key to prevention is careful control of blood sugar levels just as soon as the
diagnosis of gestational diabetes is made.
You should be reassured that there are certain things gestational diabetes does
not usually cause. Unlike Type I diabetes, gestational diabetes generally does
not cause birth defects. For the most part, birth defects originate sometime
during the first trimester (before the 13th week) of pregnancy. The insulin
resistance from the contra?insulin hormones produced by the placenta does not
usually occur until approximately the 24th week. Therefore, women with
gestational diabetes generally have normal blood sugar levels during the
critical first trimester.
One of the major problems a woman with gestational diabetes faces is a condition
the baby may develop called ?macrosomia.? Macrosomia means ?large body? and
refers to a baby that is considerably larger than normal. All of the nutrients
the fetus receives come directly from the mother's blood. If the maternal blood
has too much glucose, the pancreas of the fetus senses the high glucose levels
and produces more insulin in an attempt to use the glucose. The fetus converts
the extra glucose to fat. Even when the mother has gestational diabetes, the
fetus is able to produce all the insulin it needs. The combination of high blood
glucose levels from the mother and high insulin levels in the fetus results in
large deposits of fat which causes the fetus to grow excessively large, a
condition known as macrosomia. Occasionally, the baby grows too large to be
delivered through the vagina and a cesarean delivery becomes necessary. The
obstetrician can often determine if the fetus is macrosomic by doing a physical
examination. However, in many cases a special test called an ultrasound is used
to measure the size of the fetus. This and other special tests will be discussed
later.
In addition to macrosomia, gestational diabetes increases the risk of
hypoglycemia (low blood sugar) in the baby immediately after delivery. This
problem occurs if the mother's blood sugar levels have been consistently high
causing the fetus to have a high level of insulin in its circulation. After
delivery the baby continues to have a high insulin level, but it no longer has
the high level of sugar from its mother, resulting in the newborn's blood sugar
level becoming very low. Your baby's blood sugar level will be checked in the
newborn nursery and if the level is too low, it may be necessary to give the
baby glucose intravenously. Infants of mothers with gestational diabetes are
also vulnerable to several other chemical imbalances such as low serum calcium
and low serum magnesium levels.
All of these are manageable and preventable problems. The key to prevention is
careful control of blood sugar levels in the mother just as soon as the
diagnosis of gestational diabetes is made. By maintaining normal blood sugar
levels, it is less likely that a fetus will develop macrosomia, hypoglycemia, or
other chemical abnormalities.
What can be done to reduce problems associated with gestational diabetes?
In addition to your obstetrician, there are other health professionals who
specialize in the management of diabetes during pregnancy including internists
or diabetologists, registered dietitians, qualified nutritionists, and diabetes
educators. Your doctor may recommend that you see one or more of these
specialists during your pregnancy. In addition, a neonatologist (a doctor who
specializes in the care of newborn infants) should also be called in to manage
any complications the baby might develop after delivery.
One of the essential components in the care of a woman with gestational diabetes
is a diet specifically tailored to provide adequate nutrition to meet the needs
of the mother and the growing fetus. At the same time the diet has to be planned
in such a way as to keep blood glucose levels in the normal range (60 to 120
mg/dl). Specific details about diet during pregnancy are discussed later.
An obstetrician, diabetes educator, or other health care practitioner can teach
you how to measure your own blood glucose levels at home to see if levels remain
in an acceptable range on the prescribed diet. The ability of patients to
determine their own blood sugar levels with easy?to?use equipment represents a
major milestone in the management of diabetes, especially during pregnancy. The
technique called ?self blood glucose monitoring? (discussed in detail later)
allows you to check your blood sugar levels at home or at work without costly
and time?consuming visits to your doctor. The values of your blood sugar levels
also determine if you need to begin insulin therapy sometime during pregnancy.
Short of frequent trips to a laboratory, this is the only way to see if blood
glucose levels remain under good control.
(From National Institute of Health)
See also
Types of Diabetes
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes
Juvenile Diabetes
Diabetes Insipidus
Feline Diabetes
Note:
This diabetes
health education project is supported
by Chong's Health Care at http://www.cljhealth.com, one of the leading companies in the discovery of
alternative
medicines for diabetes.
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