Feb. 26, 2004 – Remember the term "borderline" diabetes? I think that's where "a touch of sugar" came from. Well, there is no such thing as borderline, or a touch of, diabetes.
There are relatively few individuals with diabetes Type 1. This occurs when the pancreas is unable to produce any insulin at all. Statistics show that only 1 percent of the total population with diabetes has Type 1. It does not go undiagnosed like Type 2.
There are several pre-diabetes conditions, such as hyperglycemia and abnormal glucose tolerance. Chemically induced diabetes and gestational diabetes may be temporary. We are learning more all the time.
Diabetes and pregnancy: the mother, the baby
Gestational diabetes is the most common form in young women. It occurs during pregnancy. There are so many things happening within the mother's body. The most common situation would be high blood sugar due to high levels of hormones, which increases production of glucose from the liver as well as from the intestines. The mother's pancreas is incapable of producing enough insulin; therefore, the glucose levels stay very high in her bloodstream.
During the first few weeks of pregnancy, the baby's organs are formed. High blood-sugar levels can cause malformations and some severe birth defects. The result may be spontaneous abortion or a miscarriage. Later, as she progresses into the second and third trimester of pregnancy, the high levels of blood glucose cross the placental barrier to the baby, but not the insulin. The infant's brand new pancreas is very good at producing insulin and does so at a high rate. This promotes fat storage and the baby grows and grows.
The most common effect of gestational diabetes is macrosomia, or "very large baby." The result can be injury to mother and baby at birth; more likely is a Caesarean section birth or, in the worse case, the baby dies.
After delivery the baby's pancreas continues to produce insulin at a high rate, but the blood glucose level is not high anymore. This results in hypoglycemia, or low blood sugar, at 6-12 hours after birth. This may cause respiratory distress, immature liver problems, and seizures. Long-term effects include possible impaired metabolic or neurological development and increased chance of obesity in childhood, adolescence and young adulthood.
The effects on the mother are high blood pressure, swelling, and seizures. The hormones present during pregnancy accelerate the development of diabetic retinopathy, which can cause permanent blindness.
The pills commonly used to treat diabetes Type 2 are not an option during pregnancy. Insulin is a hormone itself. Therefore there are no side effects. It only does one thing, that is: allow the glucose passage from the bloodstream into the cells, (muscle, organ and nerve or brain cells), to be used as fuel. The insulin used to treat diabetes is synthetically created from human DNA biotechnology in a test tube. The only possible side effect is hypoglycemia, or low blood sugar, which is treated and prevented by carbohydrate ingestion, or eating.
A woman with diabetes can have a healthy pregnancy and a beautiful, normal, healthy baby. She must control her weight gain, test and control her blood sugar, and get plenty of exercise. Planning, controlling the blood sugar, and reaching ideal weight before conception are all suggestions for a perfect start for pregnancy.
Testing blood sugar: methods
Testing blood sugar can be something people with diabetes have feared since the diagnosis was first made. "Stabbing" a finger with a needle, especially several times a day, is totally unacceptable.
Nearly all the glucometers come with a "penlet," and lancets. There are "extra fine," and/or "soft" lancets. These are the needle tips that load into the penlet, which is set to control how deep to puncture the skin. The patient loads and cocks the penlet, washes his or her hands with soap and warm water, and selects the site. (It can be the forearm, finger, thigh, or other sites.) Next, he or she places the penlet and pushes the button to accomplish the puncture. Many times if the site is selected carefully and the penlet used properly, this will turn out to be totally painless and without tenderness even after repeat punctures. Recording the results, time and date of each test is so important; you really can't remember them accurately.
Testing and treating during pregnancy
Ideally, gestational diabetes can be controlled with diet and exercise, but monitoring is essential. Each blood-sugar test is like a photograph. It tells us what the sugar level is at that minute. Stress of any kind — emotional, physical, or mental, hydration, exertion, or eating — can change this level in less than five minutes. Hormones make mood changes part of every personality, especially with something as complex and profound as pregnancy happening. The blood sugar may be changing as we are testing, going up or going down.
With frequent tests the patient learns to sense changes in one's own body and clues as to what the blood sugar is doing. Each individual has different signs and symptoms of low or high blood sugar, as well as different responses to stress. The target range is 80-110 fasting or before meals, and 110 to 130 one-half hour after meals. Below 70 must be treated promptly: eating 15 grams of carbohydrates and at least a small meal soon after.
The rule of 15 is very helpful. This is: if the test result is 70 or below eat 15 grams of carbohydrate, wait 15 minutes, and test again. If the result remains low, eat another 15 grams of carbohydrate, wait another 15 minutes and test again. Most people can eat a lot in 15 minutes with no restriction. 15 grams of carbohydrates is not much: for example, four ounces of juice, (that's one-half cup), or half a banana, or 1 cup of milk.
If the test result is above 130, this needs treatment as well; exercise and insulin are needed. Stabilizing the blood sugar by eating consistently, regular exercise, and adequate insulin determined by monitoring blood sugars is the goal. The result is a healthy newborn with a bright future and a healthy mother.
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