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  Gestational diabetes

Gestational diabetes is a type of diabetes mellitus in pregnant women who have never been diagnosed with diabetes before but was found to have high blood sugar (glucose) levels or hyperglycemia during pregnancy. The medical term diabetes is metaphorical in origin which means “flowing through” referring to the urine flow. One of the cardinal symptoms of diabetes is polyuria or increase frequency or excessive urination within a 24-hr period. The other two cardinal manifestations of diabetes are polyphagia (excessive eating) and polydipsia (excessive thirst). These three cardinal symptoms may be present among patients with gestational diabetes as well.

Gestational diabetes
Gestational diabetes


The exact cause of gestational diabetes remains to be idiopathic or unknown but the theory on insulin resistance is one possible explanation why blood glucose rises in pregnancy. It has been hypothesized that hormones produced by the placenta not only supports the developing fetus, but it also block the action of the mother's insulin to the target receptors in her body. Therefore with insulin resistance, the mother’s body is having difficulty in utilizing the insulin and the end result of which is elevations of the plasma glucose. Gestational diabetes starts when the insulin is insufficient in amount, because the glucose cannot leave the bloodstream and cannot enter the cells where it is converted to energy for cellular utilization. Hence, glucose continuously builds up in the blood to high levels, this is now called hyperglycemia. In short, the insulin will serve as a key to the receptors found along the cell membrane so that the glucose molecules can enter the cells and leave the blood. This process is impaired among patients with gestational diabetes because of insulin resistance.

Unlike those pregnant mothers who have been afflicted with disease during the first trimester of pregnancy, gestational diabetes does not cause congenital birth defects. This is due to the fact that gestational diabetes affects the mother in the late trimester of pregnancy, which is time after the baby's body has already been formed, but while the baby is still growing.

If left untreated or for those with poorly controlled blood sugar among patients with gestational diabetes, harmful effects to the baby may be evident before or after childbirth. The baby may have abnormally low blood sugar level (hypoglycemia), pathologic jaundice (yellowish discoloration of the eyes and skin), or may be found to be an LGA or large for gestational age (weigh much more than is normal). The above manifestations seen in babies are due to the mother’s pancreas that is working overtime to produce insulin despite the fact that the insulin in her body does not lower her blood glucose levels. These extra glucose along with the other nutrients except for the insulin can cross the placenta giving the baby high blood glucose levels and as a consequence, stimulating the baby's pancreas to make extra insulin to lower down the blood glucose coming from the mother. Since the baby is getting more extra energy than it needs for growth and development, the extra energy is eventually stored as fats. This can lead to macrosomia or “fat baby” and therefore, placing the pregnant mother’s health at risk for dystocia (difficult labor) and possibly cesarean section (C-section) during delivery because of significant cephalopelvic disproportion (CPD). Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes mellitus, the non-insulin dependent diabetes mellitus.

Treatment for patients with gestational diabetes may begin with maintaining an ideal body weight. If you are more than 20% over your ideal body weight, computed based on body mass index (BMI) then it is advisable to reduce weight. Obesity is also an independent risk factor to develop cardiovascular diseases such as hypertension, coronary artery disease, osteoarthritis, dyslipidemia and other overweight related health problems.

Dietary modifications such as making healthy food choices are very important. Eating a variety of foods including plenty of fresh fruits and vegetables and limiting fat intake to 30% or less of daily calories is another way of reducing weight. Avoid eating foods that contain a lot of simple sugar such as pastries (e.g. cake, cookies), candies, chocolates or ice cream.

Exercising regularly will allow the body to utilize the extra glucose without extra insulin which is more or less a way of counteracting insulin resistance and helpful in maintaining your blood sugar level within normal limits. If you are pregnant, walking is the easiest type of exercise that is recommended.

Gestational diabetes will spontaneously go away after pregnancy but there is a possibility of recurrence of the same problem in future pregnancies. However, in a few pregnant women, conception will lead to incidental findings of type 1 or type 2 diabetes which need to be addressed with proper treatment even after pregnancy. Many women who have encountered gestational diabetes may tend to develop type 2 diabetes or the non-insulin dependent diabetes mellitus several years later. Both gestational diabetes and type 2 diabetes have the same pathophysiology which is insulin resistance.

Regular fasting blood glucose (FBG) to monitor your blood sugar level is important for appropriate management of this condition. These tests will serve as a guide to your doctor if your diet and exercise are sufficient measures in keeping your blood sugar level normal. A normal fasting blood sugar level is less than 105 mg per dL. Some doctors may request for a 2-hr postprandial test, which is taken 2 hours after a meal and normally should be less than 120 mg per dL. If there’s a need for you to start insulin treatment then you may be asked to see a specialist who can properly manage this condition, they are called endocrinologists.

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Glucotrol tablets

Glucotrol

Glucotrol XL, also known as Glipizide is used to treat a type of diabetes called Type 2 Diabetes. It is part of a group of medicines called Sulfonylureas that help insulin get into the cells where it can work properly to lower blood sugar. Be sure to more...


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