Pregnancy Diabetes Symptoms, Diet and Treatments

Pregnancy Diabetes Symptoms, Diet and Treatments - During normal pregnancy occur metabolic adaptations, aimed at correcting the imbalance resulting from the need of a greater nutritional intake for the fetus. One of these imbalances is that the body needs a greater intake of insulin to require greater use of glucose.

Clear proof of this change is experienced by all pregnant, that I often notice the unpleasant symptoms of hypoglycemia in the morning: nausea, drowsiness, tiredness, weakness, etc.

As the pregnancy progresses, the metabolic adaptation intensifies, reaching great importance during the last 20 weeks of pregnancy.

All these metabolic changes lead to a number of considerations when they occur in a diabetic woman:

In some patients the Diabetes appears for the first time during pregnancy.
The conventional criteria for the diagnosis of Diabetes are not applicable in gestation.
As gestation advances produced an increase in the needs of insulin.
The usual criteria of strict metabolic control are not applicable during gestation.

Detection of diabetes mellitus gestational (DMG)

The data that suggest the possibility of a DMG are:

Family history of diabetes, especially among the relatives in the first degree.
Glycosuria (glucose in urine) in a second urine sample in fasting (see below).
A history of:
Unexplained abortions.
New born large for gestational age.
Malformations in the newborn.
Important maternal obesity (90 kg or more).

Some minor data are: multiparity, toxemia of pregnancy recurrent and repeated premature birth.

The presence of more than one data increases the likelihood of a disorder in the metabolism of glucose.

Glycosuria (glucose in urine) is a common finding, since 15% of pregnant women have it, so the search for cases based on this isolated data is fruitless. The validity of this test can be increased when used a second urine sample in fasting: issued to wake up urine, you despise and collect a second sample 15 minutes later, when the patient is still in fasting.

Suspected cases of diabetes mellitus gestational DMG should be seen every fortnight by the endocrinologist, working together this and an obstetrician. The usual prenatal measures should be taken. Special emphasis on weight control should be.

Each visit must be a blood sugar after eating. If this test does not exceed 120 mg/dl), oral glucose tolerance test should be postponed until the week 37th-38th of gestation, which is more likely to give positive. If any visit blood glucose after eating more than 120 mg/dl, should be promptly glucose tolerance test.

If the test is negative at the beginning of pregnancy does not exclude, however, the diagnosis, and the test should be repeated at 37-38 weeks, before making a final decision.

Patients who have a negative tolerance test at 37-38 weeks are considered normal.

If the test is positive the diagnosis of gestational diabetes can be and offers the patient a diet and controlled in the same way that a diabetic clinician.

If the ideal blood sugar control criteria are not met soon, insulin therapy is started. In well controlled and not complicated cases, waiting for spontaneous labor.

The existence of a high need for insulin during pregnancy does not necessarily indicate that diabetes persists after childbirth.

Monitoring of diabetes mellitus gestational DMG

The glucose tolerance test should be repeated after the postpartum period. If the test is still positive, the patient has a clinical diabetes (which was shown for the first time during gestation).

If it is negative, the correct diagnosis is gestational diabetes mellitus.

As some patients with diabetes mellitus gestational DMG develop diabetes mellitus clinical subsequently, should be recommended to maintain a normal body weight and advise who come annually to review, or immediately if they become pregnant.

Problems of gestation in diabetic women

The special problems of diabetic pregnancy can be considered under several headings:

Maternal problems

Hypoglycemia

Hypoglycemia is common in the first half of the pregnancy, especially in the first quarter. Fortunately the fetus is well tolerated hypoglycemia.

Diabetic Ketoacidosis

Diabetic Ketoacidosis is a real danger and contrary to what occurs with hypoglycemia, fatal to the fetus

Retinopathy (retina damage)

Retinopathy is already present in many women at the beginning of the pregnancy, and may progress as this progresses. Regular ophthalmoscopy is, therefore, important. Paradoxically, the progression of the retinopathy may be linked to the onset of metabolic control. When neo-vascularization, it can be controlled with photocoagulation, and is therefore not an indication for termination of pregnancy.

Nephropathy (kidney damage)

Nephropathy in the diabetic pregnant woman is defined as the presence during the first half of the gestation of proteinuria (presence of protein in the urine) persistent, more than 400 mg in 24 hours, in the absence of infection.

Many patients also have high pressure and other complications of kidney injury. These cases require a meticulous supervision and control of hypertension and diabetes mellitus, quickly making the hospitalization and inducing childbirth.

Patients with functioning renal transplant tend to have successful pregnancies.