Gestational Diabetes in Lean Women

Gestational Diabetes in Lean Women

Gestational diabetes in someone who is lean

Typically we think of Gestational Diabetes (GDM) as due to an imperfect pancreas that cannot cope with the extra insulin needed in pregnancy. This need is there because the hormones from the placenta cause insulin resistance so one needs extra insulin just to keep the same glucose. The insulin resistance is worse if there is obesity present or the mom gains excess weight so that even more insulin is needed.   The defect in the pancreas is poorly understood but almost certainly sets the stage for the later Type 2 diabetes that women who had gestational diabetes are more prone to develop.

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Type 2 diabetes and pregnancy, a modern condition

Type 2 diabetes and pregnancy, a modern condition

The older name for type 2 diabetes is Maturity Onset Diabetes reflecting the fact that it usually develops over the age of 50.  As we grow older our pancreas seems to make less insulin. This is just at the time of our lives when we exercise less and gain weight, so the amount of insulin needed to keep the glucose in check increases. Just like the household budget must balance for happiness, if you need more insulin that your pancreas can’t make – there will be problems this time  in the form of diabetes. The obesity epidemic and its presence in younger women pushes up the need for insulin and so we are seeing more diabetes in women of a fertile age.

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The toll of toiling with Type 1 diabetes – you deserve a medal

The toll of toiling with Type 1 diabetes – you deserve a medal

Managing Type 1 diabetes demands a lot of work.  At meal times the quality and quantity of food has to be dealt with, the glucose measured, forth coming activity considered, the dose of insulin calculated and administered.  Sometimes I think the amount of work diabetes engenders is about the same as a two year old, you have fed them, changed them, given something to drink, put them down, sit down to have a cup of coffee and “Waahh”;  with diabetes you calculate your carbs, adjust for your glucose level, exercise the right amount, take the appropriate insulin and wham – your glucose is low or high –go figure!

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Insulin therapy in Gestational Diabetes, the ouch is more expectation than reality

Insulin therapy in Gestational Diabetes, the ouch is more expectation than reality

People with Type 1 diabetes have to take insulin and although no one likes insulin injections or shots in fact they are not the major irritation in the handling of diabetes.  Certainly when I was caring for people who had islet transplants and  these people had come off insulin, it was the freedom from the regimen of diabetes, the attention to meals, the timing of meals, the monitoring rather than just escaping the insulin injection that was the bigger deal.

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Keeping weight gain in pregnancy in check

Keeping weight gain in pregnancy in check

Controlling weight gain in pregnancy is a challenge.  Weight gain is normal but too much carries more risk for a large baby, for gestational diabetes and maybe even long term risk for obesity in the offspring.  In a previous blog we have looked at what amount of weight gain is normal but for many the pounds just seem to pour on regardless of what they do.  Keeping track of your weight is useful to guide things and you may find the chart we made from the Institute of Medicine recommendations useful. What can be done to keep the weight gain in check.  A recent study came up with a simple approach which seemed to work and may help.

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What is A1c and is it an accurate reflection of blood sugar in pregnancy?

What is A1c and is it an accurate reflection of blood sugar in pregnancy?

In diabetes a lot of attention is paid to the A1c. What is it and is it good at reflecting over sugar levels?
Simple average blood sugars are not that great at telling how the blood sugar control is really like.  Consider Mr Smith who has sugars ranging from 2 to 20 mmol/l (36 – 360 mgs/dl) and Mrs Dixon with sugars of 10 to 12 mmol/l (180 – 216 mgs/dl).  Both have the same average of 11 mmol/l (198 mgs/dl) but the control of sugar in Mr Smith sounds much worse.  The A1c is a much more stable reflection of overall sugar control.

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