Posts Tagged ‘Dealing with Diabetes in Pregnancy’
Pregnancy occurring metabolic adjustments aimed at correcting the imbalance that occurs when a greater nutritional need for the fetus. One of these imbalances is that the body needs more insulin to bring a more precise use of glucose. Clear evidence of this change is experienced by all pregnant women, usually in the morning noticed the unpleasant symptoms of hypoglycemia: nausea, sleepiness, fatigue, weakness, and so on.
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, Diabetes first appears during pregnancy.
* The conventional criteria for diagnosis of diabetes are not applicable during pregnancy
* As the pregnancy progresses there is an increase in insulin needs.
* The usual criteria of strict metabolic control are not applicable during pregnancy
Detection of Diabetes Mellitus (DMG)
The data suggest a DMG are:
* Glycosuria (glucose in urine) in a second fasting urine sample (see below).
* A history of:
* Abortions unexplained.
* Newborns large for gestational age.
* Malformations in the newborn.
* Significant maternal obesity (90 kg or more).
Some minor data are multiparity, toxemia of pregnancy and recurrent preterm birth repeated. The presence of more than one data increases the likelihood that a disorder in glucose metabolism.
Glycosuria (glucose in urine) is a frequent finding, as 15% of pregnant women have, so the search for cases based on this information alone is ineffective. The validity of this test may increase when using a second fasting urine sample, the urine is released into the wake despises and collected a second sample 15 minutes later when the patient is still fasting.
Suspected cases of DMG should be seen every 15 days by the endocrinologist, is working together and the obstetrician. Measures should be taken prenatal routine. There should be special emphasis on weight control. Each visit must be a blood sugar after eating. If this test does not exceed 120 mg / dl), evidence of oral glucose tolerance should be deferred until the 37 th -38 th weeks of gestation, at which time it is more likely to give positive. If at any visit after eating glucose exceeds 120 mg / dl, it should be a test of glucose tolerance without delay. If the test is negative in early pregnancy, however, 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 is considered normal.
If the test is positive you can make the diagnosis of gestational diabetes and the patient is given a controlled diet and you are in the same way that a diabetic clinic. If the criteria for ideal glycemic control are not achieved soon, we start treatment with insulin. The existence of a high need for insulin during pregnancy does not necessarily indicate that diabetes persists after birth.
MONITORING OF DMG
After the test should be repeated postpartum glucose tolerance. If the test is still positive, the patient has a diabetes clinic (which was revealed for the first time during pregnancy). If not, the correct diagnosis is gestational diabetes mellitus. As some patients with DM develop clinical DMG then they should be advised to maintain a normal body weight and requested to attend an annual review, or immediately if you become pregnant again.