A doctor check up pregnant woman at a hospital in Katmandu
Diabetes mellitus is a condition in which the blood glucose too high (hyperglycaemia). It is due to insufficient insulin being produced or the cell in the body being unable to use insulin the way they should. Because without insulin, the blood glucose can not get into the body's cells accumulates in the bloodstream.
Diabetics pregnancies had invariably resulted in miscarriages or stillbirths until about three decades ago. Many diabetics get pregnant today, although there are potential complications. A healthy baby will result, provided there is good control of the blood glucose. This can be achieved by close partnership between the patient with her obstetrician and her physician or endocrinologist.
The body's changes during pregnancy make control of blood glucose more difficult. During the first trisemester, the insulin requirement may decrease slightly and can lead to hypoglycaemia which can affect brain function. Nausea and vomiting during this time affects carbohydrate absorption in the gut, thereby impacting on insulin dosing. Pre-existing diabetics complications may worsen during pregnancy.
Insulin requirements increase gradually between 16 to 20 weeks of pregnancy and then markedly. This is due to the placental hormones which are important for foetal growth but concomitantly, blocks the effect of insulin.
The insulin requirements will be less during labour as the body is working using glucose for its energy requirements. After birth, the body's insulin requirements decreases but it will take weeks or months before the body's changes are complete.
The insulin requirements will be less during labour as the body is working using glucose for its energy requirements. After birth, the body's insulin requirements decreases but it will take weeks or months before the body's changes are complete.
A routine urine screen for glucose is carried out at every antenatal visit to enable the doctor to decide who needs further investigation. Gestational diabetes mellitus (GDM) is diagnosed by an oral glucose tolerance test (GTT). After an overnight fast, the patient will be given a dose of oral glucose and the blood and urine checked for glucose at regular intervals.
The diabetes management plan during pregnancy includes : knowing and keeping the blood glucose level under control, healthy died, regularly moderate physical activity, maintaining a healthy weight gain, taking medications as prescribed , keeping records as advised by the doctor, and keeping appointments with the doctor as advised. (DR. MILTON LUM / The Star Online)



