How to Manage Gestational Diabetes

Adam — Wed, 02 Sep 2009 09:02:02 +0000

Gestational diabetes occurs in approximately 5% of pregnancies. Several complications arise for both the baby and the mother if gestational diabetes is left uncontrolled, including large birth weight and difficult delivery, preeclampsia (high blood pressure), and the chance of developing Type 2 diabetes later in life. For the expectant mother recently diagnosed with gestational diabetes, the revelation and information regarding treatment can be overwhelming. However, there are several steps a woman can follow to minimize the complications.
Maximize Food Choices
The diet for a woman with gestational diabetes does not restrict her food, but only the amount of carbohydrates she can have throughout a day. She can choose to have a brownie or ice cream, but she must do so with the understanding of the carbohydrate count of each food item. A two-inch by two-inch square brownie, without icing, is about one carb serving. If she is on a diet which allows for three carbohydrate servings in a meal, the brownie would count as one, as would one slice of bread or a half-cup of cooked rice. When deciding on what to eat, the pregnant woman would be better served by finding the food choice which will meet her dietary requirements and nutritional needs, as well as satisfy her hunger.

Keep A Journal
One way that an expectant mother can help with the treatment of gestational diabetes is to keep a food journal with her charts of blood sugar readings. The mother can track everything eaten for each of her meals and snacks to see how well she has kept to her prescribed diet. Along with this, she should write down her blood sugar readings after each meal. This will help her chart which foods create a blood sugar spike so she can modify her diet accordingly.

Walk It Off
The experience of gestational diabetes can be stressful with the dietary changes and prescribed medications. Exercise is a key not only in helping to regulate gestational diabetes, but also to help alleviate stress. This may become more difficult as the pregnancy comes to term. However, an exercise program which keeps the doctor’s guidelines in mind will benefit both the mother and baby.

Build The Support System
Expectant mothers may feel like they live in a vacuum regarding their diagnosis, with little understanding from family and friends. In order to keep up with the treatments prescribed, the mother should bring a close family member or friend to the doctor’s appointments and meetings with the dietitian. She can cook carbohydrate-friendly meals for her family to show how one can be healthy and enjoy good food at the same time. She can also allow her family to experiment with the glucometer, taking their blood sugar readings and comparing them with hers.

A diagnosis of gestational diabetes does not have to cast a shadow over an expectant mother’s pregnancy. With these simple management tips, she can assist her doctor with controlling her blood sugar levels while enjoying all of the experiences of a healthy pregnancy.

Oral Agents for Type 2 Diabetes

Article Poster — Fri, 10 Apr 2009 04:44:01 +0000

By Marie McCarren (author of american Diabetes association Guide To insulin & Type 2 Diabetes. She lives in Arnold, Md.)

There are now six classes of diabetes pills and several combination oral meds. Each has a different way of helping you control your diabetes.

About 90 percent of diabetes in the U.S. is the type 2 form, which occurs in most people after the age of 40. Type 2 diabetes is increasing in young people, especially among those who are overweight, physically inactive, or have a family history of diabetes. Obesity is a major risk factor for diabetes. Upper-body obesity is a stronger risk factor for type 2 diabetes than excess weight below the waist. Regular physical activity can protect against type 2 diabetes, while a lack of exercise is a risk factor for developing diabetes.

if you’re a typical person with type 2, your blood glucose levels are high because you have:

# a pancreas that doesn’t make enough insulin to control your blood glucose
# a liver that releases glucose inappropriately
# muscle cells that don’t easily take in glucose

But it wasn’t always that way. Here’s how things worked before you developed type 2 diabetes:

# You ate. Your blood glucose level started to go up. When your pancreas sensed the glucose, it sent out insulin. When your muscle and fat cells sensed the insulin, they let in glucose.
# Your liver helped control your blood glucose levels, too. it tracked insulin levels in your blood. Under normal conditions, when there was insulin in your blood, glucose levels were high, too. Your liver would
say, “oh, good, the body just ate. no need for me to send out glucose.” But when you didn’t eat for hours (like when you were sleeping), your liver sensed the lack of insulin in your blood. it then released glucose to keep your glucose level from dropping too low.

But today you have type 2 diabetes. If your diabetes is typical, it began like this:

# You’d eat. Your blood glucose levels would go up. Your pancreas would put out the right amount of insulin. But your muscle cells couldn’t sense the insulin. So they didn’t take in much glucose.
# Your liver may have failed to sense the insulin, too. it would think, “Hmm, no insulin means the body hasn’t eaten recently. i’d better put out glucose.”
# Your pancreas would sense that there was still a lot of glucose in your blood, so it would produce extra insulin. This may have gone on for years. When your pancreas could no longer keep up with the extra
demand, your blood glucose levels went up and stayed up. And you were told you had diabetes.

So type 2 diabetes involves several problems, and there are a number of potential solutions. one may be insulin injections. These can overcome insulin resistance. There are also six classes of diabetes pills. Each class acts in a different way to control blood glucose levels.

Many people benefit from taking two or more diabetes drugs, each of which addresses a different problem. such combination therapy is so common that some drug companies now market combination pills. (see “Combination pills” TABLE 1)

No matter which diabetes pill you use, you may also need insulin injections to move glucose into your cells and control blood glucose levels.

TABLE 1. Oral Agents for Type 2 Diabetes

Class	Generic Name	Available as a Generic	Brand Names	Comments/Cautions
Alpha-Glucosidase inhibitors	acarbose	no	Precose	Take with the first bite of each meal. Advantages: Acarbose and miglitol normally do not cause weight gain. Side effects include gas, bloating, and diarrhea. To minimize side effects, ask your doctor about starting with a low dose and building up slowly. Who shouldn’t take: Because these medications work directly in the intestines, people with inflammatory bowel disease, other intestinal diseases, or obstructions should not take them. Hypoglycemia: Acarbose and miglitol don’t cause low blood glucose (hypoglycemia) when used alone. When used with certain other diabetes medications, low blood glucose can occur. In these cases, treat hypoglycemia with pure glucose, such as glucose tablets or glucose gels, or fruit juice. Acarbose and miglitol delay the breakdown of many other carbohydrates, so those carbs should not be used to treat low blood glucose.
Alpha-Glucosidase inhibitors	miglitol	no	Glyset
Biguanides	metformin	yes	Glucophage	Advantages: Metformin does not cause weight gain and may improve cholesterol levels. It does not cause low blood glucose hypoglycemia) when used alone. Common side effects when starting metformin are nausea, diarrhea, or loss of appetite, but these should subside within a few weeks. To minimize these side effects, take with meals. In some cases, the dose may need to be reduced and then gradually increased as the body gets used to the medicine. Lactic acidosis is a rare but serious side effect. Metformin may not be right for you if you have kidney problems or severe respiratory problems, are 80 or older, are taking medication for heart failure, have a history of liver disease, drink alcohol excessively (binge drinking), or are hospitalized. If you are scheduled for any medical testing, radiology, or surgical procedures where you will have to fast or have an iodinated dye injected into your veins, you must inform medical personnel that you are taking metformin.
	metformin (long-acting)	yes	Glucophage XR, Glumetza, others
	metformin (liquid)	no	Riomet
DPP-4 inhibitors	sitagliptin	no	Januvia	Advantages: Does not cause weight gain. side effects: May occasionally cause stomach discomfort and diarrhea. Cautions: If you have kidney problems, your doctor may prescribe lower doses. Your doctor may do blood tests from time to time to see how well your kidneys are working.
Meglitinides (Can cause low blood glucose, but risk is lower than with sulfonylureas.)	nateglinide	no	Starlix	Take at start of meals. Skip the dose if you skip a meal.
	repaglinide	no	Prandin	Take at start of meals. Skip the dose if you skip a meal.
Sulfonylureas (These drugs can cause low blood glucose.) Note: Drugs followed by an asterisk are older sulfonylureas. They tend to cause more hypoglycemia and are seldom used today.	glimepiride	yes	Amaryl	Probably safe in people with kidney disease, but patients who have kidney disease or who are elderly should be started on a lowerthan- usual dose.
	glipizide	yes	Glucotrol	Most effective when taken with a meal, and may be more effective when taken 30 minutes before meals.
	glipizide (long-acting)	yes	Glucotrol XL	Should be taken with meals.
	glyburide	yes	DiaBeta, Micronase	Effects may last entire day. May not be suitable for patients with kidney disease.
	glyburide (micronized)	yes	Glynase PresTab	More readily absorbed than regular glyburide, so the strengths of the tablets are different.
	chlorpropamide*	yes	Diabinese	Longest-acting drug in this class, so it has a higher potential to cause low blood glucose. Not recommended for elderly patients and those with kidney disease. May cause low blood sodium levels, jaundice, and possibly skin rashes.
	tolazamide*	yes	generic only	Patients with kidney disease may need smaller doses. Used infrequently.
	tolbutamide*	yes	generic only	An older agent; used infrequently for diabetes.
Thiazolidinediones (TZDs)	pioglitazone	no	Actos	It typically takes 4 to 6 weeks to see an effect on your blood glucose. Side effects: Can cause weight gain and fluid retention. Heart failure: These drugs can cause heart failure. Call your doctor right away if you have any signs of heart failure, such as rapid weight gain, shortness of breath, edema (fluid retention in ankles, legs, or hands), or fatigue. People with heart failure should not take these drugs. Liver tests: Your doctor should check your liver function prior to starting these medications and periodically throughout your treatment. Call your doctor right away if you have any symptoms of liver damage, such as nausea, vomiting, abdominal pain, fatigue, loss of appetite, or dark urine. Women: These medications may cause women who are not ovulating and haven’t gone through menopause to begin ovulating again, enabling them to conceive. Also, oral contraceptives may be less effective when taking these medications. Women should discuss this issue with their doctors. Avandia: Carries a potential increased risk of heart attack.
Thiazolidinediones (TZDs)	rosiglitazone	no	Avandia
Combination pills	metformin + glyburide	yes	Glucovance	See cautions for each drug in the combination, listed separately above.
	metformin + rosiglitazone	no	Avandamet
	metformin + glipizide	yes	Metaglip
	metformin + pioglitazone	no	Actoplus Met
	metformin + sitagliptin	no	Janumet
	pioglitazone + glimepiride	no	Duetact
	rosiglitazone + glimepiride	no	Avandaryl

Female Care » Type 2 Diabetes

How to Manage Gestational Diabetes

Oral Agents for Type 2 Diabetes