within five to ten years. The good news is that studies clearly show that progressing to type 2 diabetes isn’t inevitable. Weight loss of roughly 5–10 percent of starting weight coupled with moderate exercise of at least 150 minutes per week reduces the risk by up to 58 percent. Early detection and intervention may return blood-glucose levels to near normal ranges.
Gestational diabetes
Gestational diabetes is typically diagnosed in the second or third trimester of pregnancy. Pregnancy hormones interfere with the way insulin works by inducing a state of insulin resistance. As the pregnancy progresses, the mother’s pancreas has to work harder to make enough insulin to keep blood-glucose levels controlled. Some women simply can’t keep up with the demand, and they get diabetes during pregnancy, which resolves after delivery. Gestational diabetes is abbreviated as GDM (gestational diabetes mellitus). Women should be screened for GDM at 24 to 28 weeks of pregnancy. GDM also indicates a risk for developing type 2 diabetes in the future. (See Chapter 17 and the nearby sidebar “Diabetes and pregnancy” for more information.)
Other forms of diabetes
Other forms of diabetes make up only a small fraction of the cases of diabetes. These forms include the following:
❯❯ Neonatal diabetes occurs within the first six months of life and can be transient or permanent. Genetic testing is needed to clarify the defect, because some babies are best treated with oral medications while others require insulin.
❯❯ Cystic fibrosis–related diabetes (CFRD) can affect as many as half of the adults and 20 percent of the children who have cystic fibrosis. Insulin is the therapy of choice for CFRD.
❯❯ Maturity-onset diabetes of the young (MODY) is inherited and caused by any number of different chromosomal mutations. Treatment depends upon the specific genetic defect, so testing is required to clarify the diagnosis.
Diabetes during pregnancy is considered a high-risk pregnancy. It is imperative for women with type 1 and type 2 diabetes to have tightly controlled blood-glucose levels prior to becoming pregnant. Uncontrolled diabetes can have devastating consequences. When maternal glucose levels are elevated, the extra glucose readily passes to the baby and that can cause big problems. High blood glucose in the first trimester increases the risk of birth defects and miscarriage. Gestational diabetes doesn’t develop until later in the pregnancy, so birth defects aren’t a concern with GDM.
There are late-pregnancy risks that apply to women with type 1, type 2, and gestational diabetes. High glucose in the second half of the pregnancy can cause the baby to grow too big, which makes for a riskier delivery for both baby and mom. Uncontrolled glucose levels also increase the risk of preeclampsia and stillbirth. Stringent glucose control throughout the entire pregnancy is critical. Women with diabetes who are of childbearing age should have preconception counseling. Some medications are not safe for the baby and thus must be discontinued prior to conception, including meds used to treat hypertension and cholesterol. Have a discussion with your healthcare provider. For more information on managing diabetes during pregnancy, see Chapter 17.
The onset of type 1 diabetes tends to be sudden and come as a complete surprise. Prediabetes and type 2 diabetes can go undetected for years. Early diagnosis and intervention improve outcomes. I address screening protocols and diagnostic testing in the following sections.
Конец ознакомительного фрагмента.
Текст предоставлен ООО «ЛитРес».
Прочитайте эту книгу целиком, купив полную легальную версию на ЛитРес.
Безопасно оплатить книгу можно банковской картой Visa, MasterCard, Maestro, со счета мобильного телефона, с платежного терминала, в салоне МТС или Связной, через PayPal, WebMoney, Яндекс.Деньги, QIWI Кошелек, бонусными картами или другим удобным Вам способом.
