DIABETES AND PREGNANCY

Normally diabetes put quite a lot of pressure on women. Pregnant women who have diabetes are at risk of having a miscarriage, stillbirth or a baby with congenital defects.

Women who have diabetes can have very safe pregnancy and very healthy baby once their blood glucose is managed properly all through the pregnancy.
It is important for women who have diabetes to plan their pregnancy ahead, this will help them keep the blood glucose on target levels:

• Fasting blood glucose 60-100/dl
• 2 hours after meal 100-140mg/dl
• HBA1c level at <7.0% 

If the blood glucose level is controlled and kept as close to normal as possible before pregnancy, the risk associated with diabetes especially birth defects can be prevented, this is based on the fact that baby's organ formation is usually in the first few weeks (6-8) of pregnancy. Achieving and maintaining good control levels will not only prevent birth defects but will also help control the weight of the baby in the second trimester.Pregnant women living with diabetes tend to have babies who are too big for normal delivery.

MANAGEMENT TIPS FOR DIABETES CONTROL IN PREGNANCY

• Monitor your blood glucose level more often. It will be great if you get a glucometer (blood glucose monitoring device) to keep track of your blood glucose level.
• Find a meal plan that works for you during the pregnancy. Eat small portions of food at a time and try to snack between meal instead of eating one heavy meal.
• Try taking dry food to avoid nausea or vomiting.  Note that dry food like crackers biscuits can help control nausea.

• Women with type 2 diabetes may need insulin during pregnancy, while those with type 1 may need to increase their insulin dosage. 

As a rule , visit your health care provider and determine what works best for you and follow the plan.                                                                                                   

WHAT CAUSES DIABETES?

Diabetes is grouped into 2 types:
1.Type 1: This is also called insulin dependent diabetes mellitus or juvenile diabetes. It is common in children. It is usually caused by the inability of the pancrease to produce insulin.

2. Type 2: Non-insulin dependent diabetes, this type is common in adults. This occurs either as a result of the pancrease not been able to produce enough insulin or the body cells are not making use of the insulin.

3. Gestational diabetes: this is the type of glucose impairment that sets in during pregnancy. It usually resolves after delivery. Those who had gestational diabetes are likely to have type 2 diabetes in future.

SUGAR NOT THE CAUSE
Contraly to what a lot of people believe, sugar is not the main cause of diabetes. Sugar only make diabetes worse but not a cause.

Type 1 diabetes is as a result of the inability of the body to produce the hormone INSULIN which is the key that opens up the body cells to enable them use insulin.

Type 2 diabetes is caused by the inability of the body cells to use the INSULIN or the insulin produce is too little.

INSULIN is produced by the Beta cells in the islets of the Langerhan in the pancrease.

THE CAUSE OF DEATH CALLED 'HE SLUMPED AND DIED'.

I have heard and in fact know some people whose cause of death was 'he/she just slumped and died' .This cause of death keep occurring, more often in most cases you hear people saying, 'i was with him (her) this morning, nothing was wrong with him oooo', or she wasn't sick, just like that she slumped, next thing we heard she is dead.

There are two most ignored and undiagnosed common reason for this slumped and died cause of death. Millions of people daily are just too busy chasing their daily bread and paying little or no attention to their health.

Most common cause is hypertension and next to it is high blood glucose- DIABETES.
Quite a number of people live with undiagnosed diabetes and (or) hypertension. They suffer without paying any attention until 'he just slump and died' becomes the case.

Uncontrolled hypertension can lead to heart damage, stroke and eventually death. Diabetes when not diagnosed or properly controlled can lead to complications  such as heart problem, foot ulcer which may result to amputation, eye problem, lack of general response to medication, kidney problem, stroke and at the long run death.

Early diagnosis and proper management of this diseases save life. All it takes to stay checked is to walk into any good health facility and have your blood glucose level and your blood pressure checked.

Importance of RANDOM BLOOD GLUCOSE TEST in management of diabetes.

Two days ago (12th Nov. 2015) i was trying to be sure of an appropriate lunch for my mum. I asked her to come and get her glucose level checked before we decide if she can have semovita for lunch, she said but i had breakfast already, i went wop!
I realized that all these years we have been managing diabetes, we have never had a RANDOM GLUCOSE TEST done for her. I had to start preaching, explaining the meaning of random glucose test. She didn't quite accept the test, we did it anyway, the result was 10.6mmol/L and my mum screamed that is very high. i had to do the second round of preaching to let her know the value for her as a diabetic is not bad.
Just like my mum i realized a lot of diabetics and of course other healthy individuals may not know about other test methods to keep their blood glucose in check and of course achieve adequate control.

This brings us to the question: WHAT IS RANDOM BLOOD GLUCOSE TEST?
Random blood glucose is the test you can do at anytime of the day. It doesn't require any special preparation unlike the fasting blood glucose test. Your blood sample can be tested at anytime of the day whether you have eaten or not.
There are expected value ranges for this test.

• Non-diabetics, the expected value 2 hours after meal is 7.8mmol/L and random is expected to be less than 11.0mmol/L.
• Diabetics, target value for type 1 is 9.0mmol/L and 8.5mmol/L for type 2 individuals. In general random blood glucose in diabetics is usually above 11.1mmol/L (200mg/dl). 
• Target value in well controlled patients is aimed at 125mg/dl.

*To convert mg/dl to mmol/L divide by 18 ie 125mg/dl /18 = 6.9mmol/L.

WHAT IS THE IMPORTANCE OF RANDOM GLUCOSE TESTING?
Random blood glucose test varies greatly throughout the day in everybody, diabetic or not. The value at every point in time depends greatly on the time one had his last meal. The father away from the time of last meal before the test,the lower the result of the test.
For a diabetic, the test helps you stay check and make decisions on how best to manage your sugar level. 

GESTATIONAL DIABETES: MY EXPERIENCE AND SOLUTION

I had checked in for my antenatal with a fasting blood glucose level result of 106mg/dl and a urine analysis result showing glucose to be ++.
From the urine analysis result i knew my results are not good. Am 28 weeks pregnant and i was always urinating, like every 5-15 minutes, cultured my urine no bacteria was found.
Sitting in front of my doctor, she looked at my results and said to me, i will have to diagnose you with GDM- gestational diabetes mellitus. As a diabetes expert i wasn't expecting anything less. I asked her what the glucose target in pregnancy is suppose to be, she said not more than 92mg/dl.
For me reversing it was simple. Below are the steps i took to achieve my present result which is 87mg/dl with no glucose in my urine for the past 4 weeks and counting.
1. Diet modification; i got to the market, i changed my entire food choices. These are the food i shopped for; unripe plantain which i eat either boiled, porridge and sometimes i fry it for snack in the afternoon. Irish potatoes which i use for a lot of wonderful yummies. i replaced my milk with skimmed milk (marvel) and my beverage with lipton. Now this will interest you, i eliminated swallows such as eba, pounded yam, semo etc totally, i started eating my soup with agidi.
I eliminated water melon and pineapple from my fruits since they have the tendency to hike blood glucose, garden eggs, apple, carrots, lettuce became the order of the day. I drastically increased my intake of green leafy vegetables. Another interesting meal i took advantage of its season is fresh corn. i started making delicious corn meal with vegetables. Beans also constituted major part of my meal as i cooked different varieties. I eliminated all canned, bottled and other artifiial drinks, i replaced them with home made drinks like zobo and kunu AYA.  Generally i tried to make healthy choices.
2. Exercise: though i am a very active person even in pregnancy, as the pregnancy advance, the more difficult taking a walk became. I always push myself, outside the normal working day activity, i try to take extra 20-30 minutes walk.

These are the two major simple steps i took and in 2 weeks i was already reaping the results. I advice you share this experience with someone, who knows you may be a saviour.
If you have experience with diabetes you like to share with us, please feel free to comment below or mail us @ diabetesplusmagazine@gmail.com and we will be publishing you right away.

GESTATIONAL DIABETES:MANAGEMENT FOR THE FUTURE

My mum's first encounter with diabetes was during her last pregnancy in 1991.
Gestational diabetes is to mean high blood sugar (glucose) during pregnancy.
Once diagnosed with gestational diabetes the question on your mind may be any of these;

• How will it affect my unborn child?
• How does it affect me?
• Will my blood glucose level be normal again?

Women who develop gestational diabetes never had it until when they are diagnosed during pregnancy. This term does not refer to known diabetics who are pregnant.

EFFECT ON MOTHER AND CHILD.

Risk to child

• If not well managed, the baby have high risk of having low blood glucose and jaundice at birth.
• The baby usually have high birth weight- MACROSOMIA. This causes the baby to be too largeto be delivered vaginally, leading to delivery through cesarean section.
• Most often than not, these babies are delivered before their due date.
• Because the baby develop too fast, early delivery through cesarean section is required, since the lung at the time of delivery is not well developed, the baby may develop respiratory distress.

Risk to mother

• Delivery through cesarean section place the mother at risk of increased bleeding, prolonged recovery and infections.
• The mother may have high blood pressure in pregnancy (PREECLAMPSIA),  This is dangerous to both mother and child.
• Because the body is trying to compensate for glucose, it breaks down fat for energy, thus producing ketones as by product. Ketone can be detected in urine, and it is harmful to both mother and child.

SYMPTOMS
Most expectant mothers do not show any symptoms. Women at risk are usually tested for their blood glucose level between the 24-28 weeks of gestation. this is the period when the baby begins to use insulin. Test method is Oral Glucose Tolerance Test  (OGTT).

MANAGEMENT
Just like in type 2 diabetes, management plans is as follows:

• Diet plan
• Exercise
• Medication (may be insulin)
• Treatment is usually based on outcome of test results.
• Frequent monitoring of blood glucose level at this time is very important

MANAGING GESTATIONAL DIABETES FOR THE FUTURE
Though gestational diabetes increases a woman's chances of developing diabetes in the future, it usually goes away after delivery.
According to American diabetes Association, only 5-10% of women develop type 2 diabetes after giving birth.
6 weeks after delivery women who had gestational diabetes should have a blood glucose test and repeat at least every 3 years.
As soon as you become pregnant again,let your health care provider know you had gestational diabetes earlier, it will help guide them towards prevention or management of diabetes. You can also request for a blood glucose test.
After delivery ensure adequate diet and exercise plan to enable you loose weight and get into shape to prevent diabetes,
Healthy food such as vegetables, fish, fruits, lean meat, whole grain, low or non-fat milk, beans, peas and nuts are of utmost necessity.
Ensure you drink plenty of water at least 8 glasses daily.
Smaller food portions will help you achieve healthy weight.

Walk against diabetes during world diabetes day 2011 in Abuja,Nigeria.

Volunteers walking to curb diabetes



Volunteers dancing during the walk--- music by igbo cultural troupe



Convoy with the Nigeria Road Safety Corps

The 2011 World Diabetes Day in Abuja Nigeria didnot only achieve the aim of increasing diabetes awareness but was also fun for all those who volunteered. A cultural troupe gave pleasure to the walk. Information materials on diabetes prevention and management was distributed to the general public during the walk. We are looking forward to geater things in 2012, join us as we work towards a diabetes free generation. email us on : pdfagainstdiabetes@gmail.com