Diabetes is a disease of the pancreas that effects the entire body. The pancreas fails to manufacture enough insulin for the body’s use. Diabetes can be inherited. The deficiency causes an unhealthy level of glucose in the bloodstream, which is detrimental and damaging to the blood vessels and nerves. Diabetes can be hazardous to your health if unknown. However, once diagnosed, there are many treatments that can be used to lead a normal life style.
There are two principle forms of diabetes Type 1 diabetes and Type 2, however among pregnant women there has been the presence of gestational diabetes. The case study chosen for this assignment has type 1 diabetes (see appendix 1 for case study details). Type 1 diabetes, formerly known as insulin-dependent diabetes, is caused by the destruction of the body's insulin-producing cells in the pancreas. Although this type of diabetes is more prevalent among children and adolescents, it cans strike at any age and accounts for 10 percent of all diabetic cases. Due to the fact that the body in this case fails to produce insulin, daily injections must be taken to metabolize the glucose digested. Whereas Type 2 diabetes formally known as non-insulin dependent diabetes, results from the body's inability to respond properly to the action of the insulin produced by the pancreas. Type 2 diabetes is the more common form of diabetes occurring more frequently in adults, but appearing increasingly in adolescents.
Diabetes in pregnancy has long been recognized as a serious problem for both the mother and fetus. Before the availability of insulin in the 1920's women with diabetes rarely became pregnant. Those who did become pregnant rarely carried a fetus to viability. Diabetes now occurs in approximately 2% to 3% of the pregnant population. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance and is first recognized during pregnancy. It can be that the onset of this condition in a pregnancy might indicate a previously undiagnosed type 2 diabetes, or it might be GDM can resolve spontaneously after the birth. There is no real consensus on what methods to use for screening for GDM. Women with GDM have a 30 per cent chance of developing type 2 diabetes later in life, compared to a likelihood of 10 per cent in the general population. The risk is higher for women of Asian and African-Caribbean origin. Approximately five to ten per cent of women with GDM develop type 1 diabetes in later life. These women have a slowly developing form of type 1 diabetes which is revealed during pregnancy . There is a risk of GDM in subsequent pregnancies, but this can be reduced through weight control, exercise and careful attention to diet.
In women diagnosed with gestational diabetes, the main complication is fetal macrosomia. These large for gestational age fetuses are at risk of birth trauma, including shoulder dystocia, bone fractures and brachial plexus injury. Neonates born to diabetic women are also at risk of hypoglycemia and other transient metabolic disorders. Although rarer than in type 1 diabetes, prenatal mortality may be increased with insulin-requiring gestational diabetes.
Women who are considered to be at risk of gestational diabetes undergo a glucose tolerance test. This will indicate whether they have normal or impaired glucose tolerance or have developed diabetes. The criteria for carrying out this test vary but have relied upon generally the risk factors and the presence of heavy or repeated glycosuria.
In the early stages of the pregnancy diabetic control may be complicated by nausea and vomiting. However as the fetus does gradually grow the mothers need for carbohydrates increases and ketosis is induced more without difficulty, especially in the later stages of the pregnancy. Diabetics who rely upon their diet to control their diet may become insulin dependent. Blood sugar must be maintained at a sustainable level in order to avoid intensifying the effects of the diabetes.
The result of unrestrained diabetes on the fetus is moderately due to disturbed maternal metabolism. Severe maternal ketosis can cause intrauterine death and sometimes maternal death and therefore demands urgent hospitalization is suspected. The fetus blood glucose is similar to that of its mother and it is generally considered that congenital abnormality is caused by fetal hyperglycemia during the first trimester of pregnancy. No particular congenital abnormality is typical but the rare combination of sacral agenesis and neurological defects is most often seen in babies of diabetic mothers. Neural tube defects are twice as common amongst babies of diabetic mothers and defects in the kidney and heart are also seen.
Glycosylated Hb releases oxygen poorly to the fetus and this may lead to intrauterine growth retardation. A compensatory fetal polycythaemia develops and will result in neonatal jaundice when the excess red cells are broken down. This is worsened by relative immaturity of liver enzymes in these babies. Babies of mothers with poorly controlled diabetes may be large (macrosomic) rather than small. The fetus responds to the extra glucose by producing more insulin which can increase its body fat and muscle mass. Birth weight and body length are both greater and kidneys and adrenal cortex are larger. The head circumference and brain size are however normal.
Pregnancy can worsen pre-existing complications of diabetes, particularly retinopathy. It is therefore, advisable for women with diabetes to have a retinal examination before they become pregnant. Inevitably, some women will become pregnant without having had the opportunity to optimize their health, and some pregnancies are not planned. Women with type 2 diabetes who are contemplating pregnancy should stop taking their oral hypoglycaemic medication. This medication is teratogenic (a substance that interferes with normal pre-natal development, causing one or more fetal abnormalities) in early pregnancy it is not recommended. Women with high blood pressure who are taking ACE inhibitors should discontinue taking them, as they are also detrimental in pregnancy