BEING ALIVE WITH DIABETES

Diabetes is not a new word and everybody is aware of the two types of diabetes I and II.

Here I wish to discuss the way of living with and after Gestational Diabetes Mellitus.

Although the cause of GDM is unknown, there are some theories as to why the condition occurs.

The placenta supplies a growing fetus with nutrients and water, and also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

Fighting with GDM is not a tough task. It is recommended to keep a diligent track of blood glucose levels, eat a well-planned diet as suggested by a nutritional expert (that should include the correct balance of proteins, fats, carbohydrates, vitamins, and minerals), and a regular routine of physical exercises, for at least 30 minutes of a day. Studies have shown that moderate exercise helps improve the body's ability to process glucose, keeping blood sugar levels in check.

If still it is difficult to control the blood glucose well enough with diet and exercise alone, it is high time to switch on the artificial insulin under strict medical supervision. About 15 percent of women with gestational diabetes need insulin. Recently, some practitioners have been prescribing oral medications instead of injections for some cases of gestational diabetes.

After successfully conquering over GDM and maintaining a normal level of glucose throughout the tenure of pregnancy, clinicians may wish to take a break after delivery. If it is presumed that no further management is required, an excellent opportunity to improve the future health status of these high-risk women may be gone.

Some women with GDM might have sustained high levels of glucose in the days after delivery that will justify medical management for diabetes and perhaps for hypertension, microalbuminuria, and dyslipidemia. Treatment should be maintained in the strict vigilance of a doctor and adjusted for the needs of lactation. Encouragement and facilitation of exclusive breastfeeding is very important because of the intense short-term as well as long-term health benefits to the infant and the reduced risks for subsequent obesity and glucose intolerance demonstrated in many breastfeeding women.

On the other hand, most women with GDM might not observe such higher glucose levels after delivery. This group should be followed for at least 6–12 weeks to determine their glucose status. Many studies have demonstrated the high risk of subsequent diabetes in this female population. The degree of this risk is best assessed by glucose tolerance testing. Randomized controlled trials have proven that several interventions (diet and planned exercise 30–60 min daily at least 5 days per week and anti-diabetic medications) can significantly delay or prevent the appearance of type II diabetes in the women with impaired glucose tolerance (IGT). The high-risk women can also be assessed for cardiovascular risk factors, with appropriate management and follow-up to reduce the risk of coronary heart disease, cardiomyopathy, and stroke.

It is therefore advised to maintain a record of blood glucose levels even after delivery, for a mother who had GDM. This is quite apparent that after the baby arrives, the whole concentration shifts from diabetes to the baby. But it should never be forgotten that to take good care of baby, the mother needs to take a good care of her first! She should follow a strict regimen that might help her to maintain the normal levels of blood glucose. Moreover, her long-term goal should be to achieve a healthy body weight, not to just lose the weight that she has gained during pregnancy.

Reaching and maintaining a healthy weight, following a diet high in fruits, grains, and vegetables, and getting at least 30 minutes of exercise every day can lower the risk for future health problems. There is some evidence that breastfeeding can lower the baby's chance of being overweight as an adult. Breastfeeding can also help to cut down on the disproportionately added weight of a mother and may lower the risk for her developing type 2 diabetes in future.

The first days, weeks, and months after gestational diabetes are a time when you are at some risk for physical and emotional problems, but they are also the time when you can start to establish the good habits that will help you stay healthy in the future. Stay connected to your medical supervisors and make sure to reach and maintain a healthy weight. Eat well and exercise regularly. You managed your gestational diabetes; now is the time to start managing your future and staying alive even with diabetes.