Gestational diabetes is high blood sugar occurs in the second and third trimester of pregnancy and resolves at birth. 

Gestational diabetes occurs in approximately 9.2 percent of pregnancies in America.

Gestational Diabetes Risk Factors

Researchers are yet unable to understand why some women develop gestational diabetes and others not. However, we know there are some risk factors as underlined below that make it more likely. Although having a high BMI is a risk factor for gestational diabetes, slim women can also get it.

1. History of diabetes - the first-degree relatives; parent, brother, or sister is having diabetes.
2. Have pre-diabetes; high glucose levels yet not high enough to diagnose diabetes.
3. Have hypertension and or dyslipidemia.
4. Thirty-five years of age or older – our body organs start losing their normal functioning, including the pancreas. Thus, aging makes it challenging to support increasing insulin requirement and the risk of gestational diabetes.
5. Overweight and or obese; body mass index (BMI) + 25 kg/m2 or during pregnancy weight gain of 10 kg in the first trimester.
6. Has PCOs (polycystic ovarian syndrome)
7. During previous pregnancy have had gestational diabetes.
8. Previous recurrent abortion (>3 in previous pregnancies);
9. History of preterm delivery (<37 gestational week) or cesarean section.
10. In the previous delivery, gave birth a baby weighing more than 9 pounds (4000 grams).

You have one or more of the above said gestational diabetes risk factors, then you are more likely to have gestational diabetes. 

If you have many of the gestation diabetes risk factors, then you need to be professionally monitored. So that modifiable risk factors can be reduced or even eliminate.

Routine screening for gestational diabetes involves an oral glucose test; it consists of drinking a sugary drink contains 50 to 75 g of glucose. This test measures how your body metabolizes this sweet drink.

Gestational diabetes causes

Almost all women have some degree of impaired glucose intolerance during pregnancy due to hormonal changes that occur during pregnancy. That means their blood glucose is higher than usual, but not high enough to have diabetes. During the later part of pregnancy, these hormonal changes place a pregnant woman at risk for gestational diabetes.

The elevated blood glucose level in gestational diabetes is caused by hormones released by the placenta during pregnancy.

The placenta produces a hormone that is similar to growth hormone (it helps the baby grow) that modifies the metabolism and how she processes carbohydrates and lipids. It raises maternal blood glucose level and reduces insulin sensitivity (less able to utilize insulin properly). Thus the baby can get the nutrients it needs from the extra glucose in the blood.

At 15 weeks of pregnancy, human placental growth hormone also raises maternal blood glucose level. 

Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and convert into energy. Glucose builds up in the blood to high levels, called hyperglycemia.

Almost 80% of urinary tract infections (UTIs) in adults are causing by Escherichia coli (E. coli). An e.coli bacterium is normally present in the colon.

Urinary tract infection causes

Normally, urine is sterile and usually free of bacteria, viruses, and fungi. However, it does contain fluids, salts, and waste products.

An infection occurs when microorganisms, usually bacteria from the digestive tract, enters into the opening of the urethra and begins to multiply.

• Almost 80% of urinary tract infections (UTIs) in adults are causing by Escherichia coli (E. coli). An e.coli bacterium is normally present in the colon and may pass into the urethral opening from the skin around the anus and genitals. Women are more susceptible to UTI because their urethral opening is nearer to the anus and their urethra is shorter, so bacteria easily get in to the bladder.
• Other bacteria that may cause urinary tract infections include; Staphylococcus saprophyticus (5 to 15% of cases), Chlamydia trachomatis, and Mycoplasma hominis. Chlamydia trachomatis or mycoplasma hominis can transmit to their partner during sexual intercourse, causing UTI.
• Sexual intercourse may trigger UTI in some women, for unknown reasons.
• Urinary catheterization (i.e., to drain urine from the bladder by inserting a small tube through the urethra) can also induce UTI by introducing bacteria into the urinary tract.
• In infants, bacteria from soiled diapers can enter the urethra and cause UTI.
• E. coli may also enter the urethral opening when young girls do not wipe from the front to back after a bowel movement.

The overall prevalence of gestational diabetes was 13.2%. The prevalence increased with age, from 8% to 26% in women aged 45 or older.

Therefore, it is necessary to diagnose; early diagnosis is always good for both mother and baby.

What is Gestational diabetes?

GDM is characterized as any degree of glucose intolerance onset first during pregnancy’.

Pregnant women who never had diabetes before but develop high blood glucose levels during pregnancy is diagnosed as having gestational diabetes.

Out of every 100 pregnant women in the United States, 3 to 8 get gestational diabetes.

Therefore, it is necessary to diagnose; early diagnosis is always good for both mother and baby.

Diabetes onset age is declining and the childbearing age is increasing, so it is not uncommon for women to have undiagnosed diabetes while pregnant. Thus it is important that all pregnant women should be tested both early in the pregnancy (to rule out diabetes), also later in the 2nd and 3rd trimesters (to detect GDM).

In studies, the cumulative incidence of diabetes ranged from 2.6% to over 70% that examined women 6 weeks postpartum to 28 years postpartum.

Worldwide one in 10 pregnancies is associated with diabetes, out of which 90% is gestational diabetes. Undiagnosed or improperly treated gestational diabetes can lead to maternal & fetal complications. Additionally, women with gestational diabetes and their child’s are at increased risk of developing type 2 diabetes later in life.

Maternal risks of gestational diabetes are an infection, prolonged labor, obstructed labor, cesarean section, uterine atony, postpartum hemorrhage, polyhydramnios, pre-eclampsia, and progression of retinopathy.

Fetal risks of gestational diabetes are spontaneous abortion, intrauterine death, stillbirth, congenital malformation, shoulder dystocia, birth injuries, neonatal hypoglycemia, and infant respiratory distress syndrome. 

Women with gestational diabetes and their children are at increased risk for type 2 diabetes and metabolic abnormalities in the future.

Women with a history of gestational diabetes and their children are at high risk for developing diabetes. Children exposed to maternal diabetes are at higher risk for obesity and diabetes compared to their unexposed to maternal diabetes siblings.

Hormone Insulin is necessary for effective conversion of glucose into energy, if the right amount of insulin is not secreted by their-own, then needs insulin therapy.

Insulin therapy help tips

Each Insulin type works at a different pace, and most people have to use more than one kind to mimic their actual bodies system.Insulin types available: Rapid-acting insulin, Short-acting insulin, Intermediate-acting insulin, Long-acting insulin and Very long-acting insulin.

Insulin analog commonly available is a vast range. Mostly, you need to use more than one kind to suit your individual requirement. Consult your doctor or diabetes educator and choose a best one individualized to you need.Depend upon individual body condition, lifestyle, food habits, and physical activity, design their insulin regimen for efficient blood-glucose control. Consult with your doctor for your insulin requirement as per your need.

A Good insulin care starts with how properly the insulin is stored. Insulin does not work to its level when it is stored for too long or is exposing to extreme temperatures both high and very low. So learn the correct procedure and follow it for better blood-glucose control.

Nowadays there are more choices for the ways to take insulin (Insulin injecting products), even the choices make us confusing to choose the opt one. Consult your diabetes educator and discuss which one is best suits you.Start your Insulin treatment by following procedure designed as per user’s experience and manufacturer’s suggestions for better diabetic care.

Keep an eye on any sign’s indication either high or low glucose levels. You should know about hyperglycemia (very high blood-glucose – at or over 180 mg/dl), hypoglycemia (low blood-glucose – lower than 70 mg/dl).Learn how to measure glucose levels and do it regularly using your home glucose meter, which enables you to control your insulin dose. If ill or have any unwanted symptoms, then increase the frequency of glucose level check.

Try to follow your diet as careful as possible. Have your food in time and maintain a same volume every day.Try to follow particular time for your insulin therapy and the same dose volume or vary with respect to the requirement.Learn how to give you insulin injections, inspect insulin appearance, check the insulin date, avoid refrigerated insulin it may be painful, rotate the injecting site, avoid injecting site close to mole or scars.Always carry glucose with you to treat hypoglycemia (low blood-glucose). Once you noted symptoms of hypoglycemia, immediately chick blood-glucose if it is lower than 70 mg/dl have the glucose rich food to bring back to normal.See your doctor regularly to carry out check-ups on your eyes, kidneys and feet, and check for any late-stage diabetes signs.

Useful information regarding Insulin injection

• Insulin is injecting into the fatty tissue known as the subcutaneous layer and not into muscle or blood directly.
• You should inject into the deep subcutaneous tissue at a 45-degree angle or at a 90-degree angle when the subcutaneous layer is greater than the needle length.
• Insulin absorption varies depending on the body area it has injected. Insulin is most rapidly absorbed when injected into the abdomen, followed by the upper arm and thigh area.
• Make sure you are rotating the injection site; if you always use the same spot can make the skin tough and uneven. So make sure you rotate the insulin injection sites for easy insulin absorption as well as for low pain injection.

Massage Injection site

Do you massage your injection site? A Review published in Diabetes Spectrum October 2001 vol. 14 no. 4 218-224. The study shows massage at injection sites may increase insulin absorption. In addition, other uncontrolled studies suggest that massage may have a positive effect on blood-glucose levels and symptoms of diabetic neuropathy.

Massaging injection sites after insulin injection can help to reduce irritation in the injection site. It is recommendable to massage the injection site immediately after injection.

You should massage the site gently for two or more minutes. It helps to disperse the insulin as well as absorption effectively and reduce irritation.

Stop bruising during insulin therapy

Bruising is a common occurrence among people on insulin therapy. Certain area of your body has tinier blood vessels, injecting this area tend to bruises easily. If you experience this avoid that area for future injections. To reduce bruising, you have to apply pressure for few seconds to minutes at the injection site after the syringe has removed. An insulin pen user can use 5 mm pen needle to minimize bruising.

Amylin mimetic - Pramlintide (brand Symlin) is a synthetic amylin hormone, secreted by the pancreas along with insulin help to normalize blood-glucose levels.

Synthetic Amylin

Synthetic Amylin (Pramlintide) injections are usually taken with meals; it shows modest improvement in A1C levels without causing weight gain and even promotes moderate weight loss.

Important for synthetic amylin users

Amylin Pramlintide should not combine in the same vial or syringe with insulin and must inject separately. Amylin Pramlintide can be used for people who use insulin (suitable both for type 1 and type 2 diabetes) and not able to achieve their target A1C level. Taking Amylin mimetic may change the amount of insulin you take.

Pramlintide (amylin mimetic) helps keep your blood-glucose from going too high after you eat a common problem in people with diabetes. It works by helping food move more slowly through your stomach. Amylin mimetic helps keep your liver from putting stored glucose into your blood. It also may prevent hunger, helping you eat less and may be helpful in losing weight.

Pramlintide (amylin mimetic) - who should avoid?

Talk with your doctor about whether you should take this type of medicine if you are

• having low blood-glucose, a condition called hypoglycemia unawareness,
• have recently had been severe low blood-glucose,
• have stomach problems caused by diabetes-related nerve damage,
• pregnant or planning to get, or breast-feeding,
• Symlin is not studied for use in children.

There may be times when you should not take your usual dose of Amylin mimetic. If you are having surgery, or you are sick and cannot eat, you should not take your Amylin mimetic.

Nowadays, there are more choices to take insulin (Insulin injecting products), even the choices make us confusing to choose the best.

Different ways to take Insulin

What are the modes of administration of insulin? At present, you cannot take insulin orally like other medications, because your digestive system will break down insulin (a protein) before absorption. Researchers are going on for an oral insulin medication, hope for an earlier outcome that helps stop puncturing your skin.

Usually diabetes injects insulin into their subcutaneously by a syringe, insulin pen, auto-injector, or insulin pump. Patients who like to avoid repeated skin punctures prefer to use an injection port in conjunction with syringes.

• Taking insulin shots by syringes, it has a needle attached to a hollow tube filled with insulin, and it is press or injects into the skin by a plunger. This is the oldest and cheapest insulin injecting system.
• An insulin pen is a pen-like device with a needle and a cartridge of insulin. It is convenient and accurate insulin injecting system than syringes.
• An insulin infuser uses a small tube, which need to insert just beneath the skin and remains in place for several days. Insulin is injected into the end of the tube instead of through the skin. So that we can avoid piercing the skin, many times.
• Jet injectors are useful to deliver the dose of insulin, but they do it without using a needle to make a tiny hole. Jet injectors are useful to deliver trans-dermally. Jet injector uses micro jet (needle-less injection) to deliver insulin into your body. Jet of insulin is forces through the skin with pressure.
• Insulin auto injector has a special design for those who have difficulty injecting themselves; it automatically inserts the needle and injects the contents.
• An insulin pump is a small device, worn on a belt or in a pocket, which holds insulin. The pump connects to a needle through a plastic tube. The needle is inserts under the skin and stays in for several days. Pump automatically drips insulin through the needle under the skin.

Insulin treatment strategy

If you are a diabetes type 1, then you require a base level of insulin called basal insulin to cover a daylong insulin requirement and insulin to cover meals called bolus insulin. Managing the basal and bolus insulin is a continuous process for effective blood-glucose control in type 1 diabetes patients.

Long acting insulin is useful for your basal insulin requirement and short-acting insulin is for your bolus insulin requirement.

Depend upon individual body condition, lifestyle, food habits, and physical activity their insulin regimen or insulin shots or diabetes shots are designed for efficient blood-glucose control.

Individualized Insulin regimen

Consult your doctor or health care team, to design an insulin regimen that will suit your needs and better blood-glucose control. It helps you feel good, physically and mentally.

The regimen design depends on

• Your body condition,
• The food you eat,
• Your normal physical activity,
• How your body responding to treatment

Insulin regimen type 1 diabetes

A person diagnosed with type 1 diabetes usually begins with two insulin shots per day of two dissimilar types of insulin. Slowly, they may progress to three or four insulin shots per day of different insulin types. The types of insulin used to depend on their blood-glucose levels. Studies have shown that three or four diabetes shots of insulin a day give the best diabetes control and can prevent or delay the eye, kidney, and nerve damage caused by diabetes.

Insulin regimen type 2 diabetes

Most of the type 2 diabetes patients need one insulin shot per day without diabetes pills. Some may need both one insulin shot and diabetes pill in the bedtime. Sometimes diabetes pills will not lower blood-glucose for type 2 diabetes, and they need to take two insulin shots per day of two different types of insulin. It may progress to three or four injections of insulin per day in a due course.