Defeat Diabetes Diabetes Mellitus is a metabolic disorder characterized by the decreased ability or complete

inability of the tissues to utilize carbohydrates, accompanied by changes in the metabolism of fat, protein, water and electrolytes. The disorder is due to a deficiency or diminished effectiveness of the hormone insulin.

There are two common types of diabetes mellitus: Insulin dependent diabetes mellitus (IDDM) or type I: It usually occurs before the age of 40 years. The disease usually has an abrupt onset and the abnormality of carbohydrate metabolism is severe due to lack of endogenous insulin to control blood glucose levels. These diabetics require high doses of insulin. Non-Insulin dependent Diabetes Mellitus (NIDDM) or Type II: This type usually occurs in middle life or beyond the age of 40 years, although it may also occur in the younger age group. The patients are most often obese. The onset is gradual and there is some amount though limited, of endogenous insulin.

General instruction for patients suffering from diabetes;

1. Keep strictly to your diet if any change is required then consult the dietician
2. 3. 4. 5. 6. 7. 8.

If you do not feel well or if you are in difficulty about your medicine, consult the doctor. If you are gaining or losing weight, inform your doctor Test your urine regularly and get your blood examined once a month Walk at least a mile daily. Keep your skin clean and feet dry. Avoid wearing tight shoes and socks. Consult your doctor on any skin problems. If you have any injury or you are going for an operation, declare to your doctor that you are a diabetic. If any other problem worrying you, see the social worker / counselor.

Instructions to patients taking Insulin

I. II. III.

Do not alter the dose of Insulin without consulting the doctor. Do not allow more than an hour to elapse between a injection of Insulin and your food. If you get a cold, sore throat or feverish illness, do not stop taking Insulin. Take plenty of milky food instead of solids, if it is difficult to swallow.

Norms for sugar level of Urine and blood Urine - Blue reduction with benedict solution Blood - Fasting and two hours after meal below 120 mg per 100 ml

Prohibited Foods Glucose, sugar , honey and all sweets, jaggery, ice-cream, pastries, cake, jam, jelly, squash, canned fruit juice, sugarcane juice, chocolates, bourn vita, all aerated waters except soda. Foods to avoid Potatoes, Yam (zimikand), Arbi, Mangoes, Grapes, Cheeku and Bananas, Dried food stuffs, Dried fruits and Nuts e.g. peanuts, almonds, cashew nuts, raising and coconut etc., all alcoholic drinks. Foods to be used freely Green leafy vegetables, tomatoes, cucumber, radish, lime, clear soups, black coffee without milk and sugar, butter milk (lassie), sour chatnis and pickles without oil, pepper and zeera water, jamun fruit and karela juice. Foods that help diabetics bring down sugar levels

Diabetics should fill up on leafy vegetables, bitter gourd (karela), papaya, oranges, lentils and legumes with strings and skin intact, whole grain cereals, bran, pulses, sprouted mung, and 10 to 20 grams of guar gum (from cluster beans)

Diabetes in Pregnancy
Diabetes mellitus (DM) can occur during pregnancy in 2 forms: pregestational and gestational diabetes. Pregestational diabetes is defined as Type I or Type II DM that existed before conception. Gestational diabetes (GDM) is defined as glucose intolerance that is first detected during the pregnancy and is associated with a probable resolution after the end of the pregnancy.[1] Despite the defining feature of glucose intolerance, pregestational diabetes and GDM and are very different entities. Pregestational diabetes represents very high-risk obstetrics. Poor glucose control before conception and during organogenesis places the fetus at high risk of congenital malformations, especially cardiac and neural tube defects. [2] Women with pregestational diabetes have a higher risk of diabetic ketoacidosis and require careful and frequent monitoring to manage their complex insulin needs. Intensive fetal monitoring to identify and anticipate complications is also necessary.[3-5]Extensive experience and training are required to feel comfortable managing the care of women with pregestational diabetes. By contrast, if good glucose control can be achieved with diet (and insulin, if necessary), GDM confers a much lower risk for both the mother and fetus. The remainder of this article focuses on the woman with GDM. Etiology of Gestational Diabetes Pregnancy is a diabetogenic state. The hormones that lead to fetal growth and development do so by mobilizing the woman's nutritional resources, primarily glucose, and making them available to the fetus. Figure 1 illustrates the plasma levels of the critical anabolic hormones present during pregnancy. All increase dramatically in the last 20 weeks of gestation. Human placental lactogen plays a pivotal role in triggering the changes that can lead to glucose intolerance. It has strong anti-insulin and lipolytic effects. Peripheral insulin sensitivity during the third trimester decreases to 50% of that seen in the first trimester, and basal hepatic glucose output is 30% higher despite higher insulin levels.[6]

Figure 1. Changes in plasma levels of hormones of pregnancy during normal gestation.HCG = human chorionic gonadotropin; HCS (HPL) = human placental lactogen. Reprinted with permission from Freinkel.[61]

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This combination of increased mobilization of glucose, along with decreased sensitivity to insulin, places women at risk of developing diabetes during pregnancy; however, not all women do. There is evidence that women who develop GDM secrete less insulin in response to a glucose load than women who do not develop the disease.[7-9]Unfortunately, the reasons for this (and potential ways to prevent it) are not well understood.

Demographics of Gestational Diabetes Approximately 4% of all pregnant women develop GDM, making it about 100 times more common than pregestational diabetes.[10] Certain subgroups of women are at much higher risk. At particularly high risk are the Pima Indians of Arizona, whose risk (approximately 40%) is 10-fold higher than that of the general population.[11]Other groups at increased risk are African Americans, obese women, women of advanced maternal age, those with a prior history of GDM or family history of DM, and women who have had previous large for gestational age (LGA) babies.[12,13] (The latter group possibly represents women in whom GDM was missed or who had minimally abnormal glucose tolerance tests). Nahum and Huffaker[14] examined the effects of race on prevalence of GDM and found that African American women have a 1.5-fold higher rate of GDM than white women and a 2-fold higher risk than Filipino women ( Table 1 ). Other groups of women have a much lower risk of GDM. Teens have a relative risk approximately one fourth that of women aged 35 and older (OR 1.0 vs 4.2).[10] The relative risks of different ethnic groups have yet to be completely defined in teens. Nahum and Huffaker found a lower risk in Asian/Asian American and Filipino women; however, their results are inconsistent with those of other studies, and results by race/ethnicity must take into account diet and length of residence in the United States.