Diabetes gestational

Histoiy of gestational diabetes (diabetes that develops during pregnancy but disappears when pregnancy is over)... 

Distinguish clinical differences in type 1, type 2, and gestational diabetes mellitus. 

History of gestational diabetes or delivery of a baby weighing greater than 9 pounds (4.09 kg)... 

TABLE 40-4. Diagnosis of Gestational Diabetes with a 100 or 75 g Glucose Load8... 

Mastitis. Characterized by localized redness, tenderness, and warmth on one breast accompanied by fever and flulike symptoms. Although uncommon, symptoms also may be bilateral. Nipple candidiasis. Typical symptoms include nipple pain, itching, burning, and/or breast pain that persist after feeding. Gestational diabetes. See Chapter 40. 

Uncommon causes of diabetes (1% to 2% of cases) include endocrine disorders (e.g., acromegaly, Cushing s syndrome), gestational diabetes mellitus (GDM), diseases of the exocrine pancreas (e.g., pancreatitis), and medications (e.g., glucocorticoids, pentamidine, niacin, and a-interferon). 

Family history of thromboembolism History of gestational diabetes... 

Screening for gestational diabetes mellitus utilizes the oral glucose challenge test. Groups at high risk are African Americans, Native Americans, Asian Americans, Latino Americans, and Pacific Islanders. 

Goals for self-monitoring of blood glucose are the same as for gestational diabetes. 

Concern has been expressed over the use of SGAs in pregnancy because of the risk for weight gain and potential risk for gestational diabetes. 

Gestational diabetes Pregnancy Usually transitory but many women have an increased long-term risk of diabetes. 

Highly purified (single component) and human Insulins Local insulin allergy, immunologic insulin resistance, injection-site lipodystrophy temporary insulin use (ie, surgery, acute stress type 2 diabetes, gestational diabetes) newly diagnosed diabetic patients. 

Diabetes mellitus is defined as an elevated blood glucose associated with absent or inadequate pancreatic insulin secretion, with or without concurrent impairment of insulin action. The disease states underlying the diagnosis of diabetes mellitus are now classified into four categories type 1, insulin-dependent diabetes) type 2, non-insulin-dependentdiabetes) type 3, other, and type 4, gestational diabetes mellitus (Expert Committee, 2003). 

Thiazolidinediones have benefit in the prevention of type 2 diabetes. The Diabetes Prevention Trial reported a 75% reduction in diabetes incidence rate when troglitazone was administered to patients with prediabetes. Another study reported that troglitazone therapy significantly decreased the recurrence of diabetes mellitus in high-risk Hispanic women with a history of gestational diabetes. 

Despite its considerable involvement in metabolic processes, no specific deficiency syndrome in humans has been attributed to vitamin B6 (19,103). A considerable number of nonvitamin functions have been suggested, but they remain controversial (102,103,108-111). These include roles in coronary heart disease, immune response, premenstrual syndrome, sickle-cell anaemia, asthma, autism, gestational diabetes, carpal tunnel syndrome, and cancer. 

Fisher JE, Smith RS, Lagrandeur R, Lorenz RP. Gestational diabetes mellitus in women receiving beta-adrenergics and corticosteroids for threatened preterm delivery. Obstet Gynecol 1997 90(6) 880-3. 

In six women with gestational diabetes, acarbose 50 mg before meals normalized fasting and postprandial glucose concentrations (67). The pregnancies were uneventful and the neonates were healthy. Internal discomfort persisted during the whole pregnancy. 

A 54-year-old woman with gestational diabetes was later found to be allergic to chromium, pollen, dust, penicillin, acarbose, and metformin (130). She was treated with diet and glibenclamide, but later required insulin. With Humulin N insulin she developed a wheal of 15 mm immediately after the injection, which resolved in a few hours. However, a painful itchy induration appeared 2-3 hours after the injection and lasted a few days. She had an immediate reaction to isophane insulin, with induration, but insulin lispro was well-tolerated. 

Simmons D, Thompson CF, Conroy C, Scott DJ. Use of insulin pumps in pregnancies complicated by type 2 diabetes and gestational diabetes in a multiethnic community. Diabetes Care 2001 24(12) 2078-82. 

Jovanovic L, Ilic S, Pettitt DJ, Hugo K, Gutierrez M, Bowsher RR, Bastyr EJ 3rd. Metabolic and immunologic effects of insulin lispro in gestational diabetes. Diabetes Care 1999 22(9) 1422-7. 

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