Hello, I am Shefali Karkhanis, I am a practising diabetes specialist in Thane, Mumbai. Today I am going to talk about a different topic call gestational diabetes. What is gestational diabetes, diabetes which is diagnosed first during the pregnancy, it is called as gestational Diabetes. This can occur all throughout the 9 months of pregnancy it does not mean that it will last forever, in 90% of the patients after the delivery of the child, diabetes also disappears. However, there are few patients who will continue to have diabetes even after delivery of the child. Why does it occur, of course, its an interplay of hormones the pregnant womb is like a firecracker it's an atom bomb of hormones. So there are a lot of hormones which are released in the mother's body during the pregnancy, this increases the need for insulin from the weather and when this demand is not meant that is when you develop gestational diabetes, 90% of the times after the delivery these pregnancy hormones come back to normal and so does your diabetes. If it continues, well you develop diabetes for life. Who are at risk of diabetes during pregnancy, the patients who have a family history of diabetes, patients for more than 25 years of age, patients who have a history of having developed diabetes during the previous pregnancies, patients who have delivered a child who was more than 3.5 kg in worth weight, patients who have had a history of miscarriage or spontaneous abortion in the past, patients who have had a history of PCOS or Polycystic ovarian disease , a patient who has obesity and it is overweight before pregnancy, patients who have had a history of hypertension or blood pressure before pregnancy, patients who have had acanthosis that means blackish discolouration beneath your neck line as well as beneath your armpit which are signs insulin resistance, patients who have had delivered a child with malformations or with some kind of abnormalities. All of these patients are at high risk of developing diabetes so are they the only people who should be scream, no. Every pregnant lady must undergo a screening for diagnosis of diabetes at the time when you diagnose with pregnancy, so the day you come to know the good news about having been pregnant you must test for diabetes to make sure that your pregnancy is healthy all throughout. It's a very easy test, you have to the obestatin at the time of the first visit, will give you a glucose load and one hour later that is a blood sample which is connected, this is called as, spot test for diabetes. Now if this is positive then you have to undergo a little elaborate test called oral glucose tolerance test, wherein you go on fasting stomach they collect the blood sample another glucose load is given and periodically samples are collected. Anyone of the sugars if they are high you is diagnosed with gestational diabetes and you will meet treatment immediately.
There is another test which is called Hba1c, HbA1c will give you an average of last 2-3 months and if it is positive then again you are diabetic. During the pregnancy you will have to have immediate treatment and we'll have to continue treatment probably throughout the pregnancy HbA1c is a very important factor because the higher the HbAa1c the more is a risk to develop complications as well as a child to develop problems, so the higher the HbAa1c levels that means the patient probably has diabetes even before the onset of pregnancy and it was just not diagnosed at that time. So uncontrol hyperglycemia is associated with a higher rate of miscarriages a higher complication in mother and higher from congenital anomalies in the baby. Early diagnosis is very very important and so is the control of blood sugars all throughout the pregnancy you know that there are only 9 months that you got the foetus, so every day is extremely important for the child as well as for you, so control sugars every single day is essential that cannot be any cheat days during the pregnancy and diabetic control. The effects on the baby are many, the most commonly will see that the baby is a big baby that is the birth weight is almost more than 3.5 kgs, sometimes a liquor i.e. the fluid inside the womb is also very very high, there can be hard defects, there can be spinal defects, most commonly find up Bifida. There can be brain defects in the child sometimes these babies are of very low weight, so that can be one of the things. The respiratory system, the lungs are not very well developed in this children so it might have to be put on ventilators after delivery. There might be a chance of kidney malformation in the child. So all of these things are very very important, similarly to the mother also in the mother they can we increase chances of infection whether it is unary infection, whether it is vaginal infections there can be repeated spontaneous miscarriages or abortions, they can have blood pressure during the pregnancy just because they are not controlled with diabetes, they can have vascular complications. These patients have a higher risk of going into preterm labour that means delivering before the 9 months are completed. They are more prone to placental bleeding or bleeding through the vagina during the pregnancy and of course preeclampsia and eclampsia that means fits or seizures during the pregnancy. Treatment of diabetes in pregnancy is very simple and it has to be maintained, the goal for treatment is a lot lower than the normal person so we attend to target the fasting values at around 95 and the postprandial or after food values at around 120. The diet forms a very important part of the treatment of diabetes, the calorie restriction is not so much because now you are eating for 2 people so you have to have a nutritionally balanced to meet. So we do not restrict the calories but we restrict the calories from carbohydrates, simple sugars and sweets are absolute no no you cannot have any form of sweet all throughout the pregnancy, if you are a diabetic, diet has to be well planned and well balanced. So you are nutritional compromises should not happen it is ideal that you need a dietician before you start with this kind of a diet. Exercise again if you are permitted by the obstetrician only and only when exercise is recommended.
I generally recommend patients simple walking half an hour or two times a day or yoga under the guidance of experts, but again this has to be done only and only if your obstetrician agrees to that fact. Coming to the medications oral hypoglycemic agents and not being safe for use during pregnancy. Except from metformin which can be used in the earlier half, insulin is the drug of choice for pregnancy. The sound of insulin gets everyone scared, there will be 100 other people who will come and tell you that this means that you are in the last stage of diabetes or this means you'll be addicted to the insurance etc-etc-etc. this is not the case. Insulin is very safe to be given and diabetes because it not only promote healing but it also is very good for control of sugars only thing is it is an injectable. So, yes you have to inject yourself once a day, maybe twice a day, maybe three times a day depending upon how is your sugar levels Vary, always remember that the requirement of insulin will increase as a pregnancy growth. So as your child is becoming bigger you are hormones are waiting Haywire and your insulin levels also will keep on increasing, so there is nothing wrong with that. You have to realize that 90% of the time after delivery, when the sugar comes back to normal, the dosage of insulin also stops. Even if your sugars do continue after delivery the requirement of insulin will come down drastically, so it will not be the same amount of insulin that you will be required as you required during your pregnancy. If you do continue to have diabetes this advisable to continue insulin, till the time that you are breastfeeding the child because again, it is safe for both you as well as a child. However, once the child is big enough is being off the milk, you can go back to having oral medication, so definitely insulin does not detect, so you can be get assured about that all the complications of the child, as well as the mother, can be easily avoided just by early diagnosis and by correct treatment of your diabetes, also your pregnancy and that is whatever be patient should aim at. A regular follow up is a must with your diabetologist as well as your obstetrician because just because you do not feel it, does not mean that it isn’t there. So don't wait for symptoms to appear because, by the time the symptoms appear in you, it might be too late for both you as well as your child, so take care of your pregnancy right now,
Thank You. If you have any other queries you can contact me at Lybrateread more
A trusted and noted diabetologist in Thane, Dr. Shefali Karkhanis has been highly competent in her work for the last 16 years. She has pursued her M.B.B.S. from K.J. Somaiya Medical College and Hospital, Mumbai and her Post-Doctoral Fellowship in Diabetes in Madras Diabetes Research Foundation. She also holds a diploma in diabetology from Annamalai University. The doctor had been awarded a gold medal for Fellowship in Diabetes at Dr.V.Mohan's M V Diabetes Centre. Apart from this, she has several papers and accreditations to her name.
At present, Dr. Karkhanis practices in Varun Polyclinic, Thane. Previously, she was the director at Karkhanis Super Specialty Hospital. Her services include diabetes management, diabetic ulcer treatment, hypertension treatment, diabetic retinopathy, diet counselling, diabetic eye care and pregnancy, hypothyroid, blood glucose monitoring, neuropathy assessment, glucose profile, foot care, diabetic kidney care, etc. The renowned Dr. Shefali Karkhanis has memberships with Research Society for the Study of Diabetes in India (RSSDI) and Indian Medical Association (IMA).
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Rajeev Kumar Dutta
Dr. Shefali Karkhanis provides answers that are well-reasoned, caring, professional and very helpful. She is very knowledgeable, explains things with proper reasoning why the lab results are are high , informs patient about risk associated with disease which very few doctors do and answers any query after listening and bit jokingly to ease the patient's tension. The best thing i felt , she gives a prescription of her medicine that is seldom found in online
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I found the answers provided by the Dr. Shefali Karkhanis to be very helpful, knowledgeable, prompt and helped me improve my health. The revised medication is helping me to reduce the blood sugar levels which had shown an increasing trend. Thanks doctor for the help.
I found the answers provided by the Dr. Shefali Karkhanis to be very helpful, prompt, helped me improve my health, knowledgeable and professional. Reply really helped me a lot. Gave me a clear way to proceed with my confusion
Jude P. Bayer
I found the answers provided by the Dr. Shefali Karkhanis to be very helpful. Thanks dear Doctor. Yes I agree with you on Human Mixtard Insulin, as it is more hypoglycemia prone. Will stick to Novamix :-)
I found the answers provided by the Dr. Shefali Karkhanis to be very helpful. Thank you doctor for your time. I will keep it in mind. Could you please enlighten me on the controlling part. Thanks again.
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Performing physical activities on a daily basis always have its benefits, but doing exercise in a well-planned manner is essential for those people who suffer from either type-1 or type 2 diabetes. Becoming more active helps lower blood sugar levels and keep diabetes under control.
Relation between exercise and sugar levels
The food we consume contains sugars which are stored in our blood in the form of glucose. This glucose is absorbed by the muscles in our body, but body fat is the enemy of this absorption process. An obese person is prone to type-2 diabetes since excessive amounts of fat are present in the body which does not allow the muscles to absorb the glucose from the blood. This results in more glucose or sugar levels in the blood which leads to diabetes.
By regularly exercising, a person not only burns his/her excessive body fat, but also makes use of the muscles in his body thus allowing the muscles to absorb the glucose present in the blood readily. This helps reduce the sugar level in the blood. Moreover, doing exercise on a regular basis helps increase insulin sensitivity. It helps cells to use available insulin in taking up glucose during and after physical activity.
Understanding blood glucose reaction
The duration for which you perform physical activities will determine your blood glucose level. Physical activity has its effect on your blood glucose level and can keep it in check for up to 24 hours by increasing your body’s insulin sensitivity. Every individual needs to monitor how his body responds to physical exercise by regularly monitoring the blood sugar level before and after exercise or as advised by the doctor.
Once you are familiar with the results you achieve with respect to duration and types of exercises you perform you shall be able to control your blood sugar levels more effectively and prevent your sugar levels from going either too high or too low.
Hypoglycemia and physical activity
People who have diabetes should be prepared to treat hypoglycemia or low blood sugar level. Hypoglycemia is more common in people with type-1 diabetes, and people with type-2 diabetes are at lesser risk unless they are on insulin. Individuals who experience Hypoglycemia during or after exercise should consult a doctor immediately.
If you choose to resume your exercise routine, make sure you take a break and treat your low blood sugar level. Once your sugar level gets normal, you can begin your physical activity. What you need to know is that a drop, in sugar level, can occur just after exercise or even long after exercise.
Chances of a drop, in sugar level, occur in those diabetic people who either take insulin, skip meals, or exercise for too long or too hard. If you are finding it hard to keep your sugar level in check, consult a doctor immediately and follow his advice diligently.
In order to avoid hypoglycaemia, you can eat a fruit or nuts before exercise. It is also very important to hydrate yourself during the exercise. Ideally, take a fruit half hour before exercising. Keep yourself hydrated during the workout. Avoid energy drinks. In case you have a concern or query you can always consult an expert & get answers to your questions!
Diabetic patients should have a meticulous focus on the kind of food they consume. While too much food can shoot up the blood sugar level, too less food can bring down the blood sugar level. It is necessary to maintain a fine balance. It is also very critical to refrain from certain food items which can give a blow back to diabetes.
Here is a list of 8 such food items to stay away from:
- Candy: Candies contain a high amount of sugar and largely contribute to weight gain and increase in blood sugar. Instead of consuming candies, it makes sense to satisfy the sweet tooth with food items such as berries, fruit salad etc.
- Pastries and cakes: Pastries and cakes are loaded with white flour, sugar, and sodium. They not, only interfere with the proper functioning of insulin in the body but can shoot up blood sugar level in a very short span of time.
- White bread: White bread acts just like sugar. Once the body digests it, the refined starch in the white bread interferes with insulin and disturbs diabetes control. A better option to white bread is a whole bread English muffin.
- French fries: A favorite to many, this can wreak havoc to the blood sugar level of a person suffering from diabetes. It contains tons of oil, carb, and starch. It raises the cholesterol level and invites other diseases as well.
- Syrup and pancakes: It is one of the worst choices in a breakfast. It has loads of white flour and carbs. The butter inside the pancakes makes it worse. Not only does it interfere with the insulin in the body, it majorly disturbs the diabetes control regime.
- Raisins: While raisins may not be as harmful as other food items, it still has a detrimental effect on the body. Owing to its concentrated sugar content, it can raise the blood sugar level.
- Fruit juice: Strange as it may sound, fruit juice, even if they are hundred percent pure is as good as a sugar syrup. It can sharply increase the blood sugar level and be a major roadblock to diabetes control.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Is it true that till profit of diabetic medicines is more there will be no cure for diabetes. Because I do not think it is so tough to find the cure as there are so good technology that can help to get it. I think the cure of diabetes depends on profit of medical industry. I hope I am wrong and the cure of diabetes will be found quick as diabetes became a epidemic in world especially in India. Its cure must be found as it is spreading to quickly. Thank you.
Hi, my sugar test report 95 mg|dl for ref. Range 70-110 after break fast 130 mg|dl ref. Range 90-160. These ref ranges are correct? How can we know pre diabetic? Ref. Ranges Lastly I am diabetic or pre diabetic or free of diabetic.
I am 31 years old male. Recently I got some blood tests done and results were shocking. It shows I am having high TG 530, high cholesterol 230 TSH 11. Blood sugar 215 (fasting) Kindly suggest.
Hypertension is commonly witnessed among patients suffering from type 2 diabetes as compared to those who do not have diabetes. Studies have revealed that arterial hypertension among patients suffering from type 2 diabetes is in the vicinity of 40-50 percent. What’s more, a patient suffering from hypertension and diabetes has an increased risk factor for certain other diseases such as left ventricular hypertrophy, dyslipidemia, elevated fibrinogen and hyperuricemia.
The measurement practice:
It is important to measure blood pressure in a person who is suffering from type 2 diabetes with or without hypertension and renal diseases. Blood pressure measurement should be repeated within a month, if the measurement is 150/190 mm Hg. BP should be measured within a couple, of months if BP is greater than 140/80 mm of Hg.
If a person is consistently suffering from type 2 diabetes and has a BP range of 140/80, the following life style practices should be maintained always:
- A daily exercise schedule: Hypertension coupled with diabetes can be a dangerous combination. To ensure that a person remains healthy it is imperative to maintain a daily exercise schedule for at least half an hour. Exercise consumes extra calories and helps a person maintain a steady blood-sugar level.
- Food habits: Food habit is yet another important criterion to maintain good health for a person suffering from diabetic hypertension. Avoiding starch, glucose, and food with high carbs should be a mandate. Refraining from processed food with a high density of condensed fat, sugar and oil will go a long way in maintaining good health. Consulting a nutritionist is the best way to go.
- Stress is yet another factor that drives diabetic hypertension: A person suffering from regular stress has a greater tendency to fall prey to cardiovascular and renal diseases. The only way to stay away from stress is to ensure that good lifestyle choice are made. A stress -free life can pay rich dividends to a person suffering from diabetic hypertension.
A doctor’s first line of treatment hovers around ACE inhibitors. A pregnant woman suffering from diabetic hypertension is typically prescribed a calcium blocker. This is an antihypertensive drug that helps to stabilize the pregnancy and keep complications at bay. For a person who is resisting to ACE Inhibitor, a doctor might subscribe angiotensin 2 receptor. If the BP is not reduced after the first line of treatment, a doctor adds a thiazide-related diuretic along with the ACE inhibitor to expedite the treatment process.
Even after a triple therapy if a person continues to suffer from high blood pressure, a doctor might prescribe an alpha-blocker, potassium blocker or a beta blocker.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Diabetic neuropathy is a nerve disorder caused by diabetes. The high blood sugar from diabetes affects the nerves and over time increases a person's risk for nerve damage. Keeping blood sugar levels within the target range recommended by your doctor helps prevent diabetic neuropathy.
Types of Diabetic Neuropathy-
Diabetic neuropathy can be classified as Peripheral, Autonomic, Proximal, or Focal. Each affects different parts of the body in various ways...
Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, and hands.
Autonomic neuropathy affects the nerves that control involuntary body functions such as digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.
Proximal neuropathy causes pain in the thighs, hips, arms, or buttocks and leads to weakness in the legs and hands, resulting in difficulty in walking, standing, picking up objects, buttoning your clothes, etc.
Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.
How Diabetes Causes Damage to the Nervous System?
There are several factors that are likely to contribute to nerve damage through diabetes...
- high blood glucose, a condition associated with diabetes, causes chemical changes in nerves. These changes impair the nerves' ability to transmit signals.
- high glucose levels affect many metabolic pathways in the nerves, leading to an accumulation of a sugar called sorbitol and depletion of a substance called myoinositol. These changes are the mechanism that causes nerve damage. Nitric oxide dilates blood vessels. In a person with diabetes, low levels of nitric oxide may lead to constriction of blood vessels supplying the nerve, contributing to nerve damage.
- presence of mechanical injury like carpal tunnel syndrome in a diabetic patient worsens its symptoms and prognosis
- inherited traits increase susceptibility to nerve disease
- lifestyle factors, such as smoking or alcohol use
- Numbness, burning sensations, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
- Either hypersensitivity to touch or insensitivity, even to hot and cold temperatures
- Weakness in muscles and loss of reflexes
- Indigestion, nausea, or vomiting
- Diarrhea or constipation
- Dizziness or faintness due to a drop in blood pressure after standing or sitting up
- Problems with urination
- Changes in gait and balance
- Injuries that are taking longer to heal and are more prone to infections
Prevent Diabetic Nerve Damage-
Keeping your blood sugar levels in your target range, set with your doctor, may help prevent nerve damage from ever developing. The best way to do this is by checking your blood sugar and adjusting your treatment. It is also important to get to and stay at a healthy weight by exercising and eating healthy foods. In case you have a concern or query you can always consult an expert & get answers to your questions!
Is diabetes curable permanently with medicines. Medicine ,once diabetes is controlled, can be stopped?
Diabetes is a complex group of diseases with a variety of causes. People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia.
Diabetes is a disorder of metabolism, the way the body uses digested food for energy. The digestive tract breaks down carbohydrates, sugars and starches found in many foods, into glucose, a form of sugar that enters the bloodstream. Diabetes develops when the body doesn't make enough insulin or is not able to use insulin effectively, or both.
The two main types of diabetes are:
Type 1 Diabetes: Type 1 diabetes typically occurs in children and young adults, though it can appear at any age. In the past, type 1 diabetes was called juvenile diabetes or insulin-dependent diabetes mellitus.
Heredity plays an important part in determining who is likely to develop type 1 diabetes. Genes are passed down from biological parent to child.
Type 2 Diabetes: Type 2 diabetes develops most often in middle-aged and older people who are also overweight or obese. The disease, once rare in youth, is becoming more common in overweight and obese children and adolescents. Type 2 diabetes is caused by a combination of factors, including insulin resistance, a condition in which the body's muscle, fat, and liver cells do not use insulin effectively.
Physical Inactivity, Obesity, and Diabetes: Physical inactivity and obesity are strongly associated with the development of type 2 diabetes. People who are genetically susceptible to type 2 diabetes are more vulnerable when these risk factors are present. About 80 percent of people with type 2 diabetes are overweight or obese.
An imbalance between caloric intake and physical activity can lead to obesity, which causes insulin resistance and is common in people with type 2 diabetes. Central obesity, in which a person has excess abdominal fat, is a major risk factor not only for insulin resistance and type 2 diabetes but also for heart and blood vessel disease, also called cardiovascular diseases (CVD). This excess belly fat produces hormones and other substances that can cause harmful, chronic effects in the body such as damage to blood vessels.
So, measuring your waist is a quick way of assessing your diabetes risk. This is a measure of abdominal obesity, which is a particularly high-risk form of obesity. Women have a higher risk of developing type 2 diabetes if their waist measures 80cm (31.5 inches) or more. Asian men with a waist size of 89cm (35 inches) or more have a higher risk, as do white or black men with a waist size of 94cm (37 inches) or more.
Simple Steps to Lower Your Risk: Making a few lifestyle changes can dramatically lower the chances of developing type 2 diabetes. The same changes can also lower the chances of developing heart disease and other life taking cancers.
- Control Your Weight: Being overweight increases the chances of developing type 2 diabetes seven-fold. Being obese makes you 20 to 40 times more likely to develop diabetes than someone with a healthy weight. Losing weight can help if your weight is above the healthy-weight range. Check your BMI. Losing 7 to 10 percent of your current weight can cut your chances of developing type 2 diabetes in half.
- Get Moving and Turn Off the Television: Inactivity promotes type 2 diabetes. Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose. This puts less stress on your insulin-making cells.
- Tune Up Your Diet: Four dietary changes can have a big impact on the risk of type 2 diabetes-
Choose whole grains and wholegrain products over highly processed carbohydrates.
- Skip the sugary drinks, and choose water, coffee, or tea instead.
- Choose good fats instead of bad fats.
- Limit red meat and avoid processed meat; choose nuts, whole grains, poultry, or fish instead.
All of us must take a walk everyday or atleast do half hour of exercise everyday and adopt healthy eating habits. Along with that relieve your stress and take proper doses of insulin or medications as prescribed by your doctor. In case you have a concern or query you can always consult an expert & get answers to your questions!