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Management of Diabetes Mellitus in Pregnancy

Management of Diabetes Mellitus in Pregnancy
In this blog we are going to discuss diabetes mellitus, and its dietary management during pregnancy and after delivery. As we all know, diabetes mellitus is a syndrome characterized by a raised concentration of glucose in the blood due to a deficiency or the diminished effectiveness of insulin.
Most cases of pregnancy-complicating diabetes occur in women who are already diabetic at the start of their pregnancies. On the other handsome women develop diabetes during pregnancy and they are called gestational diabetics. Of these some remain diabetic after pregnancy while others revert to normal. There are, however, women who are not obviously diabetic but whose carbo hydrate metabolism is not completely normal They are said to have impaired glucose tolerance. This group requires close observation, though usually no treatment is required. If a diabetic woman wishes to have a child there is no reason why she should not provide she suffers from none of the more serious complications and is under close medical care.

The general management of pregnant women with diabetes mellitus

The care of diabetic, pregnant women includes attention to their diets and insulin therapy.

Diet

The diet of a pregnant diabetic woman requires no more modification than that of a healthy, pregnant, non-diabetic woman. That it should be well balanced is, of course, essential. It should supply her essential nutritional needs and maintain her optimal weight gain without contributing to vascular sclerosis. An increase in her metabolic rate is necessary in order to provide sufficient energy for the growth and development of her baby during pregnancy: this is called 'the added work of pregnancy. She should expect to gain about 9-11 kg. and 35-40 kcal per kg ideal body weight will generally provide this gain. About 60% of total calories should be derived from carbohydrates and the remainder from proteins and fats. Approximately 1.5 g protein per kg ideal body weight is optimal, while fats should be largely polyunsaturated vegetable oils.

Insulin therapy

During the first half of a pregnancy, a diabetic woman may have a reduced need for insulin, as maternal glucose is transferred to the foetus and nausea and vomiting may lead to a reduced food intake. However, a woman's need for insulin increases during the second half of a pregnancy and by the time of delivery may he double the normal requirement. Initially a pregnant diabetic should he managed by gradually increasing her doses of insulin without changing its type or the schedule she followed before she became pregnant.
Pregnant diabetics should be taught how to check their urine sugar and about the administration of insulin. Their blood sugar should be monitored regularly, and this is even more important than checking their urine sugar.
An expectant mother should spend a week as an ambulant in-door patient towards the end of the third month of her pregnancy. This enables her and the doctors and dietitian to get to know each other so that her diabetes can be brought under the best possible control.

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