Treatment of diabetes mellitus in pregnancy

 


Current treatment for type one diabetes is an automated insulin delivery system. This system includes a continuous glucose monitor, insulin pump, and a computer algorithm that continually adjusts insulin responding to the continuous glucose monitoring signal.

Pretensions of treatment are:

Fasting blood glucose situations at< 95 mg/ dL.(<5.3 mmol/ L)

2- Hour postprandial situations at ≤ 120 mg/ dL.(≤6.6 mmol/ L)

No wide blood glucose oscillations

Glycosylated haemoglobin (HbA1c) situations at<6.5

Insulin is the traditional medicine of choice because it cannot cross the placenta and provides more predictable glucose control; it's used for types 1 and 2 diabetes and for some women with gravid diabetes. Mortal insulin is used if possible because it minimizes antibody conformation. Insulin antibodies cross the placenta, but their effect on the fetus is unknown. In some women with long- standing type 1 diabetes, hypoglycemia doesn't spark the normal release of counterregulatory hormones (catecholamines, glucagon, cortisol, and growth hormone); therefore, too important insulin can spark hypoglycemic coma without monitory symptoms. All pregnant women with type 1 should have glucagon accoutrements and be instructed (as should family members) in giving glucagon if severe hypoglycemia (indicated by unconsciousness, confusion, or blood glucose situations< 40 mg/ dL (<2.2 mmol/ L)) occurs.

Oral hypoglycemic medicines are being decreasingly used to manage diabetes in pregnant women because of the ease of administration (capsules compared to injections), low cost, and single diurnal dosing. Several studies have shown that glyburide is safe during gestation and that it provides control original to that of insulin for women with gravid diabetes. For women with type 2 diabetes before gestation, data for use of oral medicines during gestation are spare; insulin is most frequently preferred. Oral hypoglycemics taken during gestation may be continued postpartum during breastfeeding, but the child should be nearly covered for signs of hypoglycemia.

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