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Gestational Diabetes

Definition:
Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during their third trimester). Gestational diabetes is caused when insulin receptors do not function properly. This is likely due to pregnancy-related factors such as the presence of human placental lactogen that interferes with susceptible insulin receptors. This in turn causes inappropriately elevated blood sugar levels.

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Gestational diabetes generally has few symptoms and it is most commonly diagnosed by screening during pregnancy. Diagnostic tests detect inappropriately high levels of glucose in blood samples. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied.

As with diabetes mellitus in pregnancy in general, babies born to mothers with untreated gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, and jaundice. If untreated, it can also cause seizures or stillbirth. Gestational diabetes is a treatable condition and women who have adequate control of glucose levels can effectively decrease these risks. The food plan is often the first recommended target for strategic management of GDM.

Clasifications:
There are two subtypes of gestational diabetes:
Type A1: abnormal oral glucose tolerance test (OGTT), but normal blood glucose levels during fasting and two hours after meals; diet modification is sufficient to control glucose levels

Type A2: abnormal OGTT compounded by abnormal glucose levels during fasting and/or after meals; additional therapy with insulin or other medications is required

Approximately 7% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed.

Symptoms:
Because gestational diabetes does not cause much symptoms, the patient need to be tested for the condition. This is usually done between the 24th and 28th weeks of pregnancy. It is surprised if your test shows a high blood sugar level and is important for the patient to be tested for gestational diabetes, because high blood sugar can cause problems for both the pregnent woman and the baby.Sometimes, a pregnant woman has been living with diabetes without knowing it. If she has the  symptoms of diabetes  and that may include:

*Increased thirst.
*Increased urination.
*Increased hunger.
*Blurred vision.

Pregnancy causes most women to urinate more often and to feel more hungry, so having these symptoms doesn’t always mean that a woman has diabetes.Doctor should be consulted wheather  these symptoms are for diabetes  and then he can suggest for the test of diabetes.

*Infections:
Since diabetes interferes with the body’s ability to fight infections, the pregnant woman may experience frequent infections in areas such as the bladder, vagina and skin. White blood cells defend the body against bacteria, but these cells aren’t able to function normally when a person has a high blood sugar. A woman with gestational diabetes may also complain of a yeast infection in the vagina or on the skin. Yeast cells are normally present in the vaginal area in small amounts. The vaginal secretions and urine contain more glucose when a woman has gestational diabetes. The yeast cells use the glucose as food, which causes the cells to multiply. With the body’s immune system compromised by the high level of glucose in the blood, this increase in yeast cells turns into a yeast infection.

*High Blood Sugar:
Since a woman may not have any noticeable symptoms of gestational diabetes and symptoms can mimic regular pregnancy symptoms, screening for this condition is part of prenatal care for at-risk women between weeks 24 and 28 of pregnancy. The doctor will initially order a blood test called a glucose challenge test. If the glucose challenge test indicates a high blood sugar level, the doctor may order a glucose tolerance test to confirm the diagnosis of gestational diabetes. Both tests involve drinking a sweet glucose solution and having your blood drawn after a prescribed amount of time.

Causes:
Almost all women have some degree of impaired glucose intolerance as a result of hormonal changes that occur during pregnancy. That means that their blood sugar may be higher than normal, but not high enough to have diabetes. During the later part of pregnancy (the third trimester), these hormonal changes place pregnant woman at risk for gestational diabetes.

During pregnancy, increased levels of certain hormones made in the placenta (the organ that connects the baby by the umbilical cord to the uterus) help shift nutrients from the mother to the developing fetus. Other hormones are produced by the placenta to help prevent the mother from developing low blood sugar.

They work by resisting the actions of insulin.
Over the course of the pregnancy, these hormones lead to progressive impaired glucose intolerance (higher blood sugar levels). To try to decrease blood sugar levels, the body makes more insulin to get glucose into cells to be used for energy.
Usually, the mother’s pancreas is able to produce more insulin (about three times the normal amount) to overcome the effect of the pregnancy hormones on blood sugar levels. If, however, the pancreas cannot produce enough insulin, blood sugar levels will rise, resulting in gestational diabetes.

Risk factors:
Any woman can develop gestational diabetes, but some women are at greater risk. Risk factors for gestational diabetes include:

*Age greater than 25. Women older than age 25 are more likely to develop gestational diabetes.
*Family or personal health history. the risk of developing gestational diabetes increases if the woman has prediabetes — slightly elevated blood sugar that may be a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes.the woman is also more likely to develop gestational diabetes if she had it during a previous pregnancy, if the woman delivered a baby who weighed more than 9 pounds (4.1 kilograms), or if she had an unexplained stillbirth.
*Excess weight. You’re more likely to develop gestational diabetes if you’re significantly overweight with a body mass index (BMI) of 30 or higher.
*Race factor. For reasons that aren’t clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

Complications:
Most women who have gestational diabetes deliver healthy babies. However, gestational diabetes that’s not carefully managed can lead to uncontrolled blood

sugar levels and cause problems for patient and the baby, including an increased likelihood of needing a C-section to deliver.

Complications that may affect the baby are:
1.Excessive birth weight. Extra glucose in your bloodstream crosses the placenta, which triggers your baby’s pancreas to make extra insulin. This can cause the baby to grow too large (macrosomia). Very large babies — those that weigh 9 pounds or more — are more likely to become wedged in the birth canal, sustain birth injuries or require a C-section birth.

2.Early (preterm) birth and respiratory distress syndrome. A mother’s high blood sugar may increase her risk of early labor and delivering her baby before its due date. Or her doctor may recommend early delivery because the baby is large.

3.Babies born early may experience respiratory distress syndrome — a condition that makes breathing difficult. Babies with this syndrome may need help breathing until their lungs mature and become stronger. Babies of mothers with gestational diabetes may experience respiratory distress syndrome even if they’re not born early.

4.Low blood sugar (hypoglycemia). Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Severe episodes of hypoglycemia may provoke seizures in the baby. Prompt feedings and sometimes an intravenous glucose solution can return the baby’s blood sugar level to normal.

5.Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
Untreated gestational diabetes can result in a baby’s death either before or shortly after birth.

Complications that may affect the patient are:
1.High blood pressure and preeclampsia. Gestational diabetes raises your risk of high blood pressure, as well as, preeclampsia — a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both mother and baby.

2.Future diabetes. If the pregnent woman has gestational diabetes, she is more likely to get it again during a future pregnancy and also more likely to develop type 2 diabetes as she gets older. However, making healthy lifestyle choices such as eating healthy foods and exercising can help reduce the risk of future type 2 diabetes.Of those women with a history of gestational diabetes who reach their ideal body weight after delivery, fewer than 1 in 4 eventually develops type 2 diabetes.

Diagnosis:
Gestational diabetes usually starts halfway through the pregnancy. All pregnant women should receive an oral glucose tolerance test between the 24th and 28th week of pregnancy to screen for the condition. Women who have risk factors for gestational diabetes may have this test earlier in the pregnancy.

Once the pregnent woman is diagnosed with gestational diabetes, she can see how well she is doing by testing the glucose level at home. The most common way involves pricking her finger and putting a drop of the blood on a machine that will give her the glucose reading.

Treatment:
The goals of treatment are to keep blood sugar (glucose) levels within normal limits during the pregnancy, and to make sure that the growing baby is healthy.

Watching the baby:
1.The health care provider should closely check both the patient  and the baby throughout the pregnancy. Fetal monitoring will check the size and health of the fetus.

2.A nonstress test is a very simple, painless test for the patient and the baby.

3.A machine that hears and displays the baby’s heartbeat (electronic fetal monitor) is placed on the abdomen.
The health care provider can compare the pattern of the baby’s heartbeat to movements and find out whether the baby  is doing well.

Diet and exercise:
The best way to improve the pregnent woman’s diet is by eating a variety of healthy foods.She should learn how to read food labels, and check them when making food decisions.The doctor or dietitian  should advice the diet chart and that should be strictly followed  during pregnancy.

In general, when the pregnent woman has gestational diabetes the diet should:
*Be moderate in fat and protein.

#Provide  carbohydrates through foods that include fruits, vegetables, and complex carbohydrates (such as bread, cereal, pasta, and rice)
Be low in foods that contain a lot of sugar, such as soft drinks, fruit juices, and pastries.

#If managing the diet does not control blood sugar (glucose) levels, she may be prescribed diabetes medicine by mouth or insulin therapy.
Most women who develop gestational diabetes will not need diabetes medicines or insulin, but some will.

Prevention:
Theoretically, smoking cessation may decrease the risk of gestational diabetes among smokers.Physical exercise has not been found to have a significant effect of primary prevention of gestational diabetes in randomized controlled trials. It may be effective as tertiary prevention for women who have already developed the condition.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Gestational_diabetes
http://www.webmd.com/diabetes/guide/gestational-diabetes-symptoms
http://www.ehow.com/list_6080912_signs-symptoms-gestational-diabetes.html
http://www.webmd.com/diabetes/guide/gestational_diabetes
http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/risk-factors/CON-20014854
http://www.nytimes.com/health/guides/disease/gestational-diabetes/overview.html

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Toolkit Helps Parents Recognize a Child’s Risk of Obesity

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Some simple interventions used by pediatricians were enough to change a parent’s perspective about a child’s being overweight or obese, and change the parent’s behaviors at home to reduce those risks.
..
Researchers confirmed previous reports that parents of overweight or obese children do not recognize their child’s weight problem. But this time, by arming pediatricians with a “toolkit,” an easily used chart and a series of questions and suggestions, the researchers addressed several problems.

“Doctors often don’t have time to discuss overweight; they don’t have the tools to do it; and many aren’t confident that they’re going to make a difference in their patients’ lives,” said Eliana Perrin, lead author of the study.

“Also, parents don’t recognize weight problems or don’t know how to make things better, and even if they do, there are often barriers to healthier eating or more activity for these families,” says Perrin.

As First Lady Michelle Obama‘s “Let’s Move!” campaign aims to reduce childhood obesity – almost one-third of young people are overweight – two leading questions are how to affect that change and if it can be successful.

Perrin’s study is likely the first evidence that a parent’s assessment of their child’s weight can be changed. Her study also showed improved dietary behaviors in children and reduced time playing video games or watching television, called “screen time.”

“We found something we can do to help stem the obesity epidemic,” says Perrin, whose previous research in childhood obesity has shown that using a body mass index, or BMI, chart color-coded like a traffic light helps parents understand the often confounding measurement.

Perrin’s research group trained pediatric resident physicians on how to use the color-coded BMI chart and a revision of a questionnaire called “Starting the Conversation,” originally designed by Alice Ammerman, a co-author on the study. The STC gives health care providers a snapshot of potential red flags to help counsel patients as well as tips to implement change.

Parents were asked about their children’s weight status and discussions about weight in the doctor’s office. The Starting the Conversation form used in this study was revised by Perrin and asked parents about non-healthy eating habits – frequency of sugary snacks, sugar-sweetened beverages and eating out at restaurants, as well as activity and screen time. It also asked about the parent’s readiness to change. The pediatrics residents were instructed to show parents their children’s weight status in a color-coded BMI chart and were taught to use the parents’ responses to the questionnaire to engage the parents in discussions about healthier eating behaviors and activities.

Researchers enrolled 115 children ages 4 to 12 who were covered by Medicaid or the State Health Insurance Program and repeated the Starting the Conversation questionnaire as well as questions about weight status at one-month and three-month follow-up appointments.

The study showed the most significant improvement in dietary changes among children who were overweight. At follow up, they were more likely than healthy-weight children to drink lower-fat milk and showed the largest reduction in the frequency of eating out. But overall, children improved fruit and vegetable consumption, decreased sweetened beverages and unhealthy snacks, drank lower-fat milk more and reduced screen time.

In the initial visit, all of the parents of healthy-weight children accurately perceived their child’s weight. However, only 57 percent of overweight children’s parents did so at baseline. That improved significantly to 74 percent at three month follow up.

BMI was measured and tracked and a few children became more overweight, while more reached healthier weights but no significant improvements in weight status were noted in this short study, Perrin says. “The research has to be replicated and expanded, and it must determine if improvements in parental perception of children’s weight motivates families to improve behavior and, ultimately, leads to healthier weight over time,” she says.

“Everyone’s talking about BMI and we have a lot of studies to show that parents do not see their overweight children as overweight. That often does not sink in with parents,” Perrin says. “This is the first time we’ve seen a changed perspective from parents. We hope that parents who know their children are overweight will be empowered to help them achieve healthier lifestyles that can last a lifetime.”

Source: Elements4Health

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Older People More Fit Than Yonger

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The average 50-year-old is now healthier and fitter than someone half their age, a study revealed .
Researchers found the average 25-year-old consumes over 2,300 calories a day, exercises only three times a week and indulges in 12 portions of junk food a month.

But the typical 50-year-old has only 1,990 calories each day, does at least four forms of exercise and treats themselves to just one piece of junk food each week.

And while those in their mid-20s treat themselves to three takeaways a month, the older generation have only one.

The study, commissioned by global nutrition and direct selling company Herbalife, quizzed 4,000 Brits on their diet and lifestyle.

Neil Spiers, Herbalife’s Regional Vice President, said: ‘The results of the study will be surprising to most as it’s natural to think that the younger you are, the fitter you are.

‘It seems many young people are making the mistake of underestimating the benefit of a more balanced, holistic approach to diet and lifestyle.

‘It’s great to think that the older generation are showing the youngsters the way when it comes to healthier living.’
The nationwide research of 16-80 year olds surveyed them about their health and exercise habits.

It found the over-50s are more likely to walk as much as they can during the day – to the shops or with the dog – while those in their 20s tend to drive everywhere.

When it comes to excuses for not exercising, over a third (36 per cent) of 25 year olds blame not having enough time, compared to 22 per cent of over-50s.

The research found 70 per cent of Brits see themselves as healthy – exercising for 27 minutes a day, at least three times a week, opting to go for a walk, run, cycle or gym.

A quarter of Brits polled cycle to see friends or go to the shops, and 70 per cent take the stairs instead of the lift.

Nearly four in 10 walk to the train station or to work in a bid to keep fit.

The study also found the average Brit believes they are overweight by nine pounds.

Over a quarter of the population are currently on a diet – with the ‘low fat‘ (30 per cent), ‘low carb‘ (14 per cent) and ‘detox’ (eight per cent) diets being the most popular.

And they would wish to lose 13 pounds for them to be their ideal weight.

The study also highlighted the lengths people will go to in order to hide their true weight.

Nearly a quarter have fibbed about the amount they eat, one in five has actually lied about their weight and 12 per cent have cut labels out of clothing which revealed their real size.

A cheeky 16 per cent have turned to slimming aids without telling anyone and seven per cent have uploaded misleading pictures on Facebook.

And 30 per cent have ‘binge dieted’ to fit into a dress or to look good in a bikini in time for a holiday.
How the lifestyles compared…

………………………………………….25-year-old…………..50-year-old
Daily calorie intake ……………………….2,321 …………..1,990
Forms of exercise a week ……………………..3………………… 4
Minutes of exercise a day…………………….26……………… 30

Junk food a week………………………………… 3…………………1
Takeaways a month…………………………….. 3…………………1
Units of alcohol a week ……………………….. 6.6…………….. 5.2
Snacks a day………………………………………. 3……………….  2
Number of diets……………………………………2………………..4
Length of average diet in weeks ………………5.2……………..6.7

Source:: http://www.dailymail.co.uk/health/article-1203224/How-average-50-year-old-fitter-half-age.html#ixzz0MkLvRsRh

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Aging Is Not Inevitable

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Every day, 330 American baby boomers turn age 60. Each of them desires to live a long and fulfilling life, full of productivity and vitality, and absent of disease and disability. This quest is why thousands of people just like you are becoming interested in anti-aging medicine.

Simply put, anti-aging medicine is advanced preventive health care based on the early detection, prevention, treatment and reversal of age-related dysfunction, disorders and diseases. The goal of anti-aging medicine is not merely to prolong the total years of an individual’s life, but to ensure that those years are enjoyed in a productive and vital fashion.

Some of the “secrets” to anti-aging aren’t really secrets at all, and they don’t require drugs or surgery. For example, abundant clinical and research evidence suggests consistent physical activity plays a key role in maintaining health and vitality as we age. Exercise is one of the most valuable forms of anti-aging medicine. Substantial health benefits occur with regular physical activity that is aerobic in nature (such as 30-60 minutes of brisk walking, five or more days a week). Additional health benefits can be gained through greater amounts of physical activity, but even small amounts of activity are healthier than a sedentary lifestyle. A number of recent studies reinforce this basic concept.

Men and women age 60-plus with higher levels of cardiorespiratory fitness live longer than unfit adults, and this correlation is independent of levels of body fat. Researchers at the University of South Carolina examined the associations between cardiovascular fitness, clinical measures of body fat, and death in older adults. The researchers studied more than 2,600 adults for a 12-year period, during which there were 450 deaths. The team found that those who died were older, had lower fitness levels, and had more cardiovascular risk factors than survivors. However, there were no significant differences in body fat measures.

Across a wide variance of body-fat levels (excluding the most obese), fit study subjects were found to have lower death rates than unfit subjects. Higher levels of fitness also corresponded to lower incidence of death from all causes. In their published report, the researchers comment: “The results add to the existing evidence that promoting physical activity in older adults provides substantial health benefits, even in the oldest old.”

The size of a man’s waistline and the muscle mass of his biceps provide s snapshot of mortality risk in aging men. S. Goya Wannamethee and colleagues from the Royal Free and University College Medical School (London) studied more than 4,100 men ages 60 to 79, and found that those with a waist circumference of less than 40 inches and above-average muscle mass in their upper arms were up to 36 percent less likely to die over a six-year period compared to those with bigger waists and smaller arm muscles. The researchers also found that the combination of waist size and arm muscle mass provided a far more accurate gauge of death risk compared to body mass index (BMI) measurements, which the team found was linked to mortality only among very thin men.

According to Dr. Shripad Tuljapurkar of Stanford University, “We are on the brink of being able to extend human lifespan significantly, because we’ve got most of the technologies we need to do it.” Dr. Tuljapurkar estimates that between 2010 and 2030, the average age of death will increase 20 years if anti-aging therapies come into widespread use. This would increase the average lifespan in industrialized countries from approximately 80 years to 100 years. Remember to check with your doctor before beginning any exercise program.

Sources: http://www.toyourhealth.com/mpacms/tyh/article.php?id=1017

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Health Problems & Solutions

Few Health Questions and Answers

 

Q: Regarding weaning food. Many varieties are available in the market. What do you recommend I start with?

Weaning can begin with simple preparations like powdered rice cooked in water and milk with a little sugar .

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A: Weaning should not be started till at least the 120th day. The World Health Organization (WHO) recommends breastfeeding exclusively for six months. Homemade preparations are superior to the packaged, ready-to-eat premixes available in the market. You could begin with powdered rice cooked in water and milk with a little sugar and no salt. The consistency should be like that of breast milk. Start with one feed, gradually increasing the number after a week or so.

Careful dosage :
Q: How is the dosage of medicine for children calculated? My mother says I can give my daughter, aged seven, half a tablet of the usual adult medicines.

A: Dosage of medicine for children has to be carefully calculated based on the body weight; it is not a matter of giving one tablet to an older child and half to a smaller one!

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In case of Paracetamol, the dosage is 10-15 mg/kg/dose every 4-6 hours. For many antibiotics, it is 20 or 40 mg/kg/day while for others it is 8 mg/kg/dose. Consult a paediatrician who will weigh the child and assign the dosage appropriately. Do not self-medicate.

Unlatching baby
Q: My baby sucks so hard at my breast that I am unable to pull his mouth loose when needed. Please advise....click & see

A: Pulling yourself backwards or trying to pry the child loose will not work. Instead, insert your little finger into the corner of his mouth to reduce the suction effect. His mouth can then be pried loose.

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Master check-up
Q: I am a 50-year-old woman. I want to have a master health check-up. What tests should I ask for?

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A: You need the following tests in addition to the regular ones offered as part of the check-up

Get your weight and height measured to calculate your Body Mass Index (BMI). This should be between 25 and 27. A high BMI indicates obesity and places you at risk for diabetes, hypertension, arthritis, osteoporosis and cancer

Blood tests to screen for diabetes, cholesterol and triglycerides

A bone densitometry if you are post menopausal

A pap smear for cervical cancer

Breast evaluation by mammogram and monthly self-examination

Dental check-up

Eye check-up

The normal values are usually noted on the side. If any of your results are not in the normal range, please follow it up with the concerned consultant. If the follow-up of check-up is not done adequately, your money is wasted.

Facial hair
Q: I am a 23-year-old woman. My problem is that I have a moustache. I think it was there earlier but of late it has become very noticeable. My mother says I should leave it alone. However, I feel self-conscious. What should I do?

A: Please check with an endocrinologist/dermatologist/gynaecologist if you have other associated symptoms like menstrual irregularities or more-than-normal hair on your arms and legs. In the meanwhile, you can always go to a beauty parlour and have the hair on your upper lip removed by threading or waxing. Hair-removing creams can cause allergies. Also, please avoid shaving.

Foul odor
Q: I have terrible body odor in summer. Please help.

A: Perspiration is odourless. The smell arises due to the action of skin bacteria on the sweat. To avoid this .

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Wear cotton clothes which will allow the sweat to evaporate and not trap it inside

Bathe twice a day with Neko soap. The bacterial cell wall is destroyed by this soap

Do not apply the soap directly. Use a loofa or wash rag

Avoid talcum powder

Use a deodorant stick or spray.

Nagging cough
Q: I have diabetes and hypertension. Both are well controlled with diet and medication. I have a terrible hacking cough though. I have seen several doctors but to no avail   all they have done is take X-rays and prescribe antibiotics. I do not have fever or sputum so I don’t think I need these antibiotics.

A: Some anti-hypertensive medications cause cough. You can try adding Vitamin C 500 mg at night to your current medication. Also, you can take a cough suppressant like codeine linctus. Avoid exposure to allergens such as incense sticks, cigarette smoke and mosquito repellents (mats, coils as well as liquids). Take steam inhalation twice a day.

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Tummy trouble
Q: My stomach sticks out, making me look very ugly. Will a tummy trimmer work?

A: Spot reduction of the stomach alone is not possible unless you opt for liposuction. You need to go on a diet, exercise and reduce weight overall. In the process, you can also tone up your stomach with crunches or a trimmer.

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Answered by :Dr Gita Mathai ,paediatrician with a family practice at Vellore.India

Published in the Telegraph (Kolkata,India)

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