Blood Glucose

A new book from the American Diabetes Association is aimed at anyone planning to start or grow a family.

Diabetes & Pregnancy touches on many aspects of healthy pregnancy with diabetes, from controlling blood glucose levels before conception to post-birth care for both mothers and babies. Editor David A. Sacks, MD, an obstetrician-gynecologist, says the book came together after he worked on a clinical book for obstetricians and other medical professionals who deal with pregnancy and diabetes. “[I thought] if we could boil this down into lay language, we could get across a lot of the messages I’ve always wished that my patients had when they walked in the door,” Sacks says. The result is the ADA’S first pregnancy book to cover type 1, type 2, and gestational diabetes all in one volume.
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The term dieting refers to restrictive eating or nutritional remedies for conditions such as iron-deficiency anemia , gastrointestinal diseases, pernicious anemia, diabetes , obesity , or failure to thrive. Someone can be on a heart-healthy diet that encourages the consumption of reasonable amounts of whole grains and fresh fruits, vegetables, beans, and fish, but limits foods high in saturated fat and sodium, or one can be on a weight loss diet. Examples of weight loss diets include: the Atkins New Diet Revolution, the Calories Don’t Count Diet, the Protein Power Diet, the Carbohydrate Addict’s Diet, and Weight Watchers. There is a lack of research, however, on whether these diets (except for Weight Watchers) are helpful, especially over the long term (defined as two to five years from the date of weight loss).
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What is essential hypertension?

Blood pressure is the force of blood against artery walls as the heart pumps blood through the body. Hypertension is the term for blood pressure that keeps being higher than normal. Hypertension is called essential or primary when no cause for the high blood pressure can be found. (When the cause of hypertension is known, such as kidney disease and tumors, it is called secondary hypertension.) About 95% of all people with high blood pressure have essential hypertension.
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DEFINITION

Detoxification diets, or detox diets for short, are a group of short-term diets intended to release accumulated toxins and waste products from the body. They are based on a theory of digestion and elimination usually associated with naturopathy, an alternative medical system that emphasizes the role of nutrition in restoring or improving the body’s own self-healing properties.
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Q: What are the popular fad diets clients will most likely try in 2012?

A: One of the most common New Year’s resolutions is to lose weight. Clients will turn to the trendiest diets their friends or the media promote. As a dietitian, it’s important to familiarize yourself with the pros and cons of each so you can provide sound clinical advice to your clients. Here’s an overview of the top four:
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Definition

The Atkins diet is named for Robert C. Atkins, M.D., the diet’s founder. It is based on restrictions of carbohydrates and focuses on eating mostly protein and fat, along with use of vitamin and mineral supplements.
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Definition

The anti-aging diet is one that restricts calorie intake by 30-50% of normal or recommended intake with the goal of increasing human lifespan by at least 30%. People on the diet also have improved health providing they consume adequate vitamins, minerals, and other essential nutrients.
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Pregnancy planning

If diabetic pregnancy is to be managed appropriately, the woman needs to plan her pregnancy so that she can optimize her diabetes control before and during conception, organogenesis and fetal development. Appropriate contraceptive advice is an essential part of this (Box 12.4). Because of the vascular risk of diabetes itself, the ideal medical contraception would be a progestogen-only preparation such as the ’mini-pill’ or depot injections, or slow-release progestogen implants. However, the mini-pill becomes signifi-candy less effective if not taken regularly at 24-h intervals and so is often not appropriate for young women with hectic lifestyles. Some women are reluctant to use the depot preparations which cannot be stopped at will. All can be associated with weight gain and initially erratic vaginal bleeding, although this commonly settles into prolonged amenorrhoea. Depo-Provera, unlike the mini-pill, suppresses oestrogen levels and the patient’s oestradiol level should be checked after 5 years’ use. If the level is less than 100, a 6-month course of oestrogen replacement therapy is thought to be beneficial to reduce the risk.
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Risks of maternal diabetes to the baby

The major problems of maternal diabetes to the baby are as follows.
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Breast-feeding

Breast-feeding should be encouraged as with any mother and baby. It is usual to use insulin rather than sulphonylureas in Type 2 diabetes to control hyper-glycaemia during breast-feeding to avoid any risk of contamination of the breast milk. Breast-feeding has a similar effect to exercise and great care should be taken to avoid hypoglycaemia, particularly overnight. Many women choose to run their blood glucose slightly high post-partum to reduce this risk. Manufacturers of newer ACE inhibitors suggest avoiding their use during lactation but the penetration of the drugs into breast milk is low and enalapril or captopril can be restarted if needed to control microalbuminuria or blood pressure. The continued use of alpha methyldopa is possible but has been associated with depression.
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Early delivery and the use of dexamethasone

If an obstetric decision is made that the baby is likely to be delivered prematurely (up to 34 weeks), the babies of diabetic mothers should not be denied the benefits of dexamethsone to mature the fetal lungs. We admit diabetic women for dexamethasone treatment, because of the acute and sometimes severe loss of glucose control that ensues. It lasts about 48 h. We use the usual calculation to establish a sliding scale for intravenous insulin, adjusting the dose of insulin infused on the basis of hourly blood glucose monitoring but, as the woman is still eating normally, we do not use intravenous glucose. We add, to the full sliding scale dose, the woman’s usual pre-meal subcutaneous insulin boluses. This avoids exposing the baby to the postprandial rise in blood glucose after a meal, before the intravenous insulin is adjusted to compensate, and means the woman gets 50-150% extra insulin in the 24-h period.
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