Complicated Gestational Diabetes: A Challenge!
Gestational diabetes is a condition caused by insulin resistance and multiple metabolic abnormalities; the prevalence of gestatinal diabetes mellitus (GDM) has been rising and has almost become parallel to obesity and type 2 diabetes. However, the mechanism and treatment points are still debatable. Hyperglycemia in pregnancy (HIP) is social instability as woman infertility is associated with it. If timely screened and achieved targeted glycemic control, it gives the desired outcome of pregnancy especially in pregestational diabetes. Support of family and thorough understanding of the disease is crucial in such situations as it requires multidisciplinary management, for example, structured self monitoring blood glucose (SMBG), diet and nutrition, multiple daily insulin injections with dose adjustment, avoiding hypoglycemia, and mental stability.
Hyperglycemia in pregnancy (HIP) as a whole (pregestational and gestational diabetes) is one of the leading causes of woman infertility, miscarriages, abortions, fetal complications and anomalies Diabetes in pregnancy is challenging task for health care professionals, as the opinion on diagnosis differ and the treatment options are limited. Main stream of treatment roam around insulin with lifestyle modification and metformin  (a dilemma for the doctors). It requires more attention and discipline than usual, as it involves two lives and more emotions attached to it.
Apart from health, women have to face social instability (e.g., lack of family support, family conflict, violence, and blaming a woman), once detected with GDM, making them feel isolated and unlucky for the family. This poor attitude leads to worsening mental health in the females who are already exposed to anxiety and depression. In addition, gestational diabetes is an economic burned to the common earning man, as the overall cost of the disease is high. In this case, in spite of investing a huge amount of money, the woman has to undergo multiple traumas. Therefore, management of such cases is crucial.
One such case is of a 34-year-old woman detected with typical symptoms of type II diabetes since 6.5 years. She was on oral hypoglycemic agents (OHAs) for a long time. Her grandfather and father had a history of type II diabetes. At the time of diagnosis, her HbA1c was 10.8% without ketosis.
She belongs to Chanasma, a rural area in Mehsana district in North Gujarat. She is well educated and working as an officer (Patwari) in the government sector. After tying a knot at the age of 23 years, she had history of multiple abortions (7 reported) culprit being hyperglycemia. In year 2017, on her 7th gestational week she was referred to Arogyam Health Care—Diabetes Clinic.
Keywordshyperglycemia in pregnancy - HIP - self-monitoring blood glucose and nutrition - social burden
Received: 01 July 2019
Accepted after revision: 10 July 2019
30 March 2020 (online)
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- 1 Livshits A, Seidman DS. Fertility issues in women with diabetes. Womens Health (Lond) 2009; 5 (06) 701-70710
- 2 Wright AD, Nicholson HO, Pollock A, Taylor KG, Betts S. Spontaneous abortion and diabetes mellitus. Postgrad Med J 1983; 59 (691) 295-298
- 3 Mills JL. Malformations in infants of diabetic mothers. Teratology 25:385-94. 1982. Birth Defects Res A Clin Mol Teratol 2010; 88 (10) 769-778
- 4 Cheung NW. The management of gestational diabetes. Vasc Health Risk Manag 2009; 5 (01) 153-164
- 5 Seshiah V, Das AK, Balaji V, Joshi SR, Parikh MN, Gupta S. For diabetes in pregnancy study group (DIPSI)+. Gestational diabetes mellitus—guidelines. J Assoc Phyisician India 2006; 54: 622-628
- 6 Walford S, Gale EA, Allison SP, Tattersall RB. Self-monitoring of blood-glucose. Improvement of diabetic control. Lancet 1978; 1 (8067) 732-735
- 7 Zhang C, Liu S, Solomon CG, Hu FB. Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care 2006; 29 (10) 2223-2230
- 8 Kayal A, Mohan V, Malanda B. et al. Women in India with Gestational Diabetes Mellitus Strategy (WINGS): methodology and development of model of care for gestational diabetes mellitus (WINGS 4). Indian J Endocrinol Metab 2016; 20 (05) 707-715