Drug-induced Diabetes
Many therapeutic agents can predispose to or precipitate diabetes, especially when pre-existing risk factors are present, and these may cause glucose control to deteriorate if administered to those with existing diabetes. They may act by increasing insulin resistance, by affecting the secretion of insulin, or both. For convenience, these agents may be subdivided into widely used medications that are weakly diabetogenic, and drugs used for special indications that are more strongly diabetogenic. Examples of the former include antihypertensive agents and statins, and examples of the latter include steroids, antipsychotics and a range of immunosuppressive agents. There are also a number of known beta cell poisons including the insecticide Vacor, alloxan and streptozotocin. Introduction A wide range of therapeutic agents may affect glucose tolerance, and the list of known or suspected drugs is lengthy. This entry summarizes evidence concerning the agents most frequently implicated. Widely used medications A number of drugs used to reduce cardiovascular risk also predispose to the development of diabetes. These include the thiazide diuretics, beta-blockers and statins. It should however be appreciated that these are commonly offered to individuals who are at increased risk of diabetes by virtue of risk factors such as obesity and hypertension, and that risk association does not necessarily mean causation. Thiazides: Thiazide diuretics revolutionized the treatment of hypertension in the 1960s, but were soon noted to increase the risk of diabetes[1]. Subsequent experience showed that that this risk is greatly reduced by low-dose therapy, whose benefits therefore outweigh its risks. The thiazides have a weak inhibitory effect upon release of insulin from the beta cell. This eff Continue reading >>
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Gestational Diabetes: Does One Usually Get Induced?
prolificwillybreederThu 05-May-11 08:10:03 Also marking place as won't be seen by consultant for a couple of weeks. Been left with so many questions! prolificwillybreeder, I was left with so many questions and was very confused after the diagnosis, I didn't know what to do really. ended up overreducing the carbons and had to stay in hospital to get the keytons washed out, so get as much information as you can. now I think I manage it more or less well, but there is usually such a chaos during the diabetes clinic in my hospital so I need to get prepared to my next meeting! jenga079 did you have high blood sugar or is it routine GTT, in which case you shouldn't really worry before Piffpaffpoff do you mind if I ask you how old you are? The reason I am so curious I was actually planning two babies but now I wonder if after each baby the risk of keeping the diabetes increases. I am 38 now Thought i could answer this question as i'm on number 5 but 4th diabetic pregnancy number 2 escaped it somehow.. In my hospital they generally say that if you are managing your diabetes with diet alone then you probably won't need to be induced. Obviously they will moniter the babies weight through scans every 4 weeks. If like me you are on insulin then they will moniter the babies weight and induce at either 38/39 weeks. Luckily for me i have had two induction dates set for two previous pregnancies and they both came the day earlier by themselves. I am currently 27 weeks and on corrective insulin so the likelyhood is that my induction date will be set for 38 weeks. Have a scan on monday to find out exactly how big he is already. GD normally diasppears after birth, but you are at more risk later in life if not kept in check. I had insulin controlled GD (gutted as I only weighed 9 and a hal Continue reading >>
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Gestational Diabetes Versus Unwanted Interventions
Deborah is 36 weeks pregnant and has gestational diabetes. She’s been careful about diet and exercise and has maintained very stable blood sugar levels. Her doctor, however, is warning her she’ll probably need to be induced at 39 weeks and may need a c-section. He wants her to get an early epidural so she’ll be ready for surgery, “just in case.” Deborah’s warning bells are going off because that’s not the labor she had in mind. She’s hoping for a spontaneous and un-medicated labor and worries her doctor is setting her up for interventions she doesn’t want. Gestational diabetes (GD) can have a big impact on mothers’ and babies’ health, but it doesn’t always have to be a big deal that requires all the tools in the medical toolbox. Often times, complications like GD can be managed carefully without making major diversions from the patient’s hoped-for birth plan. Deborah’s doctor told her that GD babies have to be induced at 39 weeks because sometimes they “just don’t come” until they’re two or three weeks past their due date. Deborah, that doesn’t sound quite right to me. GD babies are at somewhat higher risk to come earlier than their due date, not later. If mom’s blood sugars aren’t well controlled, babies can get too much glucose through the placenta and grow too big. That can trigger premature labor, damage the placenta and bump up risks for delivering a baby whose lungs aren’t fully developed. Premature and super-sized babies tend to have more respiratory problems and a tough time stabilizing their own blood sugars too. That doesn’t mean these problems are guaranteed to happen to you and your baby, Deborah. It means there’s a greater risk. Many GD babies are born healthy with normal weights and perfect birthdays and neve Continue reading >>
Timing Of Delivery In Women With Diabetes In Pregnancy
Timing of delivery in women with diabetes in pregnancy 1Maternal Fetal Medicine St Michaels Hospital, Toronto, Ontario, Canada 2University of Toronto, Toronto, Ontario, Canada 1Maternal Fetal Medicine St Michaels Hospital, Toronto, Ontario, Canada 2University of Toronto, Toronto, Ontario, Canada 1Maternal Fetal Medicine St Michaels Hospital, Toronto, Ontario, Canada 2University of Toronto, Toronto, Ontario, Canada Copyright The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav The incidence of both gestational and pre-gestational diabetes is increasing worldwide. The main cause of this increase is likely the concomitant increase in the incidence of global obesity, but in the case of gestational diabetes, changes in the diagnostic criteria are also a contributing factor. The adverse outcomes associated with pre-gestational diabetes are well known and have led clinicians to implement various strategies that include increased fetal surveillance and induction of labour at various gestational ages. In many cases these same strategies have been applied in clinical practice also to women with gestational diabetes despite there being differences in the type and magnitude of perinatal complications associated with this diagnosis. Despite the widespread application of these clinical practices, there is a paucity of quality data in the medical literature to guide the clinician in choosing a strategy for fetal surveillance and timing of delivery in both gestational diabetes and pre-gestational diabetes pregnancies. In the following review, we will discuss the rationale and consequences of planned delivery in gestational diabetes and pre-gestational diabetes, the evidence supporting different strategies for delivery and finally highlight future targets Continue reading >>
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Pregnancy Diabetes (gestational Diabetes)
Resistance to insulin develops in all mothers during pregnancy. In about 2 to 4 per cent of women this results in temporary diabetes. It happens because pregnant women have less ability to produce extra insulin to overcome this insulin resistance. Pregnancy diabetes is also called gestational diabetes. Pregnancy diabetes is more likely: if you have had pregnancy diabetes before if you have had multiple pregnancies (4 or more) if you're older (over 25) if you're overweight if you smoke if you're from a minority ethnic group (South Asian or African Caribbean) if there is a previous history of a large baby (more than 10lbs, or 4.5kg). What are the symptoms? In most cases, pregnancy diabetes has no external symptoms and is detected through screening. Only rarely do the classic symptoms of diabetes appear, eg excessive thirst, frequent urination and tiredness. Checking urine for glucose is a routine antenatal test, but is unreliable for diagnosing diabetes. Criteria for screening for diabetes vary from place to place, but generally, all mums-to-be should have their blood sugar level checked between 26 and 30 weeks of pregnancy. This is done by testing glucose levels in a sample of blood on two occasions. One of two tests will be used to do this: the random glucose test or the fasting glucose test. If these tests show you have raised glucose levels, you will need a more detailed test to diagnose diabetes. This is called an oral glucose tolerance test. You should also be offered a glucose tolerance test if you are at increased risk of diabetes because of family history, obesity or having had it in a previous pregnancy. How does it affect the baby? The importance of pregnancy diabetes is still the subject of some debate, but mothers with it tend to have bigger babies, more diff Continue reading >>
Drug-induced Diabetes.
Abstract The only drugs which commonly cause diabetes during therapeutic use are the anti-hypertensive vasodilator diazoxide, and corticosteroids in high doses such as those used to palliate intracranial tumours. Thiazide diuretics have in the past been used in higher doses than necessary to treat hypertension, and the lower doses now used probably carry only a slight risk of inducing diabetes. The risk from beta-blockers is also quite small, but there is some evidence that thiazides combined with beta-blockers may be more likely to cause diabetes than either drug alone. The combination is probably best avoided in patients with a family history of non-insulin-dependent diabetes. The effect of the low-oestrogen combined oral contraceptive pill seems to be slight, and it presents a risk only to women who have had gestational diabetes. Bodybuilders who take enormous doses of anabolic-androgens can develop impaired glucose tolerance. Several drugs, including theophylline, aspirin, isoniazid and nalidixic acid can cause transient hyperglycaemia in overdosage, but only streptozotocin, alloxan and the rodenticide Vacor are likely to cause permanent diabetes. Continue reading >>
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- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
- Diabetes doctors: Which specialists treat diabetes?
Gestational Diabetes And Giving Birth
The latest guidance from NICE, published in 2015, has extended the time by which women with gestational diabetes should give birth to 40 weeks, 6 days – not much less than the general guidance for all pregnant women, which is 42 weeks. If you have not gone to birth at this point, induction of labour will be recommended. "When I was in the hospital, I felt I didn’t know what was going on. I would have liked more information about that part so I could have been better prepared." Gemma, mum of one The main reason for induction is to prevent stillbirth. For all women, the risk increases when their pregnancy goes past 42 weeks. However, one study has shown that women with gestational diabetes may be at risk earlier. So for this reason, the guidance in England and Wales states that if you have gestational diabetes, you should not go beyond 40 weeks, 6 days. An induction or caesarean may also be advised if your baby is very large (macrosomia) – as this may cause difficulties during the birth. On the other hand induction may also be recommended if the team detects poor growth in your baby. In Scotland, most women with diabetes in pregnancy are induced within 40 weeks. The guidance says that this decision should be determined on an individual basis. If you are taking diabetes medication or insulin, it recommends that you should be assessed at 38 weeks and delivered by 40 weeks. Choices you might need to make for labour and birth Most women with gestational diabetes have a healthy birth. But before you make your birth plan, you may need to take some things into account to make sure you and your baby are safe during and after the birth. If you have gestational diabetes, you will have less choice about where to deliver your baby. This is because you will need to deliver your Continue reading >>
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Will I Be Induced Early With Gestational Diabetes ?
Will i be induced early with gestational diabetes ? Hi. I am currently 35+4wks. I was told at 28wks that i have gestational diabetes, it is currently being controlled through diet plan only. At my last scan i was 32wks and i was told my baby is measuring 5pounds, which from what ive read on multiple sites online is bigger then its supposed to be at that stage in pregnancy. I am wondering if they will induce me early because there is a risk of high birth weight....i am so scared of having baby at high birth weight, would really rather they induce early to prevent that from happening. Just intrested in stories of what happened to anyone who has been or is in the same situation as i am ? Thanks guys :) My baby was 10 pounds and 6 ounces at 39 weeks. She's a healthy 19 pounds at 1 year. Don't be worried. I was induced, the baby would not come and then I had a c section. It was worth it because when they measured her they thought she was smaller than she was. I had gestational diabetes that was well controlled through diet alone. My doc told me to plan on inducing at 39 weeks if I hadn't already delivered, with gd he didn't want me going past 40 weeks. With gestational diabetes it's not so much the big baby size that means inducements, it's also a risk of the placenta failing past 40 weeks. At 38 weeks my daughter was measuring 9.75 lbs and I was given options. I had read so many things about people measuring huge babies but then delivering small ones so I asked the maternal fetal medicine doc what her accuracy was. She said the scans being off are typically from quick ultrasounds at ob offices but that the mfm accuracy was +/- .5lb. So she was predicting a 10.5 lb baby for me at full term. All the women in my family (mom, cousins, aunts) have always tried for vaginal birth Continue reading >>
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Treatment
If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels. You'll also need to be more closely monitored during pregnancy and labour to check if treatment is working and to check for any problems. Checking your blood sugar level You'll be given a testing kit that you can use to check your blood sugar level. This involves using a finger-pricking device and putting a drop of blood on a testing strip. You'll be advised: how to test your blood sugar level correctly when and how often to test your blood sugar – most women with gestational diabetes are advised to test before breakfast and one hour after each meal what level you should be aiming for – this will be a measurement given in millimoles of glucose per litre of blood (mmol/l) Diabetes UK has more information about monitoring your glucose levels. Diet Making changes to your diet can help control your blood sugar level. You should be offered a referral to a dietitian, who can give you advice about your diet, and you may be given a leaflet to help you plan your meals. You may be advised to: eat regularly – usually three meals a day – and avoid skipping meals eat starchy and low glycaemic index (GI) foods that release sugar slowly – such as wholewheat pasta, brown rice, granary bread, all-bran cereals, pulses, beans, lentils, muesli and porridge eat plenty of fruit and vegetables – aim for at least five portions a day avoid sugary foods – you don't need a completely sugar-free diet, but try to swap snacks such as cakes and biscuits for healthier alternatives such as fruit, nuts and seeds avoid sugary drinks – sugar-free or diet drinks are better than sugary versions; be aware that fruit juices and smoothies contain s Continue reading >>
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Induction Birth Stories
My gestational diabetes induction birth stories Here aremy gestational diabetes induction birth stories. With gestational diabetes, many ladies may be advised to have an induction of labour. Induction may be unknown and for many ladies, a scary and daunting, unnatural process. Many ladies hear lots of horror stories surrounding induction and so I felt it was time to share my induction birth stories. We explain induction, reasons for induction, national guidelines, lots of information around different methods of induction and links to research on our induction page . My induction birth stories - Jo, Author of Gestational Diabetes UK I only know gestational diabetes, I only know induction and so I can't say whether an induction is more painful etc as it is all I know. But I will share what my personal induction birth stories and experiences have been. Twogestational diabetespregnancies with early diagnosis, despite losing 5 stone in weight, I still got diagnosed with gestational diabetes at 11 weeks in my second pregnancy. I controlled my gestational diabetesboth times with fairly high amounts of insulin, around 200 units a day. I required more fast release insulin in my first pregnancy and more slow release in my second. In my first pregnancy I struggled more with post meal readings. I was testing at 2 hours post meals and followed poor dietary advice as advised by my dietician. In my second pregnancy I had researched gestational diabetes in depth, was learning lots about the condition, had set up the Facebook support group and was testing my levels at one hour post meals, plus additionally to test snacks and for spikes. My post meal levels were very well controlled following my own dietary advice, but I chased my fasting levels throughout, having to increase my night t Continue reading >>
Pregnant Type 1 Being Induced Next Week: Can You Give Me Any Advice??
Pregnant TYPE 1 being induced next week: can you give me any advice?? Pregnant TYPE 1 being induced next week: can you give me any advice?? Well I've just come back from the doctors and he is inducing me next week. 15.01.09. My HBA1C is 6.4 and I've felt really healthy throughout the entire pregnancy. My sugars have been monitored every two days by my educator and they have been stable. Unfortunately, my ultrasound results show my baby's abdominal circumference to be at 40 weeks when I am 38 weeks and this is making the doctors decision to induce me next week. This is my first baby and I would love any advice for a successful vaginal delivery!!! If you have been induced with type 1 can you please tell me your story!!! How were your sugar levels, insulin doses, how long did it take, what pain medication did you use, any advise on natural pain relief??? etc etc D.D. Family T1 since May 2006 Metformin, Humalog and Lantus Can't help with advice on the birth as I wasn't diabetic when I had my kids,but would just like to wish you good luck and hope all goes well.Let us know when baby arrives. Last edited by Nixo; 1/09/09 at 05:18 AM. Reason: Typo Good luck first of all!! I had my girl in 2000 when I had diabetes for exactly 10 years. I was induced at 38 weeks, though babygirl wasn't that big yet, but my blood pressure was rising. First of all, have you discussed who's in charge of your diabetes. I did, however, once they put me on an insulin and separate glucose drip, that control was out of my hands, and that's terrible, I'd meassured a low BS, I told the nurse to lower the insulin drip (at one point I demanded they turn it off, because I was working so hard, I didn't really need the insulin), she said she had to go ask the, wait for it, OB-gyn...... who was of course worki Continue reading >>
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Pregnancy Was Hard But Worth Every Moment
Save for later My pregnancy was without doubt the hardest thing I've ever done, but worth every minute to have baby James safe in my arms. My control wasn't as good as it should have been when we started trying for a baby, and I hadn't seen a diabetes consultant for years. Instead I just attended check ups at my GP surgery. To be honest I didn't fully realise the risks involved with having a baby as a diabetic, although I did know that diabetics have a tendency to have larger babies. It was during one of these check ups that I mentioned that my husband and I wanted to start a family, and the practice nurse told me I should see a diabetes consultant urgently. At that point I was already a few days' pregnant - although I didn't know it yet. I was worried about miscarriage Thankfully we found that I was pregnant very early on, and I was seen by a consultant the following week. I'd read up on what effects diabetes can have on pregnancy and I felt quite stupid and irresponsible for not having taken better care of my sugar levels before. I wanted this baby so much but was really worried that I would have a miscarriage, or that the baby would have some kind of abnormality. I was determined to get my blood sugar levels to the lowest levels I could, and started testing at least 10 times a day. I was really struggling to get the balance right, giving myself corrective injections to bring the levels down, and having hypos every single day. Hormones during pregnancy interfere with blood sugar levels. That coupled with losing hypo awareness meant I had a lot of severe hypos and we had to call an ambulance out on a couple of occasions. Ten weeks into my pregnancy I had a hypo at work where I ended up fitting at my desk. I hadn't wanted to tell my colleagues that I was pregnant until Continue reading >>
I Have Pregnancy Induced Gestational Diabetes, Is There Possibility That I Will Deliver My Baby Late
Because I had my first child born at 37 weeks will i give birth early again even if I have gestational diabetes? To my knowledge, most OB's will induce or take a baby early if the mother has GD. Most of those babies gain weight faster and the doctors might not want to chance you have a 10 pound baby. I had GD w/ our first child, and I monitored it very closely by diet. Our baby was born on her due date, perfectly healthy and a mere 7 pounds. Watch the sugars and carbs you eat, and GD is nothing more then a few stretch marks! I think it really depends on your doctor, so my best advice would be to talk to them. I was being checked twice a week with stress tests and once a week with ultrasounds, and my gestational diabetes was controlled with low doses of insulin daily. My OB would not induce me early because everything with my baby and I were fine, but he did say he wouldn't let me go past 41 weeks. I went into labor on my own on my due date and had my baby the next day. He was born weighing 7lbs 14oz and was completely healthy! Each pregnancy is different, so ask your OB. :) I hear most women with gestational diabetes are delivered early because of risk to the baby. I have GD that is controlled by diet alone and I at my 36 weeks appt, the ultrasound showed my baby to already be 7 lbs 7 oz and my dr. thinks if I go to term she will be over 9 lbs and needless to say he plans to induce me 2 weeks early...ad I have to say that I am kind of relieved so she will be safe and I not have to have a c-section and have to deal with a long recovery....your dr. will do what is best for you and your baby....there are too many risks to having a large baby...good luck to you... This is my 2nd pregnancy with GD. For the first one, I delivered 4 days late and baby was 8lbs even. Typically Continue reading >>
Will My Induction Be Different If I Have Gestational Diabetes? (video)
Will my induction be different if I have gestational diabetes? (Video) Our midwife explains whether induction of labour is any different if you have gestational diabetes. Dr Cate Bell, RM, RGN, DMid, MSc, PgCHSCE, is a practising midwife in Sussex and a hypnobirthing practitioner. If you have gestational diabetes, induction of labour is no different to if you're having your baby induced for other reasons. The only difference may be that it might take slightly longer, because most women with diabetes are induced prior to their due date. Therefore your body may not be quite ready to go into labour, so it may take slightly longer. Join now to receive free weekly newsletters tracking your babys development and yours throughout your pregnancy. To give you the best experience, BabyCentres website and emails use cookies and similar tracking systems to personalise the content and ads we provide to you. We use your health information to make our site even more helpful. By clicking the button, you agree to our policies and to get emails from us. Continue reading >>
Gestational Diabetes And Inducing
I was diagnosed with gestational diabetes and have it under control with diet. I had an appointment yesterday where a nurse told me I wouldn't be able to go past my due date at all not even a week. If I don't deliver by my due date I will be induced. Has anyone experienced this? Should I chose to be induced or a c section as I heard being induced is terrible. Any thoughts? They usually never let women go past their due date w gd. However as exhausting as being induced can be, I would take being induced and a vaginal delivery over a c section any day! Docs vary on this. High sugar levels very slightly increase the risk of early placental failure and delivery complications due to baby's size. Due to that, they typically don't like GD mommas going too far along. It's standard to induce at 39 weeks if your levels require medication to control, though some are okay with 40 weeks. If you're diet controlled, some still want to induce at 39 weeks but 40 weeks is more common. Many docs are comfortable letting you go to 41-42 weeks. My levels were very well controlled last pregnancy and my doc was fine with 41w6d (I went into labor naturally at 40w5d). Re induction vs c-section, I would hands down go for the induction. I always want to at least have a shot at a vaginal delivery. All my friends who were induced has easy labors and successful vaginal deliveries. The horror stories are over-hyped. I was insulin controlled this time and last time. I was induced at 39 weeks, which is standard procedure for my doc, but they may take you earlier if they are concerned about babies size. This time around they have told me any time after 37 weeks. I ended up with a c-section, but had a quick recovery. They will only let me try for a VBAC if I go into labor on my own or have a favorable ce Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Conjoint Associations of Gestational Diabetes and Hypertension With Diabetes, Hypertension, and Cardiovascular Disease in Parents: A Retrospective Cohort Study
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
