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Gestational Diabetes Pills Vs Insulin

Treatment

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 >>

Pill Effective Against Gestational Diabetes

Pill Effective Against Gestational Diabetes

Pill effective against gestational diabetes BOSTON (Reuters) - The diabetes pill metformin is just as effective as insulin injections in treating women who develop diabetes during pregnancy, researchers in New Zealand and Australia reported on Wednesday. A four dimensional ultrasound is seen at a pregnancy clinic in Arlington, Texas November 26, 2007. REUTERS/Jessica Rinaldi So-called gestational diabetes surfaces in one out of every 20 pregnant women, and there has been concern that metformin might affect a fetus because the drug can cross the placenta. But the study, led by Janet Rowan of the Auckland City Hospital in New Zealand, found that the risk of complications such as respiratory distress, birth trauma and newborn hypoglycemia, or low blood sugar, was no different for the 363 women who received metformin and the 370 given conventional insulin shots. Metformin is available generically but also known by the Bristol-Myers Squibb brand name Glucophage. After delivery, nearly 77 percent of the metformin recipients said they would want to stay with the pill if they developed diabetes during pregnancy again, even though 46 percent still needed supplemental insulin injections at some point. Only 27 percent of those who got insulin shots felt the same way, they reported in the New England Journal of Medicine. But doctors may still be cautious, the researchers said. Clinicians may remain circumspect about using metformin until follow-up data for offspring are available, they wrote. The children born during the study are being tested when they reach their second birthday. In a commentary, Drs. Jeffrey Ecker and Michael Greene of Harvard Medical School in Boston say one remaining question is whether metformin would be better than another generic pill, glyburide. Another s Continue reading >>

Should I Use Diabetes Pills Or Insulin?

Should I Use Diabetes Pills Or Insulin?

Diabetes affects the way your body breaks down food. Treatment depends on which type of diabetes you have. In type 1 diabetes, your pancreas stops producing insulin. Insulin is a hormone that helps regulate glucose, or sugar, in your blood. Type 2 diabetes starts with insulin resistance. Your pancreas no longer produces enough insulin or doesn’t use it efficiently. Every cell in your body uses glucose for energy. If insulin isn’t doing its job, glucose builds up in your blood. This causes a condition called hyperglycemia. Low blood glucose is called hypoglycemia. Both can lead to serious complications. A variety of pills are available to treat diabetes, but they can’t help everyone. They only work if your pancreas still produces some insulin. They can’t treat type 1 diabetes. They aren’t effective in people with type 2 diabetes when the pancreas has stopped making insulin. Some people with type 2 diabetes can benefit from using both pills and insulin. Some pills to treat diabetes include: Biguanides Metformin (Glucophage, Fortamet, Riomet, Glumetza) is a biguanide. It lowers the amount of glucose in your liver and boosts insulin sensitivity. It may also improve cholesterol levels and might help you lose a little weight. People normally take it twice per day with meals. You can take the extended-release version once per day. Potential side effects include: upset stomach nausea bloating gas diarrhea a temporary loss of appetite It may also cause lactic acidosis in people with kidney failure, but this is rare. Sulfonylureas Sulfonylureas are fast-acting medications that help the pancreas release insulin after meals. They include: People usually take these medications once per day with a meal. Potential side effects include: irritability low blood glucose upset st Continue reading >>

Metformin In Gestational Diabetes

Metformin In Gestational Diabetes

Home / Conditions / Gestational Diabetes / Metformin in Gestational Diabetes Should metformin or glyburide, or a combination of both drugs, be the first-line treatment for gestational diabetes? Uncontrolled hyperglycemia during pregnancy is known to affect fetal development and increase the prevalence of gestational diabetes mellitus (GDM) that complicates 5-7% of pregnancies. Studies show that routine care including healthy diet, physical activity, and glucose monitoring may not be adequate to achieve glucose control in those pregnant women. Although, previously US Food and Drug Administration (FDA) had approved insulin as the only treatment for GDM, ongoing studies have shown promising results with oral hypoglycemic drugs: Glyburide and Metformin are cost effective, therapeutically efficacious, easy to administer, and safe pharmacological treatment options for GDM. In a prospective, open-labeled, randomized, parallel study, women at 1333 weeks of gestation diagnosed with GDM, between the ages of 1845 years were recruited to compare the efficacy and safety of glyburide versus metformin in the treatment of GDM. Also, the improvement in glycemic control after their replacement due to adverse effects or after adding the second drug due to failure of the first were also evaluated. Pharmacotherapy was initiated in subjects with either fasting blood glucose (BG) >95 mg/dL, a 1.5-h postprandial of >130 mg/dL, or a daily average >100 mg/dL after at least a week of dietary treatment. Subjects underwent a sonographic dating of the pregnancy earlier than 24 weeks and signed a consent form. The study hypothesized that GDM is one of the chief conditions that contributes to obstetrical complications and prenatal morbidity and that they can be improved with glycemic control by impro Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

Diabetes can cause problems during pregnancy for women and their developing babies. Poor control of diabetes during pregnancy increases the chances for birth defects and other problems for the pregnancy. It can also cause serious complications for the woman. Proper health care before and during pregnancy can help prevent birth defects and other health problems. About Diabetes Diabetes is a condition in which the body cannot use the sugars and starches (carbohydrates) it takes in as food to make energy. The body either makes no insulin or too little insulin or cannot use the insulin it makes to change those sugars and starches into energy. As a result, extra sugar builds up in the blood. The three most common types of diabetes are: Type 1 The pancreas makes no insulin or so little insulin that the body can’t use blood sugar for energy. Type 1 diabetes must be controlled with daily insulin. Type 2 The body either makes too little insulin or can’t use the insulin it makes to use blood sugar for energy. Sometimes type 2 diabetes can be controlled through eating a proper diet and exercising regularly. Many people with type 2 diabetes have to take diabetes pills, insulin, or both. Gestational This is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant. Often gestational diabetes can be controlled through eating a healthy diet and exercising regularly. Sometimes a woman with gestational diabetes must also take insulin. For most women with gestational diabetes, the diabetes goes away soon after delivery. When it does not go away, the diabetes is called type 2 diabetes. Even if the diabetes does go away after the baby is born, half of all women who had gestational diabetes develop type 2 diabetes later. It’s important Continue reading >>

Metformin Vs Insulin In The Management Of Gestational Diabetes: A Meta-analysis

Metformin Vs Insulin In The Management Of Gestational Diabetes: A Meta-analysis

Go to: Introduction In recent years, the morbidity of gestational diabetes mellitus (GDM) is increasing. Approximately 1–14% of all pregnancies are complicated by GDM, depending on the population studied and the diagnostic tests employed [1]. It has been defined as any degree of glucose intolerance with onset or first recognition during pregnancy [1]. GDM, the most frequent medical complication of pregnancy, is associated with several adverse outcomes over the short- and long-term for both mother and offspring [2]. First, the presence of GDM always accompanies an increased maternal risk for preeclampsia, cesarean section, and with an increased risk for developing type 2 diabetes (T2D) after pregnancy [3], [4]. In addition, there is an increased risk for neonatal death, still birth and congenital defects [5] resulting from excessive mother-to-fetus glucose transfer [6], [7]. Another major complication is macrosomia, which is a risk factor for instrumental delivery, cesarean section and shoulder dystocia during delivery and neonatal hypoglycemia directly after birth [8]. Furthermore, the influence of the intrauterine hyperglycemia environment might go with the children in later life [3], [9]. So the management of GDM is primarily aimed at controlling glycemic level to reduce the incidence of adverse pregnancy outcomes. The previous study has demonstrated that intensive treatment in women with GDM reduced birth weight and incidence of macrosomia in infants born to mothers who had participated in the intervention compared with women who had received routine care [10]. Therefore, active treatments - such as dietary therapy, exercise, oral hypoglycemic agents, insulin - are necessary to reduce the complications [11]. When an appropriate diet, alone or associated with physic Continue reading >>

Gestational Diabetes Treatment

Gestational Diabetes Treatment

Like type 2 diabetes, gestational diabetes develops when liver, muscle, and fat cells don't respond well to insulin — a hormone that regulates glucose (sugar) levels in the blood. As its name suggests, gestational diabetes develops only in pregnant women. It's caused by changes in the body (including changing hormone levels) during pregnancy, and causes high blood glucose levels. If left uncontrolled, the condition may be harmful — or even deadly — to both the woman and her child, and can increase both of their risks of developing type 2 diabetes later in life. The key to treating gestational diabetes is to tightly regulate blood glucose levels through lifestyle changes (diet and exercise) and, if necessary, medications. Gestational Diabetes Diet Treatment for gestational diabetes always includes specialized healthy meal plans — often recommended by a registered dietician — and regular exercise, according to the American Diabetes Association (ADA). Generally speaking, diets for gestational diabetes focus on foods high in fiber and other important nutrients, and low in fat and calories. This means they tend to favor vegetables, fruits, and whole grains, and frown on refined carbohydrates (including sugar). According to a 2008 report in the journal Reviews in Obstetrics and Gynecology, a diet that can help most women with gestational diabetes maintain a normal blood glucose level is one in which 33 to 40 percent of calories come from complex carbohydrates, 35 to 40 percent come from fat, and 20 percent come from protein. Eating regular small meals throughout the day can also help keep your blood glucose level stable. Exercise as Treatment for Gestational Diabetes Regular physical activity is important to help keep your blood glucose under control. Women with ges Continue reading >>

Oral Hypoglycemic Agents Vs Insulin In Management Of Gestational Diabetes: A Systematic Review And Metaanalysis

Oral Hypoglycemic Agents Vs Insulin In Management Of Gestational Diabetes: A Systematic Review And Metaanalysis

Sheffield Teaching Hospitals NHS Foundation Trust The objective of this review was to provide pooled estimates of randomized controlled trials comparing the effects of oral hypoglycemic agents with insulin in achieving glycemic control and to study the maternal and perinatal outcomes in gestational diabetes mellitus.A protocol for the study was developed. All metaanalyses were performed using Stats Direct statistical software (Stats Direct Ltd, Cheshire, UK).Six studies comprising 1388 subjects were analyzed. No significant differences were found in maternal fasting (weighted mean difference [WMD], 1.31; 95% confidence interval [CI], 0.81-3.43) or postprandial (WMD, 0.80; 95% CI, -3.26 to 4.87) glycemic control. Use of oral hypoglycemic agents (OHAs) was not associated with risk of neonatal hypoglycemia (odds ratio [OR], 1.59; 95% CI, 0.70-3.62), increased birthweight (WMD, 56.11; 95% CI, -42.62 to 154.84), incidence of caesarean section (OR, 0.91; 95% CI, -0.68 to 1.22), or incidence of large-for-gestational-age babies (OR, 1.01; 95% CI, 0.61-1.68).Our study demonstrates that there are no differences in glycemic control or pregnancy outcomes when OHAs were compared with insulin. Do you want to read the rest of this article? ... A number of studies have demonstrated that treatment of GDM with metformin can lead to adequate glycaemic control and does not increase the risk of adverse perinatal outcomes [6,7]. ... Continue reading >>

Glibenclamide, Metformin, And Insulin For The Treatment Of Gestational Diabetes: A Systematic Review And Meta-analysis

Glibenclamide, Metformin, And Insulin For The Treatment Of Gestational Diabetes: A Systematic Review And Meta-analysis

Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis BMJ 2015; 350 doi: (Published 21 January 2015) Cite this as: BMJ 2015;350:h102 Montserrat Balsells, registrar in endocrinology and nutrition 1 , Apolonia Garca-Patterson, registrar in endocrinology and nutrition 2 , Ignasi Gich, associate researcher 5 6 7 , Rosa Corcoy, assistant professor in endocrinology and nutrition 2 8 9 1Department of Endocrinology and Nutrition, Hospital Universitari Mtua de Terrassa, Terrassa 8821, Spain 2Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain 3Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Barcelona 4Institute of Biomedical Research (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau Barcelona 5CIBER Epidemiologa y Salud Pblica (CIBERESP), Instituto de Salud Carlos III, Madrid 28029, Spain 6Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona 7Department of Clinical Pharmacology and Therapeutics, Universitat Autnoma de Barcelona, Bellaterra 08193 (Cerdanyola del Valls), Spain 8CIBER Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto de Salud Carlos III, Madrid 9Department of Medicine, Universitat Autnoma de Barcelona, Bellaterra Correspondence to: R Corcoy, Servei dEndocrinologia i Nutrici, Hospital de la Santa Creu i Sant Pau, Avinguda Sant Antoni Maria Claret 167, Barcelona 08025, Spain rcorcoy{at}santpau.cat Objective To summarize short term outcomes in randomized controlled trials comparing glibenclamide or metformin versus insulin or versus each other in women with gestational Continue reading >>

Gestational Diabetes - Treatment Overview

Gestational Diabetes - Treatment Overview

Most women who have gestational diabetes give birth to healthy babies. You are the most important person in promoting a healthy pregnancy. Treatment for gestational diabetes involves making healthy choices. Most women who make changes in the way that they eat and how often they exercise are able to keep their blood sugar level within a target range. Controlling your blood sugar is the key to preventing problems during pregnancy or birth. You, your doctor, and other health professionals will work together to develop a treatment plan just for you. You do not need to eat strange or special foods. But you may need to change what, when, and how much you eat. And walking several times a week can really help your blood sugar. The lifestyle changes you make now will help you have a healthy pregnancy and prevent diabetes in the future. As you start making these changes, you will learn more about your body and how it reacts to food and exercise. You may also notice that you feel better and have more energy. During pregnancy Treatment for gestational diabetes during pregnancy includes: Eating balanced meals. After you find out that you have gestational diabetes, you will meet with a registered dietitian to create a healthy eating plan. You will learn how to limit the amount of carbohydrate you eat as a way to control your blood sugar. You may also be asked to write down everything you eat and to keep track of your weight. You will learn more about the range of weight gain that is good for you and your baby. Going on a diet during pregnancy is NOT recommended. Getting regular exercise. Try to do at least 2½ hours a week of moderate exercise.3, 4 One way to do this is to be active 30 minutes a day, at least 5 days a week. It's fine to be active in blocks of 10 minutes or more throu Continue reading >>

Using Insulin Vs. Diabetes Pills During Pregnancy

Using Insulin Vs. Diabetes Pills During Pregnancy

I recently received the following e-mail: I am planning another pregnancy. I was on insulin for my prior pregnancies and had very good outcomes and maintained tight control. My OB has told me some oral medications are now considered safe in pregnancy and put me on Glucovance. The information I find on-line states that Glucovance either hasn’t been tested in pregnancy or isn’t recommended. I don’t want to second-guess my OB, however I also want to ensure I have a healthy baby. Have you heard anything about Glucovance in pregnancy? My answer: Congratulations on your pregnancy successes in the past Maintaining tight control of blood glucose levels during pregnancy has been well-known for decades to be of critical importance in having a good outcome for pregnancies in women with diabetes. And, as you found during your prior pregnancies, it’s frequently necessary to add insulin therapy to assure tight control. As your obstetrician mentioned, there have been occasional studies using oral medications, including metformin and sulfonylureas (the two ingredients in the combination pill Glucovance), in pregnant women. But, as you have found out, there’s little or no information about Glucovance itself. Indeed, the latest official prescribing information (available at the FDA website) says: " Most experts recommend that insulin be used during pregnancy to maintain blood glucose as close to normal as possible… GLUCOVANCE should not be used during pregnancy unless clearly needed… There are no adequate and well-controlled studies in pregnant women with GLUCOVANCE or its individual components. No animal studies have been conducted with the combined products in GLUCOVANCE." I would vote for you to plan to use insulin again, and I’d suggest to not use oral diabetes medica Continue reading >>

Assistant Professor, Department Of Pharmacy Practice

Assistant Professor, Department Of Pharmacy Practice

Jennifer Elliott PharmD, CDE Assistant Professor, Department of Pharmacy Practice Philadelphia College of Osteopathic Medicine Georgia Campus School of Pharmacy Suwanee, Georgia Sara (Mandy) Reece PharmD, CDE, BC-ADM Assistant Professor and Vice Chair, Department of Pharmacy Practice Philadelphia College of Osteopathic Medicine Georgia Campus School of Pharmacy Suwanee, Georgia Disclosure to Participants • Notice of Requirements For Successful Completion – Please refer to learning goals and objectives – Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours • Conflict of Interest (COI) and Financial Relationship Disclosures: – None to report • Non-Endorsement of Products: – Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity • Off-Label Use: – Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Oral Anti-hyperglycemic and Insulin Therapies in Pregnancy Learning Objectives • Discuss current guidelines for treatment of pregestational and gestational diabetes • Discuss current evidence-based literature for insulin therapies, and oral antihyperglycemics during pregnancy • Apply evidence based approaches to patient scenarios 8/6/2015 2 Introduction • Diabetes During Pregnancy1 – Gestational Diabetes Mellitus (GDM) – Preexisting Type 1 or Type 2 Diabetes Mellitus Treatment Guidelines • Glycemic Targets in Pregnancy1 – GDM • Preprandial ≤ 95 mg/dL and either • 1-hour postprandial ≤ 140 Continue reading >>

Taking Medication And Insulin For Gestational Diabetes

Taking Medication And Insulin For Gestational Diabetes

Depending on the levels of glucose in your blood when you are diagnosed, you may be given the option of reducing your levels through dietary changes and exercise alone. If your levels are still high after a week or two though, you will be offered metformin tablets. If your fasting blood glucose levels are high and you have particular complications such as macrosomia (where the baby is very large) or hydramnios (excessive amniotic fluid), your team may recommend that you start immediate insulin treatment, with or without metformin (as well as dietary and exercise changes). "If I’d understood more about it, I’d have stuck with the diet and found ways to lower my blood glucose levels. Having insulin is not just a quick fix so that you can eat what you want." Kiera, mum of one There are two different types of diabetes medication suitable for women with gestational diabetes: tablets and injection. Tablets - metformin and glibenclamide In pregnancy, there are two types of tablet that you may be offered to help keep your blood glucose at a healthy level: metformin and glibenclamide. Metformin reduces the amount of glucose made by the liver and helps your body respond better to the insulin you produce naturally Glibenclamide lowers blood glucose by stimulating your pancreas to produce more insulin. Like all medication, they carry a risk of side effects, so check the patient information leaflet and talk to your doctor about any possible side effects. Although the patient information leaflet will say that these medications are not to be used during pregnancy, there is strong evidence in the UK for their safety and effectiveness in treating diabetes during pregnancy. Talk to your healthcare team if you have any concerns. Insulin injections If tablets are not suitable for you, Continue reading >>

Drug’s Safety Questioned For Gestational Diabetes

Drug’s Safety Questioned For Gestational Diabetes

A study finds glyburide can lead to worse neonatal outcomes for babies of moms with gestational diabetes. Quick Hit Newborns of mothers who took glyburide to treat gestational diabetes mellitus needed neonatal intensive care more often than infants whose mothers were on insulin therapy for gestational diabetes, according to a study published in JAMA Pediatrics. While the report has not yet triggered an FDA inquiry into whether the medication should be contraindicated in pregnancy, researchers recommended further study into the matter. The researchers found that newborns of women with gestational diabetes who used glyburide had an increased risk of respiratory distress, hypoglycemia, and being large for gestational age. Glyburide therapy to treat gestational diabetes is considered an “off-label” use, meaning that its use is not specifically covered in the FDA’s stated market clearance for the drug. In pregnancy, the placenta produces a combination of hormones which can actually suppress the effectiveness of insulin, leading to elevated glucose levels, and this process accelerates as the baby develops in utero. Women who have Type 2 diabetes before pregnancy often need to either start insulin therapy or use oral medication like metformin or glyburide to boost their bodies’ insulin production. Women with Type 1 diabetes often must adjust their insulin regimen during pregnancy, as well. According to diagnostic criteria, women who have gestational diabetes are not diabetic before becoming pregnant. Usually, gestational diabetes is treated with a low-carb diet and weight control. Oral medication to combat blood glucose buildup can be prescribed, but insulin therapy is becoming an increasingly popular option. Thanks for reading this Insulin Nation article. Want more Ty Continue reading >>

Oral Medication For The Treatment Of Women With Gestational Diabetes

Oral Medication For The Treatment Of Women With Gestational Diabetes

What is the issue? Globally the number of women being diagnosed with gestational diabetes mellitus (GDM) is increasing. GDM is an intolerance to glucose leading to high blood sugars, first recognised during pregnancy and usually resolving after birth. Standard care involves lifestyle advice on diet and exercise. Treatment for some women includes oral anti-diabetic medications, such as metformin and glibenclamide, which are an alternative to, or can be used alongside, insulin to control the blood sugar. This review aimed to investigate benefits of taking oral medication to treat GDM in pregnant women. Another Cochrane Review compares the effects of insulin with oral anti-diabetic pharmacological therapies ( Brown 2016). Why is this important? Women diagnosed with GDM are at a greater risk of experiencing complications such as high blood pressure during pregnancy and at birth. They have an increased risk of developing diabetes later in life. The babies of women who have been diagnosed with GDM can be larger than normal and this can cause injuries to the mother and the baby at birth. The birth is more likely to be induced or the baby born by caesarean section. These babies are at risk of developing diabetes as children or young adults. Finding the best medications to treat the women and prevent the complications that are linked to GDM is therefore important. What evidence did we find? We searched for studies on 14 May 2016. We included 11 randomised controlled trials involving 1487 mothers and their babies (but only eight trials contributed data to our analyses). The evidence was limited by the quality and number of studies and we advise caution when looking at the results. The criteria for diagnosis of GDM and treatment targets varied between studies, and each outcome is Continue reading >>

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