Treatment for Gestational Diabetes
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While Gestational Diabetes poses significant risks to mother and child, if treated, many of the risks can be eliminated or greatly reduced. The most important aspect of any treatment plan is compliance by the patient. Therefore practitioners need to emphasis the importance of managing GDM. GDM patients need to understand the risks to her and her unborn child GDM poses. They need to be clear on dietary recommendations including an understanding of why diet components such as reduced fat intake are important. Finally, they need to fully understand the importance of and how to perform and understand the results of blood glucose testing. Women need to understand that careful adherence to the prescribed treatment will greatly reduce many of the risks associated with GDM.
Insulin therapy is used after attempts to control diet and exercise fail to regulate glycemic control. Rate of the number of women who require insulin therapy varies greatly from 30 % to 60% worldwide. Dosage of insulin also varies and needs to consider weight, ethnic characteristics, and other demographic criteria. Most studies report 50-90 units dose to achieve glucose control.
There is inconsistency in the criteria for insulin initiation. Traditionally, the criteria for determining insulin initiation were from maternal glycemic levels of FPG >105 mg/dl and/or two-hour postprandial plasma glucose of >120 mg/dl. More recently, lower FPG levels were recommended as this resulted in lower rates of macrosomia in GDM.
Infant glycemic levels have also been used to initiate insulin therapy using amniotic fluid from the 28th week of gestation. Another option includes fetal abdominal circumference during weeks 29-33 with proposed circumference of >75 percentile as a predictor of the need for insulin therapy.
There have been some attempts at providing oral insulin alternatives as well as insulin analogs such as lispro. Previous uses of such agents have not been encouraging as congenital malformations were recorded in two cases in which women were treated with lispro. reports that these therapies are being reconsidered but clearly more research need to be conducted to determine the effectiveness of such alternative treatment options.
Initial treatment efforts in GDM involve diet and exercise. However, there is discrepancy in diet recommendations as well as concerns over finding a balance between controlling the GDM while still providing the woman and fetus with required nutritional needs to facilitate healthy growth. Few randomized studies have been conducted to evaluate diet factors such as number of calories, and amount of carbohydrates, fats and proteins in treating GDM through diet. Part of the difficulty is that individual differences in the patients impact diet requirements. Obese women needed to lose weight will require a different diet than women who do not even though both have GDM. Further, there is considerable variability in the rate of glucose absorption and delay in stomach emptying in pregnant women.