What exactly is gestational diabetes? Is it the same as a patient with diabetes becoming pregnant?

Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes.

To understand gestational diabetes we need to understand what diabetes is. In simple terms diabetes is a condition where the glucose level in blood is higher than normal because the body cannot use it properly. All of us have an organ called pancreas in our abdomen which makes a hormone called insulin. Insulin is the key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel. Diabetes develops when we either make too little insulin or the insulin we are making is not working properly.

Gestational diabetes is a type of diabetes that arises during pregnancy usually around 24 to 30 weeks. Gestational diabetes occurs when the body cannot produce enough insulin to meet the extra needs of pregnancy.

How common is gestational diabetes?
Although in USA it happens in about 4 % of all pregnancies, in India about 15% of all pregnancies may develop this condition.

What exactly causes gestational diabetes?
We do not for sure as what causes gestational diabetes but there are a few theories. The placenta supports the baby inside the uterus as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother’s insulin in her body. This leads to the glucose level to rise in the mother`s blood.

Which groups of women are more likely to develop gestational diabetes?
The risk factors for developing gestational diabetes include
• Obesity
• Family history of diabetes
• Large baby in the previous pregnancy (> 4.5 kg)
• Gestational diabetes in previous pregnancies.
• Unexplained stillbirth in the previous pregnancy.

How do we diagnose gestational diabetes?
This is done by two blood tests: one fasting and the second two hours after ingestion of 75 grams glucose by talking blood from a vein. A fasting glucose value of > 126 and/or a two hour post 75 grams glucose value of 140 imply that there is gestational diabetes.

How can gestational diabetes affect the baby?
The high blood glucose levels in the mother`s blood reaches the baby and as a result the baby gets more energy than it needs to grow and develop and this extra energy is stored as fat. This can lead to macrosomia, or a “fat” baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. The newborn may also have very low blood glucose levels at birth.

How do we treat gestational diabetes?

Treatment for gestational diabetes aims to keep blood glucose levels equal to those of pregnant women who don’t have gestational diabetes. It may also include daily blood glucose testing. Often blood glucose levels can be controlled by diet .If blood glucose levels cannot be controlled by diet alone then insulin may be needed.

Does it go away after the baby is born?
It does go away in most cases. The diabetes treatment is stopped after delivery. However, to be sure the mother should have blood tests (fasting glucose and glucose level two hours after 75 grams glucose) about two months after delivery.

Women with gestational diabetes have a 30% risk of developing diabetes during their lifetime. Healthy diet and maintaining appropriate weight for height may prevent progression to diabetes later in life.

While gestational diabetes is a cause for concern, the good news is that you and your diabetologist, gynaecologist and dietitian can work together to lower your high blood glucose levels. And with this help, you can turn your concern into a healthy pregnancy for you, and a healthy start for your baby.

Myths and Realities of Bone Health

Over several decades, scientists have learned a significant amount about the prevention, diagnosis, and treatment of bone disease.

Myth: Only a small segment of the population suffers from osteoporosis or other bone diseases.

Reality: Osteoporosis is a silent condition that affects millions of Indians. If a conservative estimate is taken into consideration then 20% of the women and 10-15% of the men would be osteoporotic which would make the total affected population to be 25 million. If lower bone density implies a greater risk of fracture, as is expected, then the figure can be approximately 50 million.

Myth: Osteoporosis is only a problem for older women.

Reality: One of the most dangerous myths about osteoporosis is that only women need to worry about bone health. Osteoporosis affects men and women of all races. While bone weakness is manifested in older age, strong bones begin in childhood. People of all ages must take steps to protect their bone health.

Myth: Bone fractures from falls or injuries have nothing to do with osteoporosis.

Reality: Fractures in individuals over the age of 50 can be the first sign of weak bones from osteoporosis or low bone mass.

Myth: Diagnosing osteoporosis or other bone diseases is a lengthy and painful process.

Reality: A bone density test, the primary test that is used to screen for osteoporosis, is a simple and painless procedure that takes less than 5-10 minutes to complete.

Myth: Osteoporosis cannot be prevented.

Reality: Individuals can do a lot to promote their bone health, beginning in childhood and continuing into old age. With proper nutrition, physical activity and medical attention, one can have strong bones and live longer, healthier lives.

Myth: Once you get osteoporosis, nothing can be done to treat it.

Reality: If diagnosed, osteoporosis can be treated with new drugs that help prevent bone loss and rebuild bone. These can help to prevent life-threatening and painful fractures.

Myth: Osteoporosis and other bone diseases have no physical consequences.

Reality: Osteoporosis and bone disease often result in painful and debilitating fractures. A fracture can lead to a downward spiral in physical and mental health that, for some people, can even result in death. The risk of death is especially high during the first year after the fracture. Many individuals with fractures experience significant pain, loss of height, and may lose their ability to dress themselves, stand up, and walk. Of those who remain independent, a fracture often leads to a reduced quality of life.

Myth: There are no emotional consequences from osteoporosis and other bone diseases.

Reality: Fractures may lead to a loss of self-esteem and body image, and a change in mood, all of which cause significant anxiety and depression. Individuals who have been immobilized by a fracture may fear they will fall again and suffer additional fractures.