Ayurveda And Diabetes During Pregnancy (Gestational Diabetes)


                                            Today is World Diabetes Day 

                                     DIABETES : PROTECT OUR FUTURE

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Diabetes is the most common medical complication of pregnancy and it has increased about 40% . The increasing prevalence of Type 2 Diabetes in general and younger people in particular has led to an increasing number of pregnancies with this complication .

Women can be separated into :

–  those who were known to have Diabetes before pregnancy –                         Pregestational or Overt 

–  those diagnosed during pregnancy – Gestational .

There is keen interest in events that precedes Diabetes which includes the mini environment of the uterus , where it is believed that early imprinting can have effects later in life ( Saudek 2002) . For example in utero exposure to maternal hyperglycemia leads to fetal hyperinsulinemia , causing an increase in fetal fat cells, which leads to obesity and insulin resistance in childhood . This in turn leads to impaired glucose tolerance and Diabetes in adulthood . Thus a cycle of fetal exposure to Diabetes leading to childhood obesity and glucose intolerance is set in motion .

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GESTATIONAL DIABETES MELLITUS :

Gestational Diabetes Mellitus is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy . An alternative explanation is that Gestational Diabetes is Type 2 Diabetes unmasked or discovered during pregnancy .

Risk Factors :

a)      Positive family history of Diabetes

b)      Having a previous birth of an overweight baby of 4 kg or more

c)       Previous stillbirth

d)      Unexplained perinatal loss

e)      Presence of polyhydramnios ( excessive amniotic fluid ) or recurrent vaginal infection in present pregnancy

f)       Persistent glycosuria

g)      Age over 30 years

h)      Obesity

i)        Ethnic groups ( East Asian , Pacific Island)

Screening :

The method employed is by using 50 gm oral glucose challenge test without regard to time of day or last meal , between 24 – 28 weeks of pregnancy . A plasma glucose value of 140 mg percent or that of whole blood of 130 mg percent at 1 hour is considered as cut off point for consideration of a 100 gm ( WHO – 75 gm ) glucose tolerance test .

Complications :

a)      Increased perinatal loss is associated with fasting hyperglycemia . Fetal anomalies are not increased due to the absence of metabolic disturbance during organogenesis in early pregnancy.

b)      Increased incidence of Macrosomia ( Fetal Macrosomia is defined as infants whose birth weight exceeds 4500 gm) .

c)       Polyhydramnios

d)      Birth trauma

e)      Recurrence of GDM in subsequent pregnancies is about 50 %

OVERT DIABETES :

A patient with symptoms of Diabetes Mellitus ( increased urination , increased thirst , weight loss ) and random plasma glucose concentration of 200 mg / dl or more is considered overt diabetic  . The condition may be pre existing or detected for the first time during present pregnancy .

According to American Diabetic Association , diagnosis is positive if

a)      The fasting plasma glucose exceeds 126 mg / dl

b)      The 2 hour post glucose ( 75 gm ) value exceeds 200 mg / dl

Patients with poor glycemic control and vascular disease are at increased risk of complication of IUD , IUGR , Pre eclampsia and Ketoacidosis .

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Complications :

MATERNAL :

During Pregnancy :

  • Abortion

  • Preterm Labour ( 20% )

  • Infection – Urinary tract infection and vulvo vaginitis

  • Increased incidence of Pre eclampsia ( 25 % )

  • Polyhydramnios ( 25 – 50% )

  • Maternal distress

  • Diabetic Retinopathy

  • Diabetic Nephropathy

  • Ketoacidosis

During Labour :

  • Prolongation of labour due to big baby

  • Perineal injuries

  • Postpartum haemorrhage

FETAL :

  • Fetal Macrosomia  – With good Diabetic control , incidence of Macrosomia is markedly reduced .

  • Congenital Malformation – It is related to the severity of Diabetes affecting organogenesis , in the first trimester ( both in Type 1 and Type 2 Diabetes ) .

  • Birth injuries

  • Fetal death

NEONATAL :

  • Hypoglycemia ( < 37mg / dl )

  • Respiratory distress syndrome

  • Hyperbilirubinemia

  • Cardiomyopathy

Macrosomia

AYURVEDA :

In Ayurveda Madhumeha disease can be correlated with Diabetes Mellitus . Though there is no direct reference of Gestational Diabetes but Garbha Vriddhi is described as a complication .

Garbha Vriddhi : In Garbha Vriddhi , there is excessive increase in size of abdomen and perspiration . Labour is difficult .

This can be understood as Overweight fetus or Macrosomia .

MANAGEMENT :

Ayurveda helps in limiting the maternal and fetal complications . Herbs are helpful as a supportive treatment along with the modern medicine under supervision .

Generally beneficial , congenial , purifying and suppressive dietetics and mode of life , not causing loss of doshas and dhatus but capable of decreasing the increased doshas and dhatus should be used .

Garbhadhan Vidhi : Pre conception counseling is a must .

Diet : Following can be included in the diet ( in moderation ) :

Vegetables : Bitter gourd , fenugreek leaves , tomatoes , bell pepper , spinach , cucumber , radish , sponge gourd , drumstick leaves & fruits , broccoli , kale , lettuce , cauliflower , cabbage .

Pulses : Mainly beans – green gram , bengal gram , black eyed pea , garbanzo beans , chick pea .

Spices : Turmeric , cinnamon , garlic , fenugreek seeds .

Cereals : Wheat , barley , pearl millet , oats .

Fruits : Plums , kiwi , lime , oranges , guava , java plum / black plum , apple,  peaches , gooseberry .

Dry Fruits : Almond , apricot , walnut .

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                   Though the most appropriate diet for women with Gestational Diabetes has not been established , it is suggested that obese women with a body mass index greater than 30 kg / m2 may benefit from a 30 – 33 % caloric restriction .

                   This should be monitored with weekly tests for ketonuria because maternal ketonemia has been linked with impaired psychomotor development in the offspring .

Physical Activity : Physical activity during pregnancy reduces the risk of Gestational Diabetes .Resistance exercise helps avoid insulin therapy in overweight women with Gestational Diabetes .

Pranayam and Yogasana is beneficial .

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Herbs : Tinospora cordifolia , Holarrhena antidysenterica ,                                Rubia cordifolia , Emblica officinale , Boerhavia diffusa , Withania somnifera , Tribulis terrestris , Hemidesmus indica etc can be given under supervision .

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What Is Diabetes ?


                                       14 November is World Diabetes Day

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What is Diabetes?

Diabetes is a chronic disease that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Insulin is a hormone made by the pancreas that enables cells to take in glucose from the blood and use it for energy. 

Failure of insulin production, insulin action or both leads to raised glucose levels in the blood (hyperglycaemia).

This is associated with long-term damage to the body and the failure of various organs and tissues.

http://www.idf.org/sites/default/files/attachments/WDD-infographic-what-is-diabetes-EN.pdf

Type 1 diabetes is an autoimmune disease characterized by the destruction of the insulin-producing cells in the pancreas.Consequently, people with type 1 diabetes produce very little or no insulin and must take insulin to survive.

Type 2 diabetes is marked by insulin resistance. People with type 2 diabetes cannot use the insulin that they produce effectively. They can often manage their condition through exercise and diet. However, in many cases oral drugs are needed and often insulin is required.

Gestational diabetes (GDM) is a condition in which women without previously diagnosed diabetes have high blood glucose levels during their pregnancy. GDM affects about 4% of all pregnant women.

Understand diabetes: Know the warning signs*

• Frequent urination
• Excessive thirst
• Increased hunger
• Weight loss
• Tiredness
• Lack of interest and concentration
• Vomiting and stomach pain (often mistaken as the flu)
• A tingling sensation or numbness in the hands or feet
• Other signs include blurred vision, frequent infections and slow-healing wounds
*These can be mild or absent in people with type 2 diabetes.

http://www.idf.org/sites/default/files/attachments/WDD-infographic-warning-signs-EN.pdf

The complications of diabetes :

Diabetes is a chronic, life-long condition that requires careful monitoring and control. Without proper management it can lead to very high blood sugar levels. These are associated with long-term damage to the body and the failure of various organs and tissues.

Complications include:

Cardiovascular disease, which affects the heart and blood vessels, and may cause fatal complications such as coronary heart disease (leading to a heart attack) and stroke.
Kidney disease (diabetic nephropathy), which may result in total kidney failure and the need for dialysis or kidney transplant.
Nerve disease (diabetic neuropathy), which can ultimately lead to ulceration and amputation of the toes, feet and lower limbs.
Eye disease (diabetic retinopathy), characterized by damage to the retina of the eye which can lead to vision loss .

http://www.idf.org/sites/default/files/attachments/WDD-infographic-risk-factors-EN-2.pdf

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Understand diabetes: know the risks

There are many risk factors for type 2 diabetes. They include:
• Obesity and overweight
• Lack of exercise
• Previously identified glucose intolerance
• Unhealthy diet
• Increased age
• High blood pressure and high cholesterol
• A family history of diabetes
• A history of gestational diabetes
• Ethnicity – higher rates of diabetes have been reported in Asians, Hispanics, Indigenous peoples (USA, Canada, Australia) and African Americans.

http://www.idf.org/sites/default/files/attachments/WDD-infographic-reduce-your-risk-EN.pdf

World Diabetes Day and Primary Prevention

At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation. Type 2 diabetes, however, can be prevented in many cases by maintaining a healthy weight and being physically active.

Once identified, people at high risk of diabetes should have their plasma glucose levels measured by a health professional to detect Impaired Fasting Glucose or Impaired Glucose Tolerance, both of which indicate an increased risk of type 2 diabetes. Prevention efforts should target those at risk in order to delay or avoid the onset of type 2 diabetes.

There is substantial evidence that achieving a healthy body weight and moderate physical activity can help prevent the development of type 2 diabetes. 

 IDF recommends a goal of :

At least 30 minutes of daily exercise, such as brisk walking, swimming, cycling or dancing .

Regular walking for at least 30 minutes per day, for example, has been shown to reduce the risk of type 2 diabetes by 35-40%.

Source : http://www.idf.org/files/docs/WDD-booklet-EN-final.pdf