Developing Gestational Diabetes during pregnancy carries a 15 to 60 percent chance of developing Non-Insulin Dependent (Type II) after pregnancy within a 5 to15 year period of time. It is important to determine the significant risk factors that lead to Type II diabetes as this disease has reached epidemic proportions around the world. From 1994 to 2002, the incidence of gestational diabetes doubled to now involve 7 percent of pregnancies. This has an increased maternal and neonatal morbidity which includes but is not limited to elevated blood pressure, preeclampsia, eclampsia, placental abruption, maternal kidney disease, increased susceptibility to premature delivery, increased incidence of C-sections, uterine infection, bacteria in the blood, maternal death, fetal macrosomia (large infant) hypoglycemia of the infant, prematurity of the lungs even late in the third trimester, increased risk or neonatal infection, hyperbilirubenemia, intrauterine fetal death, and perinatal mortality.
By knowing the risk factors that lead to a higher incidence of gestational diabetes, there is hope to be able to prevent them before, during, or after the pregnancy in order to reduce the complications mentioned above associated with the immediate problems with gestational diabetes.
When patients are diagnosed with Non-insulin dependent diabetes, there are a host of complications and risk factors that occur: increased risk of heart, peripheral vascular, kidney, eye, and neurologic diseases such as heart attacks, angina, pain in legs when walking (claudication , kidney failure, blindness, stroke, transient ischemic attack, loss of balance when walking and unable to feel feet due to peripheral nerve damage.
Several studies show three factors that lead to highest risk for women developing Type II diabetes after having gestational diabetes in pregnancy:
1) BMI (Basal Metabolic Index) > 27
Patients have a 4 to 8 fold chance of developing Type II diabetes whose BMI is greater than 27
2) Developing gestational diabetes before 24 weeks gestation
Patients who develop gestational diabetes after 24 weeks have less chance of developing Type II diabetes. The fetal placenta is responsible for abnormal glucose intolerance after 24 weeks
3) Use of insulin to control the blood sugars in pregnancy
Insulin use in pregnancy means the mother has less ability to produce an adequate amount of insulin during stress (excessive sugar loads, viral or bacterial infections, ect.)
Measures must be in place to prevent, reduce, and or treat each risk factor.
Regarding prevention, reduction, or treating a BMI of greater than 27 requires a comprehensive approach involving psychological, environmental, nutritional, and exercise.
1) Eating minimal amounts of calories is noted to increase longevity. This is because obesity leads to chronic diseases such as cancer, hypertension, heart disease, diabetes, and arthritis. One must learn to eat frequent small meals. Eating 5 to 7 small meals throughout the day will increase the metabolism by 10 to 12 percent. Increasing the portion of protein and reducing the amount of carbohydrates will reduce insulin demand that is needed to metabolize sugars in the body. Patients must reduce breads, pasta, and sweets. Patients must increase fiber intake, brown rice, sweet potatoes, nuts, and non-starchy vegetables.
2) Exercise. One must engage is some form of exercise 30 minutes to 1 hour a day. Swimming, walking, riding bicycles, stationary bicycle, treadmill, weightlifting, rowing, stair climber, etc, are examples of exercises that will build muscle and help increase the uptake of sugars into muscle which in turn decreases the demand for insulin and reduces glucose resistance. Increase in one pound of muscle leads to an increase of 50 calories a day being burned.
3) Supplements known to increase glucose utilization in diets.
a. Cinnamon
b. Bitter melon
c. Cane sugar
d. Alpha Lipoic Acid
e. Chromium Piccolinate
In summary, Type II diabetes leads to serious illness and disease left untreated. Gestational Diabetes during pregnancy predicts a high incidence of developing Type II Diabetes within a few years. Knowing the risk factors that lead to Type II diabetes after Gestational Diabetes and the ways to reduce or prevent these factors from occurring, will help to reduce the incidence of this detrimental disease.
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