Diabetes Mellitus: Special Problems In Diabetes Management, Especially In Surgery And Pregnancy
Open Heart Surgery
Surgery And Pregnancy
In surgery for instance, management of diabetes depends upon the nature of the disease (IDDM or NIDDM) and the type of surgery. The general principle is to continue to administer intravenous insulin and parenteral feeding as long as the patient cannot eat normally.
Management Of Diabetes During Pregnancy
Glycosuria in pregnancy: Presence of reducing substances in urine is common in pregnancy. These may be glucose or lactose. The renal threshold for glucose is lowered during pregnancy and restored to normal after delivery.
Pregnancy is a precipitating event in the predisposed individuals. Hence all pregnant women with a positive family history of diabetes and incidence of overweight (over 4 Kg) babies in preceding pregnancies should have GTT done.
Though, in the majority of cases, the diabetic state disappears, in a small proportion, the diabetic state continues after delivery. Diabetes occurring during pregnancy and disappearing after delivery is called gestational diabetes.
Maternal complications: The most common obstetric complications include hydramnios, pre-eclamptic toxemia, urinary tract infections, vaginal moniliasis and premature labour. Hyperemesis gravidarum and infections are associated with a higher risk of ketosis in diabetic women. Diabetic retinopathy may worse during pregnancy.
Fatal Complications: These include intrauterine death, prematurity, congenital anomalies, respiratory distress syndrome and hypoglycemia. Incidence of intrauterine fetal death can be reduced by proper control of the diabetic state. Perinatal mortality is increased due to placental insufficiency, prematurity or trauma during birth.
Diabetes In Pregnancy
Management Of Diabetes In Pregnancy
The mother’s diabetes tends to become more severe during the first trimester of pregnancy. Vomiting and hyperemesis gravidarum may jeopardize the management of diabetes. In mid-pregnancy, the diabetic state stabilizes, but in the last trimester, the severity increases. The diabetic mother should have regular antenatal check- up since control should be based on blood sugar levels which should be kept below 130 mg/dl (7.2 mmol/liter). Mild cases may respond with controlled diet alone. Mothers who develop diabetes during pregnancy and even those who were previously controlled by oral hypoglycemic drugs tend to become insulin-dependent. Two daily injections of soluble insulin, sometimes in combination with NPH, may be needed from about the 20th week of pregnancy. By the 32nd week of pregnancy, hospitalization is desirable for overall assessment. From this period, the risk of intrauterine death of fetus progressively increases until delivery. Choice of delivery and its timing depend upon the fetal pulmonary maturity which can be assessed by determining the lecithin/sphingomyelin ration in the amniotic fluid. The incidence of respiratory distress syndrome is higher in babies delivered by caeserian section and hence vaginal delivery is preferable. Ultrasonography is a very helpful investigation to assess fetal size and maturity.
© 2014 Funom Theophilus Makama