During period one
the patients injected the insulin bolus before the meal and, during period two, after the Estrogen antagonist meal. The variability of blood glucose (BG) was assessed by low BG indices (LBGI) and high BG indices (HBGI) – the measure of the variability of low and high BG readings. Their sum (LBGI + HBGI) gives the BG risk index (BGRI) – a measure of overall variability and deviations towards hypo- and hyperglycaemia. Six patients were on CSII and six on MDI. The number of meals, number of insulin injections and average BG were not different between the groups. LBGI and the number of hypoglycaemic events were not affected by the method of injection. BGRI were significantly higher for post-meal injection, mainly due to increased hyperglycaemia (p=0.003). The increased HBGI and BGRI were more prominent in CSII (p=0.05). These differences were found for the 72-hour variability but not when testing 2 hours post-prandially.
It was Saracatinib concluded that injecting insulin prior to the meal can reduce the overall glucose variability, and remains the preferred method of injection. Larger studies are needed in order to reinforce these results. Copyright © 2012 John Wiley & Sons. “
“Gestational diabetes mellitus (GDM) is common, with an average prevalence in England and Wales of approximately 3.5%. It is associated with a 70% lifetime risk of developing type 2 diabetes mellitus (T2DM) for the women in the long term. It is therefore important to continue lifelong monitoring for abnormalities of glucose metabolism. There is a lack of international consensus on the best postpartum screening test, its timing, and the frequency and duration of long-term follow up after GDM. In general, screening rates are suboptimal
across the globe with perhaps an optimistic trend in recent years with just over half of the women completing Cyclin-dependent kinase 3 postpartum screening. Postpartum diabetes screening may detect T2DM and enable early treatment of hyperglycaemia, reducing the risk of adverse fetal outcomes in subsequent pregnancies and maternal microvascular complications. Screening can also identify women who might benefit from diabetes prevention interventions. Metformin has been shown to reduce the rate of diabetes development following delivery by 50% and should be considered in all cases of GDM if tolerated. Copyright © 2010 John Wiley & Sons. “
“Appropriate management of diabetes during labor and delivery plays a significant role in ensuring the wellbeing of the mother and neonate. Maternal hyperglycemia is the major cause of neonatal hypoglycemia. The role of the physician during this period is to maintain maternal euglycemia in order to prevent ketoacidosis and reduce the risk of neonatal hypoglycemia. Management of diabetes during labor should follow an established protocol in a dedicated center with a neonatal care unit equipped and staffed to deliver the most sophisticated level of care.