Diabetes is a disease resulting from insufficient action of the hormone insulin. There are two main clinical forms: type 1 and type 2. Type 1 is much less frequent, accounting for about 5% of cases.
In this clinical form, the insufficiency is total due to the destruction of the pancreatic cells producing insulin, the beta cells. This occurs because of antibodies produced by the patient himself. The reasons why this antibody production exists is still controversial.
In type 2, the insufficiency is relative. Insulin is produced but not sufficient for current needs. In most cases, it occurs in people who are overweight.
With the greatest amount of adipose tissue, a resistance to hormonal action develops. In response, the pancreas has to increase the secretion of insulin to overcome the obstacle that has been created.
If the organ is able to overcome the challenge, the metabolism remains normal. This occurs in those who are overweight, without diabetes. However, in cases where there is a history of inheritance of this disease, often not known, the pancreas is not able to sufficiently increase the production of the hormone.
In this way, type 2 diabetes appears. The mechanism by which the disease sometimes develops during pregnancy is similar.
Peripheral resistance to the action of the hormone, here caused by the production of placental hormones. These are essential substances for fetal development, but also cause resistance to insulin action. If the pancreas has sufficient reserve capacity, the metabolism remains normal.
When the organ is not as competent as it should, gestational diabetes appears and needs to be treated. If this does not happen properly, there will be negative repercussions for the fetus and the pregnant woman. In a reasonable number of pregnancies, about 5% of cases, this occurs. Because of this, it is recommended that during the prenatal, between the 24th and the 28th week, the possibility of its existence be investigated. This evaluation is done by the determination of blood glucose, after a fasting of eight to 14 hours.
The other way to perform this diagnosis is to determine the glycemic levels one and two hours after the ingestion of 75g of glucose. With childbirth, the secretion of placental hormones no longer exists. As a result, in most patients their metabolisms normalize so they do not remain diabetic.
But some of them continue with the disease. It is emphasized that those that become normal after gestation, probably repeated the same problem in a next one. This is what occurs in women who did not have the disease before becoming pregnant. When diabetes already exists, the action of placental hormones will obviously aggravate the disease. As a result of this scenario, there will be a need to strengthen therapeutic measures.
When the disease occurs during pregnancy, it can be treated only with diet and exercise. If metabolic normalization is not achieved with these measures, other resources may be used, such as the use of oral drugs and, if necessary, insulin.
In patients who are already sick before pregnancy, virtually all of them will require the administration of the hormone. The recommended metabolic control is as rigid as possible.
The blood glucose levels that are attempted to obtain are even lower than for diabetics out of gestation. Some recommend that diabetic patients should have as much control as possible even before they become pregnant. Such conduct would decrease the likelihood of poor congenital formations – more frequent in this type of patients.
To achieve control at the recommended levels, when using insulin, several applications should be made during the day or use the continuous hormone infusion pump. Because of the recommendation of a strict metabolic control, it is recommended that they be accompanied by diabetologists, who are specialists in this condition.
* He is an endocrinologist and writes biweekly in this space.