Tag: Pregnancy

What are the different types of diabetes?

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This week marks the beginning of Diabetes Week. This year the main focus is on, the misconceptions people have in terms of what diabetes is and how it affects individuals. The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.

There are many myths which surround diabetes, that make it hard for others to believe how deadly diabetes can be. Stereotypes and stigmas have created an inaccurate image of  what the condition really is. As a diabetic blogger, I feel the responsibility to spread the correct message to my readers.  Let’s start by setting the message straight about the different types of diabetes that can occur.

There are many types of diabetes, the main types include; type 1, type 2, gestational diabetes and MODY (Maturity Onset Diabetes of the Young). Diabetes is a long- standing condition that affects the body’s ability to process glucose (sugars). All these types cause blood glucose levels to increase. Glucose levels are high due to the body’s inability to use the glucose properly.

This occurs because the pancreas either:

  • No longer produces insulin
  • The amount of insulin being produced is not enough, or
  • The insulin that is being produced does not work properly (Insulin resistance)

Therefore glucose is not able to enter into the cells and remains in the blood stream.

Type 1

Type 1 is an autoimmune disorder, which occurs due to the body’s immune system attacking and killing beta cells (insulin cells) in the pancreas, where they are made. The reason why this occurs still hasn’t been discovered, however there are researchers constantly working to find out this very reason. This autoimmune disorder is usually diagnosed in children but can also affect people up to the age of 30, resulting in no insulin being produced. People with this condition learn to use insulin therapy to manage their diabetes.

Type 2

Type 2 diabetes is the most common type of diabetes. It occurs due to insulin resistance, where the pancreas either does not produce enough insulin or the insulin that is being produced does not work properly. Type 2 diabetes for some people can be managed through diet and exercise. Some people also need medication to manage their blood glucose levels/ diabetes.

Gestational diabetes

Gestational diabetes affects women during pregnancy. This usually occurs during the second or third trimester. Women who develop gestational diabetes during their pregnancy usually don’t have diabetes beforehand and for some women gestational diabetes disappears after the birth of the baby. Women who are diagnosed with gestational diabetes in the first trimester, there is a possibility that the condition existed beforehand.

During the second trimester blood tests are done to determine whether or not gestational diabetes is present. If gestational diabetes was present in previous pregnancies, then tests are performed earlier.

Pregnancy hormones can affect the body’s ability to allow insulin to function as it should. This can then cause insulin resistance to occur. Pregnancy already puts a huge strain on the body, so this additional strain on the body can sometimes cause some women to develop gestational diabetes.  Woman who are likely at risk include, women who have suffered from gestational diabetes before, overweight or obese women, women who have had very large babies and have had a family history of diabetes.  Ethnicity also plays a huge part in the development of gestational diabetes. If you are of, Caribbean, South Asia, African or Middle Eastern decent, then you are at a higher risk of developing gestational diabetes.

MODY diabetes or Type 3 diabetes

What is this type? MODY stands for Maturity Onset Diabetes of the Young. This type of diabetes is quite different from both Type 1, Type 2 and gestational diabetes. It is strongly present in families and is triggered by a mutation in a single gene. If a person carrying this gene has a child with a person who doesn’t carry the gene, then any children they have will have a 50 % chance of inheriting the gene. If a child inherits this gene they will then go onto develop MODY before they reach 25 years old, whatever their weight, lifestyle or ethnicity. These diabetic also don’t necessarily need to take insulin either.

Types of MODY:

  • HNF1-alpha– this is the most common type of MODY and can be found in populations with European ancestry. It accounts for about 70% of all cases in Europe. People with this type of MODY don’t need to take insulin, instead they take a mixture of sulphonylureas tablets.

  • HNF4-alpha– this type of MODY is very rare and usually affects people whose birth weight was more than 9lbs or suffered a low blood sugar level after birth. People who have this type of MODY are also treated with sulphonylureas tablets.

  • HNF1-beta – People with this type of MODY develop several problems which can include; renal cysts, abnormalities in uterine, gout as well as diabetes. With this type of MODY, if diabetes develops insulin treatment becomes essential. A healthy diet and exercise must also be followed to manage diabetes better.

  • Glucokinase – This gene once present and functioning allows the body to recognise increase in blood glucose levels. If this gene isn’t working then the body isn’t able to detect high blood glucose levels, allowing the BG level to go higher than it should. The BG level is only slightly higher between ( 5 – 8 mmols/l). There are no noticeable symptoms and it can only be detected through routine tests. No treatment is needed for this type of MODY.

It’s extremely important to know if you have any of these MODY types. If treatment is needed then you can then get it. Also if you have the gene, there is a 50 % chance that you could then pass this gene onto your children. Therefore genetic testing usually is extended to other family members.

I hope that this has helped you to understand the different types of diabetes that can occur.  For more information on the prevalence of diabetes and also if you want to help to spread the correct message, then click the links below.

Diabetes Facts and stats 

Diabetes Awareness Poster (print and share)

You can also follow me on twitter, instagram and facebook.

Thanks for stopping by friends

Amina xx

Sugar High Sugar Low: Preparing for pregnancy

Before conceiving I had a lot of things to contemplate such as being fit, healthy, eating well, having tight control of my blood glucose levels and most important of all achieving at least an A1c of 7.0%. Both diabetes and pregnancy combined have their own unique challenges. I knew that I would have a lot of hard work ahead of me.pregnancy tagcloud pictogram

My diabetes appointments are usually quarterly at the diabetic centre. My previous appointment showed that my A1c was 7.5%, so I decided to visit my diabetic team and inform them of my plan, as I did with my first pregnancy. The diabetic nurse retested my A1c and after two weeks I found out my A1C was actually 7.3%. Blood glucose control is vital during pregnancy because if you can imagine even before you’re aware of your pregnancy, your baby’s brain, spinal cord, heart and other organs have already started to form. This totally freaks me out because without tight control I could have possibly affected the way in which my child developed.

I was given the opportunity to have a trial run of the dexcom G4 sensor for a month which I talked about in my post, “Cyborg for a month or perhaps longer”.

Dexcom G4is a continuous glucose monitoring (CGM) sensor which is inserted into the body and is able to give blood glucose readings every five minutes. The sensor automatically transmits this reading to my insulin pump (Animas Vibe) and creates a graph. With my insulin pump I am able to set an ideal blood glucose range. If my blood glucose level goes above or below this range my insulin pump alarms to alert me of either an increase or decrease in blood glucose level.

My trial run actually went on for longer than a month and it was during that time that I conceived. My pregnancy journey had started and with my team we made the decision to continue with the CGM during this pregnancy. To start with the CGM really helped me achieve tighter control and a better understanding of patterns occurring at certain times in the day. After a month my A1c had dropped to 6.4%.

By week five of my pregnancy I had developed severe morning sickness. I was a complete mess. I had no appetite, I lost a lot of weight and I needed far less insulin. My insulin requirement continued to decrease during the next few weeks. The morning sickness continued and to make matters worse my CGM didn’t seem to want to cooperate. The readings on my insulin pump compared to a finger prick reading was completely different. It stopped picking up low and high blood glucose levels. It just did the complete opposite.

I was able to change my sensor and transmitter  a few times but unfortunately every time I got a new one the same problem occurred. No matter where I placed the sensor on my body it would react in the same way. My diabetic doctor seemed to think that it could possibly be the pregnancy hormones interfering with the sensor. I went one step further and decided to contact Dexcom with regards to this. They were unable to conform if this was a possibility or not. I was told that no research has ever been done on the effects of pregnancy hormones and the accuracy of this sensor.

My doctor asked me if I’d prefer to go without the sensor and I agreed to go without it for the duration of my pregnancy. I began my rigorous blood glucose testing and on some days I’d test up to fifteen times.

logbookHaving good control minimised risks such as miscarriage and birth defects. My pregnancy was able to progress well almost as if I did not have diabetes. Four months into my pregnancy I managed to achieve an A1c of 5.7% and it remained that way throughout the pregnancy

With the help of my antenatal diabetes consultant I was able to plan my target blood glucose range so that my blood glucose could be as close to normal as possible during my pregnancy. We also discussed and looked in detail at basal rates, insulin to carb ratio’s and insulin sensitivity. I was able to be in contact with him on a daily basis and then I attended the diabetic antenatal clinic every week. In actual fact I was very lucky to have had a team of people accessible to me which consisted of x3 diabetic midwives, x2 OBGYN’s x1 antenatal diabetes consultant and a dietician. I also still had contact with my diabetes team from before my pregnancy. I WAS VERY LUCKY!

Another important factor with diabetes and pregnancy is the health of your eyes. I had to have my eyes checked every trimester by the Eye hospital to make sure that no changes were occurring. A month after the birth of my first child, I developed changes in my eyes which then corrected themselves strangely enough. However it is routine for diabetics to have regular screenings during their pregnancy here in Manchester.

Preparing for pregnancy and the pregnancy itself was extremely difficult. I had moments when I felt stressed out, happy, anxious, nervous and mostly worried. Regardless, I felt that patience and maintaining a serene demeanour was definitely key to having a healthy pregnancy and ultimately a beautiful healthy baby.

Amina xx