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Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier
Diabetes is an increasingly common, life-long health condition. There are 3.5 million people diagnosed with diabetes in the UK, and an estimated 549,00 who have the condition but do not know it. In diabetes, the amount of glucose in the blood is too high - hyperglycaemia - either because the pancreas doesn't produce any insulin, or not enough insulin, or because the individual has developed insulin resistance. There are two main types of diabetes: Type 1, in which beta cells in the pancreas fail to produce insulin. This type usually develops before the age of 40, but is often diagnosed in childhood. It is treated with daily insulin doses, usually by self-administered injection, or by insulin pump. Type 2, in which the amount of insulin produced is inadequate or insulin resistance has developed. Type 2 diabetes usually appears in people over the age of 40, but increasingly is seen in younger people. It is treated with diet, exercise and oral hypoglycaemic agents (OHA). People often require more than one OHA to achieve target blood glucose levels. People with diabetes are at serious risk of vascular complications including loss of sight (retinopathy), kidney failure (nephropathy), cardiovascular disease, and nerve damage (neuropathy), which can result in intractable ulcers and amputation. [Itlaics]See also, [bold]Gestational diabetes Diabetic complications such as retinopathy and nephropathy may worsen during pregnancy, particularly if associated with hypertension. Women who have severe neuropathy or cardiovascular disease may be advised against pregnancy. Infants of insulin-dependent diabetic mothers have ten times the general population risk of congenital malformation, and five times the risk of stillbirth. The aim of preconception care is to achieve as close to normal blood glucose levels as possible both pre- and peri-conception as many of the problems above are a direct result of hyperglycaemia Most currently available OHAs in pregnancy are contra-indicated in pregnancy, but the British National Formulary recommends that women with pre-existing diabetes can be treated during pregnancy with metformin (unlicensed use) alone or in combination with insulin. Metformin can be continued, or a sulfonylurea resumed, during breastfeeding.
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