Diabetes mellitus is one of the health conditions that have been associated with significant healthcare burdens in recent years. Various types of diabetes exist including diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and other forms of diabetes attributed to factors such as genetics and drug-related factors. Understanding the presentation and diagnostic characteristics of the different types of diabetes mellitus is the first step to recognizing their impacts on the health of victims. For instance, gestational diabetes affects only pregnant women and is not overt after delivery, yet it is also risky for both the short and the long-term and requires effective management practices to enable patients have a strong positive health-related quality of life.
Types of Diabetes
Diabetes Mellitus is one of the major causes of morbidity and mortality across the globe. The condition is a progressive metabolic disorder that is characterized by abnormalities in the metabolism of proteins, glucose and fats. These abnormalities commonly result in hyperglycemia, which can be a cause of mortality if not managed effectively. In the United States, nearly 9.4% of the population has been diagnosed with various forms of diabetes mellitus (9.4 million people) (Woo & Robinson, 2015). Approximately 7.2 million cases of diabetes mellitus are still undiagnosed and the numbers are increasing (Woo & Robinson, 2015). The increasing prevalence of diabetes, its implications on productivity and healthcare costs warrants research into risk factors for the different forms of the condition and the management approaches suitable for them.
Diabetes mellitus has four variants namely, type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes and other forms caused by factors such as genetic defects either in beta cell function or in insulin action. Type 1 diabetes mellitus results from the destruction of beta cells, which leads to the deficiency of insulin (Woo & Robinson, 2015). Type 2 diabetes mellitus on the other hand, is characterized by progressive insulin resistance or insulin secretory defect (Woo & Robinson, 2015). The gestational diabetes mellitus refers to a variant of diabetes mellitus that emerges (is diagnosed during pregnancy) and is not overt post-delivery (Woo & Robinson, 2015). The other form of diabetes can be due to genetic factors such as those outlined earlier or drug-induced causes such as treatments for HIV/AIDS and corticosteroid use (Woo & Robinson, 2015). While these are the major categories of diabetes mellitus, there are patients who cannot be assigned to any of the four major categories. These include patients considered to be pre-diabetics (have been diagnosed with glycemic control abnormalities early on) (Woo & Robinson, 2015). Diagnosis of specific types of diabetes mellitus in a patient requires consideration of the presentation and disease progression. Presentation is characterized by the genetic presentation, differences in onset age, complications and options for effective treatment.
Insulin Treatment for Gestational Diabetes
Individuals with gestational diabetes usually require higher insulin amounts in therapy compared to other people. During pregnancy, placental hormones produced to facilitate the growth of the fetus oppose the impacts of insulin in the blood. For most women therefore, maintaining a balanced diet is inadequate for stabilizing the blood sugar levels, and insulin injections are needed (Queensland Government, 2013). In such women, the need for insulin is conventionally 2 to 3 times more than the amount taken in with other types of diabetes (Queensland Government, 2013). Up to 50% of women suffering from gestational diabetes require insulin injections in order to maintain their blood glucose levels during pregnancy (Queensland Government, 2013). Maintaining the blood glucose levels within an appropriate range during pregnancy helps in preventing pregnancy complications. Insulin therapy can then be stopped during labor for women whose conditions are entirely caused by the pregnancies.
Different types of insulin are available for use in different ways and at different times. Patients with gestational diabetes rely on the advice of their doctors with respect to the best type of insulin for their needs. The administration process is also different, whereby there is insulin that can be administered by injection and that administered using an insulin pen (Queensland Government, 2013). In most facilities, small dosages of insulin are prescribed and the dose is gradually increased until a level where the corresponding gradual decline in blood glucose levels to a final normal range. The specific dynamics of this process however varies from one person to the other. The duration taken for the blood glucose to normalize following insulin therapy is also variable from one person to another.
Dietary Recommendations for Gestational Diabetes
Besides adhering to medication as advised by physicians, patients with gestational diabetes are also required to adhere to certain dietary practices. The objective of maintaining the recommended dietary measures is to ensure that the blood sugar level remains within the recommended range (UCSF, n.d). The first step towards achieving this is through controlling carbohydrate intake. Carbohydrates are the most important sources of glucose in the body and have to be considered carefully. Checking the nutritional information of all foods is thus extremely important for patients with gestational diabetes. To effectively control the carbohydrate intake, it is recommended that patients with gestational diabetes should work closely with dieticians to determine their daily carbohydrate intake needs and to develop a meal plan based on the recommended amounts of different types of food (UCSF, n.d). In this way, it becomes possible for gestational diabetics to control their blood sugar without jeopardizing the health of their babies.
Secondly, it is recommended that foods should be distributed evenly throughout the day. Overconsumption at any given time can result in significant spike in blood sugar, which is contrary to the recommended dietary practices. Additionally, every meal should be accompanied by starch since starch is an important source of nutrients for the growing baby in spite of it being a source of glucose as well (UCSF, n.d). Those with gestational diabetes should also take one glass of milk at a time since milk is a liquid carbohydrate and too much consumption at a time can increase the blood sugar levels (UCSF, n.d). In the mornings, it is usually more difficult to control blood sugar levels due to hormonal fluctuations and certain foods may not be acceptable as breakfast. It is therefore important for individuals with gestational diabetes to focus on tolerated proteins as a good source of energy and nutrients in the morning instead of fruits, cereals or even milk (UCSF, n.d). Lastly, the objective of controlling blood sugar levels implies that patients with gestational diabetes should keep away from sweets, added sugars and high amounts of fruit juice, which can be detrimental to their health.
Short-Term and Long-Term Effects of Gestational Diabetes
Gestational diabetes mellitus is associated with various adverse maternal and fetal effects in the long-term. According to Shou, Wei, Wang, and Yang (2019), gestational diabetes increases the risk of cardiovascular disease in the other over the long-term, as well as risks of chronic kidney diseases and cancer. It is also associated with maternal hyperglycemia, which has been linked to various long-term outcomes in offspring including risks of obesity, resistance to insulin and issues in neurocognitive development. In pregnancy, hyperglycemia is reported to be less severe than among patients with overt diabetes yet with independent associations to increased maternal and neonatal risks. Through a study dubbed the Hyperglycemia and Adverse Pregnancy Outcome (HAPO), which was conducted in 2008, it was established that the child outcomes were not confounded following hyperglycemia treatment (Shou et al., 2019). This finding gives the impression that unlike other forms of diabetes mellitus, gestational diabetes mellitus has long-term effects on children whether treated or not. Furthermore, it is shown that in spite of the evidence that gestational diabetes mellitus results in these outcomes, it has not been clearly established whether treating the disease can reverse the negative health outcomes in the long-run (Shou et al., 2019). In the short-term however, Shou et al. report that the treatment of gestational diabetes mellitus has immediate short-term benefits on both the mother and the child. It is thus deductible that gestational diabetes mellitus is a life-impacting disease that should be prevented at all costs.
The healthcare burden associated with diabetes has grown tremendously over the last few years. Diabetes mellitus, which is associated with these healthcare burdens can be categorized into several classes including type 1, type 2, gestational and other forms attributed to genetic compositions and drug-related factors. Gestational diabetes mellitus occurs only in pregnant women and ends after delivery. However, the treatment of gestational diabetes mellitus requires administration of 2-3 times higher insulin levels relative to that administered to patients with other types of diabetes mellitus. Additionally, dietary recommendations aimed minimizing blood glucose levels are provided for individuals suffering from gestational diabetes mellitus. The condition is a significant cause of concern due to its long-term effects both in the mother and in the child, which are difficult to reverse even through treatment.
Queensland Government. (2013). Commencing insulin therapy. Creative Commons Attribution. Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0022/621634/sdcn-insulintherapy.pdf
Shou, C., Wei, Y-M., Wang, C., & Yang, H-X. (2019). Updates in long-term maternal and fetal adverse effects of gestational diabetes mellitus. Maternal- Fetal Medicine, 1(2), 91-94. Retrieved from https://journals.lww.com/mfm/Fulltext/2019/10000/Updates_in_Long_term_Maternal_and_Fetal_Adverse.7.aspx#:~:text=Gestational%20diabetes%20mellitus%20(GDM)%20is,kidney%20disease%2C%20and%20cancer%20risks.
UCSF. (n.d). Dietary recommendations for gestational diabetes. Retrieved from https://www.ucsfhealth.org/education/dietary-recommendations-for-gestational-diabetes
Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. F.A Davis.