Diabetes during pregnancy

Diabetes during pregnancy
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First Published: Wed, Oct 17 2007. 01 11 AM IST

Jayanti Krishnan with son Rishabh, 12, and daughter Damini, 6
Jayanti Krishnan with son Rishabh, 12, and daughter Damini, 6
Updated: Wed, Oct 17 2007. 01 11 AM IST
Soma Oberoi
Housewife
For Oberoi, this was a precious pregnancy. She was just about through with morning sickness and fears for the safety of the baby. The fetal movements were strong and she had managed to allay her fears after going through a number of late pregnancy-related tests. She had also started enjoying the prospect of motherhood.
But in some routine tests done after the 27th week, some of the results showed a slightly above normal result. The doctor immediately asked for a Glucose Tolerance (GT) blood test. When the result came in, Oberoi was devastated. She had gestational diabetes mellitus (GDM).
This was one complication she had not anticipated and the doctor’s recommendation that she would have to be hospitalized for a week to be monitored for how much insulin she would require a day, filled her with dread.
Gynaecologist Vijaylakshmi Bhargava at the Sitaram Bharti Institute of Research and Medical Sciences in New Delhi, suggested that she meets the diabetologist immediately and also prescribed additional tests. Arvind Kumar, the diabetologist, calmed a distraught Oberoi and her husband. His assurance that GDM and diabetes were two different things reassured them a little. Taking into consideration her fear of daily injections, he suggested that Oberoi go on a diet and exercise regimen for 10 days to see if GDM could be managed without insulin.
During that time however, she would have to monitor her insulin level at all three mealtimes and maintain a record of the readings. Kumar would review the reports and then decide if more aggressive intervention was needed.
Heaving a sigh of relief, Oberoi started on the diet and walk regimen, morning and evening. Test results revealed a change in insulin levels but at the end of 10 days, it was found to be insufficient, given how far the pregnancy had advanced. “The values required are very strict,” says Arvind Kumar, “The fasting blood sugar has to be below 90, and two hours after a meal, it has to be 120.” If the condition was allowed to go without intervention, it could lead to complications for the baby as well as complications during delivery. There was little option for Oberoi but to start insulin injections three times a day.
Trawling the Internet for more information on GDM, Oberoi and her husband were filled with fear. There were several complications that could arise. And, as is common in such situations, friends and relatives had varied experiences to relate. One had delivered an 8kg baby by the end of the seventh month. Somebody in the family ended up having a baby with a large head who did not survive, another baby was born with a hole in the heart. To Oberoi and her husband, it seemed a scary scenario. “I did not believe that GDM would go away. Besides, I had a family history of diabetes. The future seemed bleak and I was sure that I would be diabetic for life,” says Oberoi.
Oberoi was put on an aggressive plan. She would have to be on a strict diet, monitored by a nutritionist. She would have to take insulin three times a day and monitor her blood sugar before and after every meal. She would have to exercise for 45 minutes both morning and evening. And the baby would be frequently monitored through an ultrasound.
Oberoi put aside her fears and took to the regimen. Her doctors repeatedly assured her that GDM would go away after the delivery. The rigorous diet and exercise regimen kept her occupied. Ultrasound monitoring showed absolutely normal growth of the baby in terms of weight and size.
At the end of 38 weeks, Oberoi delivered a baby girl. All of 3.2kg, the baby was healthy, not overweight as she feared. There were no complications. But the most incredible thing was that her insulin level became normal immediately. “I was no longer diabetic,” says an ecstatic Oberoi.
Jayanti Krishnan, 40
Housewife
Jayanti Krishnan with son Rishabh, 12, and daughter Damini, 6
This mother of two, however, was not so lucky. She developed GDM during both her pregnancies but after her younger daughter Damini was born, the sugar levels did not come down but remained stubbornly high. “Perhaps family history has something to do with it,” reckons Krishnan, who describes how a couple of other women in her family had the same experience—diabetes which developed in pregnancy continued even afterwards.
During her first pregnancy, Jayanti managed to control her blood sugar through a diet that largely consisted of sprouts and a strict exercise regime, but during the second pregnancy, her sugar levels were so high (240) that her gynaecologist, who was on the verge of retirement, refused to handle her case.
Dr Seth at Escorts Hospital in New Delhi took her on, and advised her to buy a glucometer and monitor her blood sugar four times a day. Insulin injections were taken morning and evening. Both her babies were delivered three weeks before full term. During the second pregnancy, she also developed gall bladder stones that led to pancreatitis.
Although still diabetic, Jayanti manages with oral medication. But she has to maintain a fierce exercise and diet regimen. “Now I have been advised to even eliminate carbohydrates from my diet,” she says.
Write to us at businessoflife@livemint.com
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First Published: Wed, Oct 17 2007. 01 11 AM IST