Saturday, May 5, 2012

I had diabetes during my last pregnancy. Am I at risk of diabetes in the future?

Yes, you are at high risk both of having type 2 diabetes in the  future and of having diabetes again with your next pregnancy. The reason for this is that women des- tined to get type 2 diabetes in middle age or beyond tend to be the same women who will develop diabetes in pregnancy. Therefore, the  presence  of diabetes in pregnancy is an indicator of future risk for type 2 dia- betes. Because type 2 diabetes is a disorder of aging, the diabetes in pregnancy tends to be more severe and requires more intensive treatment with each successivepregnancy, unless steps are taken between pregnancies to  reverse  one  or  more  risk factors, such  as excess weight or lack of exercise.

Can diabetes sometimes be temporary and go away again?

Yes, this can and does occur, in the case of both types of  diabetes. However, in the case of type 1 diabetes, the  disappearance is very predictably temporary and the   diabetes   will  almost  inevitably  retur within months or a year or two. The reasons for it are com- plex and relate to the fact that type 1 diabetes is often diagnosed under conditions of physical stress. When the diabetes is treated and the stress to the body has resolved, there  may be sufficient remaining  insulin- producing capability in the pancreas to keep the blood sugar normal under  most  circumstances. Eventually, however, the  pancreas fails  and  permanent  diabetes supervenes. In the case of type 2 diabetes, although the hereditary factors causing it cannot be reversed, the environmen- tal and lifestyle factors can be changed. The latter are the cause of the explosive rise in the number of people affected with diabetes in recent years.Although we do not generally refer to type 2 diabetes as  being  cured   once   it  has  been  diagnosed  it can certainly  go into remission (cease to  be an  active medical problem) for  long periods, depending  on  how successfully the  causative  factors are addressed. Because excess weight  and  sedentary lifestyle are  the  two  most  important   and  serious causative factors, weight reduction and adherence to an exercise program  can often put type 2 diabetes into remission for as long as they are maintained. Some- times, all  medications, even insulin, can be stopped and all measures of  diabetes, including blood glucose and hemoglobin A1c  (HbA1c—the  measure of your blood sugar control averaged over 3 months), will com- pletely normalize. Other associated conditions, such as high blood pressure and cholesterol abnormalities, will also improve greatly. The  possibility of  stopping  all medications is more likely to occur earlier in the course of diabetes and before long-term complications have developed. Unfortunately, many of us in modern soci- ety are unable to sustain weight reduction and exercise for long periods and the failure rate is high.

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