In medicine, relevant people have made relevant investigations on diabetes during pregnancy. For people with diabetes during pregnancy, do you know what causes this? Do you know what symptoms diabetic patients have during pregnancy? Let me tell you, let's take a look.

According to medical research, there are two situations in which women suffer from diabetes during pregnancy. One is that they have been diagnosed with diabetes before pregnancy. Diabetes complicated with pregnancy? . The other is diabetes with normal glucose metabolism before pregnancy or with potential impaired glucose tolerance, which only appears or is diagnosed during pregnancy. Gestational diabetes (GDM)? .

cause of a disease

In the first and second trimester of pregnancy, with the increase of gestational age, the demand for nutrients in the fetus increases, and obtaining glucose from the mother through the placenta is the main source of fetal energy. The plasma glucose level of pregnant women decreased with the progress of pregnancy, and the fasting blood glucose decreased by about 10%.

cause

This is because the amount of glucose that the fetus wants to get from the mother is increasing, and the renal plasma flow and glomerular filtration rate are increasing during pregnancy. However, the glucose reabsorption rate of renal tubules cannot be increased accordingly, which leads to the increase of glucose excretion in some pregnant women, and estrogen and progesterone increase the utilization of glucose by the mother.

Therefore, the ability of pregnant women to clear glucose on an empty stomach is stronger than that of non-pregnant women. The fasting blood sugar of pregnant women is lower than that of non-pregnant women, which is also the pathological basis of hypoglycemia and ketoacidosis in pregnant women who are prone to fasting for a long time.

In the second and third trimester of pregnancy, the increase of anti-insulin-like substances in pregnant women, such as placental lactogen, estrogen, progesterone, cortisol and placental insulinase, makes the sensitivity of pregnant women to insulin decrease with the increase of gestational age.

In order to maintain the normal level of glucose metabolism, the demand for insulin must increase accordingly. For pregnant women with limited insulin secretion, this physiological change can not be compensated during pregnancy, which will increase blood sugar, aggravate the original diabetes or appear GDM.

1. Effect of pregnancy on diabetes mellitus

Pregnancy can make recessive diabetes manifest, make pregnant women without diabetes develop GDM in the past, and aggravate the condition of patients with diabetes.

For pregnant women, fasting blood sugar is low in the first trimester, and some patients may have hypoglycemia if the amount of insulin is not adjusted in time for pregnant women who are medically advised to use insulin. With the progress of pregnancy, anti-islet-like substances increase, and the dosage of insulin needs to be increased continuously.

In the process of delivery, physical exertion is large, and food intake is small. If insulin dosage is not reduced in time, hypoglycemia is prone to occur. When the placenta is discharged from the body after delivery, the anti-insulin substances secreted by the placenta quickly disappear, and the insulin dosage should be reduced immediately. Due to the complex changes of glucose metabolism during pregnancy, if the dosage of insulin is not adjusted in time, some patients may have low or high blood sugar, and even lead to hypoglycemia coma and ketoacidosis in severe cases.

2. The effect of diabetes on pregnancy

The influence and degree of pregnancy complicated with diabetes on fetus depends on the condition of diabetes and the level of blood sugar control. Severe illness or poor blood sugar control have a great impact on mother and baby, and the short-term and long-term complications of mother and baby are still high.

Treatment of gestational diabetes mellitus

1. Indices of whether a diabetic can get pregnant.

(1) Diabetic patients should determine the severity of diabetes before pregnancy. Once pregnant, D, F, R-grade diabetes is more dangerous to mother and baby, so contraception should be used instead of pregnancy. If you are pregnant, you should terminate it as soon as possible.

(2) Patients with mild organic lesions and good blood sugar control can continue pregnancy under active treatment and close monitoring.

(3) From the time before pregnancy, with the assistance of physicians, strictly control the blood sugar value to ensure that the blood sugar is within the normal range before pregnancy, pregnancy and delivery.

2. Management of pregnant women with abnormal glucose metabolism

(1) Satisfactory standard of blood glucose control during pregnancy

Pregnant women have no obvious hunger, and their fasting blood sugar is controlled at 3.3 ~ 5.6 mmol/L; 30 minutes before meals: 3.3 ~ 5.8 MMO1/l; 2 hours after meal: 4.4 ~ 6.7 mmol/L; At night: 4.4 ~ 6.7 mmol/L.

(2) Diet therapy

Diet control is very important. The ideal goal of diet control is not only to ensure and provide calories and nutritional needs during pregnancy, but also to avoid postprandial hyperglycemia or hunger ketosis and ensure the normal growth and development of the fetus.

Most GDM patients can control their blood sugar in a satisfactory range through reasonable diet control and appropriate exercise therapy.

Pregnant women with diabetes in the first trimester need the same calorie as before pregnancy. After the second trimester, the weekly calories increase by 3% ~ 8%. Among them, sugar accounts for 40% ~ 50%, protein accounts for 20% ~ 30%, and fat accounts for 30% ~ 40%. Control the postprandial 1 hour blood glucose value below 8 mmol/L. However, we should pay attention to avoid excessive diet control, otherwise it will lead to hunger ketosis in pregnant women and fetal growth restriction.

(3) drug therapy

The safety and effectiveness of oral hypoglycemic agents in pregnancy have not been confirmed enough, so they are not recommended at present. Insulin is a macromolecular protein, which does not pass through the placenta and is the main therapeutic drug for diabetes that cannot be controlled by diet.

The dosage of insulin varies greatly among individuals, and there is no unified standard for reference. Generally, we should start with a small dose and adjust it according to the condition, pregnancy progress and blood sugar value, so as to control blood sugar at a normal level.

Insulin demand

① Patients who use insulin to control their blood sugar in the early pregnancy have reduced their food intake due to early pregnancy reaction, so it is necessary to reduce their insulin consumption in time according to blood sugar monitoring.

② With the progress of pregnancy, the secretion of anti-insulin hormone increases gradually, and the insulin requirement in the middle and late pregnancy often increases to varying degrees.

(4) treatment of ketoacidosis

While monitoring blood gas, blood sugar, electrolyte and giving corresponding treatment, it is advocated to apply small dose of regular insulin intravenous drip. Blood sugar? 13.9mmo 1/L, insulin was added into 5% glucose and sodium chloride injection for intravenous drip, and subcutaneous injection could be changed after ketone body turned negative.

Conclusion: Through the above introduction, do you have a further understanding of the symptoms of diabetes during pregnancy? Know what matters should be paid attention to in the diet of diabetes during pregnancy? In our usual diet, patients with hyperglycemia must pay attention to their eating habits and keep healthy.