NB: We use cookies to help personalise your web experience and comply with Irish healthcare law. This site contains information, news and advice for healthcare professionals.You have informed us that you are not a healthcare professional and therefore we are unable to provide you with access to this site. For decades, the diagnosis of diabetes was based on plasma glucose criteria — either the fasting plasma glucose (FPG) or the two-hour value in the 75g oral glucose tolerance test (OGTT). Since last year, the American Diabetes Association has recommended using the A1C test to diagnose diabetes, with a threshold of ?6.5 per cent. NICE recommends metformin as an option for first-line glucose-lowering therapy where blood glucose is inadequately controlled using lifestyle interventions alone. Metformin and the thiazolidinediones (TZDs such as pioglitazone) act on the liver to reduce hepatic glucose production. The glucagon-like peptide-1 (GLP-1) analogues, the inhibitors of dipeptidyl peptidase 4, (DPP-4 inhibitors) and the sulphonylureas are effective in the area of insulin secretion. There are two incretins, known as glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1). Incretins are going to dominate the field of diabetes over the next five years, Prof O’Shea said.
The active compound GLP-1 (7-36) is very quickly broken down by DPP-4 into the inactive compound GLP-1 (9-36). Lowering A1C to below or around 7 per cent has been shown to reduce microvascular and neuropathic complications of diabetes and, if implemented soon after the diagnosis of diabetes, is associated with long-term reduction in macrovascular disease. The landmark UKPDS trial of type II diabetes observed a 16 per cent reduction in cardiovascular complications (combined fatal or nonfatal myocardial infarction [MI] and sudden death) in the intensive glycaemic control arm. Aspirin therapy may be considered as a primary prevention strategy in those with type II diabetes who are at increased cardiovascular risk. Hypertension is a common comorbidity of diabetes, affecting the majority of patients, with prevalence depending on type of diabetes, age, obesity, and ethnicity.
Patients with more severe hypertension (systolic blood pressure ?140 or diastolic blood pressure ?90mmHg) at diagnosis or follow-up should receive pharmacologic therapy in addition to lifestyle therapy. The American Diabetes Association says that treatment should include an angiotensin converting enzyme (ACE) or an angiotensin II receptor blocker (ARB). Gastric reduction surgery, either gastric banding or procedures that involve bypassing, transposing or resecting sections of the small intestine — when part of a comprehensive team approach — can be an effective weight-loss treatment for severe obesity. Bariatric surgery has been shown to lead to near or complete normalisation of glycaemia in between 55-95 per cent of patients with type II diabetes, depending on the surgical procedure. Patients with type II diabetes who have undergone bariatric surgery need life-long lifestyle support and medical monitoring.
Dr Velma Harkins of the Irish College of General Practitioners, the National Clinical Lead for Diabetes Prof Richard Firth and Dr John Devlin of the Department of Health published guidelines in regard to diagnosis, targets for clinical care and the interventions that are appropriate at each stage of the disease. Metformin is contraindicated in those with renal impairment, those at risk of sudden deterioration of renal function and end-stage cardiac and hepatic failure. DPP-4 inhibitors such as sitagliptin and vildagliptin are approved as add-on therapy to metformin.
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I knew many other women pregnant with twins and the vast majority did not have GD, but it does heighten the risk.
That may seem like not many women to you, but when you think about how many pregnant women there are in the world at any give time you are NOT alone by far. GD does not mean for certain that your babies will be born prematurely, overly large, and does not mean you WILL have any further complications during labor and delivery.


However, if you lose the weight postpartum and go back to your former size or close, you have lower than a 1 in 4 chance of developing type 2 diabetes in the future. If you look back in my pregnancy journal you will see I was completely devastated with the GD diagnosis.
Also admittedly, the thought of pricking my finger 6 times a day, changing everything about my diet overnight, running to extra doctor appointments, and walking a tightrope looking at my levels on a meter all day long made me scared and feeling overwhelmed. It all may seem overwhelming but remember, it’s for such a short time when you think about it. The LIONS have been recently and suddenly forced to migrate with the wildebeests to new web server software, so everything is kinda messed up in the LION DEN right now. A complex web-style diagram showing how this disease causes its signs and symptoms. Flow chart shows the antagonistic effects of two hormones as they affect the concentration of glucose in the blood. Diagram shows the relationships of a group hormones: their sources, targets, and action. Arrows show the complete pathway of molecules involved in making, storing, and releasing an important hormone.
An illustrated flow-chart style diagram showing how different factors influence the color of a person's skin.A  Notice how the cartoons add to the text in this one. Another flow-chart, this one without illustrations, showing the two paths the process of nerve transmission can take.A (compare to the illustrated diagram in Figure 13-25 on p. All of the examples given just above were made with the computer software Inspiration, which is available on some of the computers in the Science Resource Room at SCC (ADM 2411). More and more, students in the health professions and other disciplines are being REQUIRED to use concept mapping in their assignments. If you gain concept mapping skills now, you will be better prepared for your professional courses! For more examples and how-to hints on concept mapping, check out the links in the list below. Graphic OrganizersA  This page has many short, simple handouts that show you how to make different sorts of concept maps. Learning Skills Program - Concept Mapping Simple description of how to make and use concepts maps.
However, self blood-glucose monitoring (SBGM) is the single most expensive aspect of diabetes care to the State. It is no longer necessary to measure glucose to make a diagnosis of diabetes, Prof O’Shea said. Incretins, such as exenatide (Byetta) and liraglutide (Victoza) may be given in type II diabetes. After 10 years of follow-up, the UKPDS showed that for participants originally randomised to intensive glycaemic control — compared with those randomised to conventional glycaemic control — there were long-term reductions in MI (15 per cent with sulfonylurea or insulin as initial pharmacotherapy and 33 per cent with metformin as initial pharmacotherapy). There is an argument in diabetes about whether blood pressure management, rather than glycaemic management, should be pre-eminent. Multiple drug therapy (two or more agents at maximal doses) is generally required to achieve blood-pressure targets.
In this trial, 73 per cent of surgically-treated patients achieved ‘remission’ of their diabetes, compared with 13 per cent of those treated medically. Long-acting, once-daily sulphonylureas may be useful where concordance with therapy is a suspected problem. Anybody can potentially get gestational diabetes during pregnancy, more especially if you are carrying multiples.


Only your testing will tell you for sure as I didn’t really notice any symptoms myself. Normally the body makes and uses insulin for energy without any problem, but in the case of gestational diabetes you are not producing enough insulin and the sugar builds up in your blood and it doesn’t get used by your body for fuel. I believe it may show itself during pregnancy and you may be diagnosed later, but only if you were going to be diagnosed anyway. All of these agents are used and they all confer a benefit to the A1c — and to cardiovascular and microvascular profiles. There were also reductions in all-cause mortality (13 per cent and 27 per cent respectively).
In type II diabetes, hypertension usually coexists with other cardiometabolic risk factors. The UKPDS study proved that if blood pressure could be controlled, patients did much better. This is especially the case if the diabetes or associated co-morbidities are difficult to control with lifestyle and pharmacologic therapy. Am J Med 2009) of studies of bariatric surgery involving 3,188 patients with diabetes reported that 78 per cent had remission of diabetes (normalisation of blood glucose levels in the absence of medications) and that the remission rates were sustained in studies that had follow-up exceeding two years.
The Expert Advisory Group in Diabetes in its 2007 report recognised the need for a new model of care for people with type II diabetes. I couldn’t understand why I had it, and worried about the effects on my babies to be.
Just make sure to follow all instructions to assure both you and your babies are happy and healthy, ask questions and demand answers.
Doctors encourage this and need to steer away from it, said Prof Donal O’Shea, Consultant Endocrinologist at St Vincent’s Hospital. The DPP-IV inhibitors include Januvia (sitagliptin), Onglyza (saxagliptin) and Eucreas — a combination of vildagliptin and metformin.
As is the case with microvascular complications, it may be that glycaemic control plays a greater role before macrovascular disease is well developed. Remission rates tend to be lower with procedures that only constrict the stomach, and higher with those that bypass portions of the small intestine. This integration across primary, secondary and tertiary care requires agreed clinical guidelines. If you don’t allow all of that extra glucose to get to your babies, they will be of normal size. However, compounds have been developed that activate the GLP-1 receptor with a view to improving insulin secretion.
Additionally, there is a suggestion that intestinal bypass procedures may have glycaemic effects that are independent of their effects on weight, perhaps involving incretins.
Most people will be able to get through this with only diet changes and some increased exercise.
Nobody wants to have gestational diabetes, but it’s not a death sentence or anything.




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Comments

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