This generally occurs for no more than days and is related to irritation of the tissue injected from the cortisone itself. Nor was morbidity reduced, raising the question of the value of treatment. They also point to the many methodological flaws of the studies promoting stringent protocols. Thus, the majority of researchers now place a great deal of emphasis on very strict fasting numbers and postprandial numbersbut not all do. Advocates lowering treatment thresholds even further. Basically, they feel that the ends justify the means. How strict, of course, is the big debate. A review of the efficacy and methodological design of previous studies that examined dietary treatment vs.
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Gestational Diabetes: The Numbers Game
Critics feel that much more research needs to be done to clarify the issue of prophylactic insulin use and its effectiveness, especially in groups at higher risk for macrosomic babies. Gd moms, either due to too much insulin resistance or because they are predisposed to a pancreatic beta cell defect and thus have trouble making enough insulin , cannot produce enough insulin to counteract the effect of the placental hormones, so their blood sugars begin to go too high. There is also some evidence that weight cycling tends to increase a tendency towards diabetes, but other evidence does not show the same effect, so conclusions on this are limited. Compared the screened population vs. To support their point of view they point to research that shows that more aggressive insulin use does indeed tend to lower levels of macrosomia, and in a few cases, even the c-section rate. Carr and Gabbe Clinical Diabetes, take a middle course in their excellent summary of current treatment standards for gestational diabetes. It is the cutoff for the one-hour glucose challenge test in pregnancy, it used to be the number for diagnosing 'true' diabetes outside of pregnancy, and it is the cutoff for desirable blood glucose levels one hour after a meal in many programs.
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These are the most basic requirements you'll come across in your gd treatment process. What blood sugar readings do you find in people who are normoglycemic have no problems with blood sugar? You may find your provider's arguments convincing and agree to a recommendation differing from the current ACOG standard, which is fine if you understand the issues and make an educated choice. Notes all the confounding variables possible, and the differences in study design and observational content"because of these differences, meaningful comparison of data between studies is exceedingly difficult. How can we distinguish between these? Its preliminary findings based on the pilot study is that intensive treatment of gd insulin started at fastings of 80! Other sources do not list such strict numbers, giving as fasting goals instead. The Xray may be normal but if a fragment of bone is pulled off at the time of injury then the xray will reveal wide displacement of the fragment. Other doctors use not only a lower fasting but also other lower cutoffs as well.
Description:Don't feel that the position of your provider is the only advice you would get; there are many others who will offer different advice. Outstanding article summarizing gd testing, management, and even some of the controversies involved in gd, though from a traditional medical approach. Half of the group were randomly assigned to insulin therapy originally, half were not. Proponents of 'evidence-based medicine' or the 'minimum school of management' feel that until prophylactic insulin use has been proven unequivocably to be beneficial and also shown to be not harmful in the long term or short-term, aggressive insulin protocols should not be adopted. Some studies show improvement in shoulder dystocia and birth injuries when birth weights were reduced, but many do not. Numerous studies have shown that low-birthweight babies are at especially high risk for diabetes, heart problems, and other health difficulties later in life. Proponents also further point out that the current cutoffs for diagnosing 'gd' were arbitrarily chosen decades ago, but they were chosen for their ability to predict future diabetes in the mother, not for their ability to prevent complications to the fetus. Still, it is an interesting finding and one of the few studies to study the results of insulin on the child. However, if your readings are over 90 or consistently around 90, your provider will probably adjust your insulin dosage usually your bedtime insulin dose in order to lower your morning numbers to what they consider your optimum range.