…more from Amy Campbell at Diabetes Self-Management. This is part 2 her series on gestational diabetes mellitus.
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Treatment of Gestational Diabetes Mellitus
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What’s “Gestational Diabetes”? No, It’s Not Type 3
You can’t tell if she has it just by looking
In a recent article Amy Campbell over at Diabetes Self-Management defines it and goes over risk factors, diagnosis, and why it’s important. I expect a second post on management principles in the near future.
Here’s my review from 2010.
In terms of the best diet, a recent study found no significant outcome differences on a 40% carb diet compared to a standard 55% carb diet. I would have guessed the lower-carb diet would better (see below).
Update Sept. 16, 2013:
Here’s part 2 of Amy’s series, beginning discussion of treatment.
I logged onto UpToDate.com and reviewed treatment briefly. The high points are:
- See a registered dietitian for counseling.
- “There is scant level 1 [high quality] evidence to support most aspects of the nutritional prescription for gestational diabetes mellitus.”
- The authors limit carbohydrates to less than 40% of total calories.
- Goals of treatment are 1) prevent ketosis, 2) support adequate weight gain of the mother based on body mass index, 3) support the baby, and 4) when drug therapy is needed, use insulin instead of pills.
- UTD agrees with Amy that frequent blood sugar tests (at least 4x/day) with a home glucose monitor are helpful.
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Metformin Impairs Brain Function In Some Users
Metformin is the most-recommended drug for type 2 diabetes
…according to an article at MedPageToday. I consider this finding preliminary, but definitely something to keep an eye on. We need confirmatory data before taking action. Long-term metformin users should get vitamin B12 levels checked periodically in view of the well-established association of low levels in users. Low B12 impairs cognition and is easily preventable or treated.
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Another Research Report Links Type 2 Diabetes With Dementia
Compared with non-diabetics in the study, T2s had brain atrophy (shrinkage on MRI scans) and cognitive deficits reminiscent of pre-clinical Alzheimer’s disease.
Click for details at Diabetes Care.
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Alcohol Consumption Linked to Lower Risk of Death and Kidney Disease in Type 2 Diabetics
…according to an article at MedPageToday. Over 6,000 T2 diabetics were followed for over five years.
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Franziska Spritzler Explains Why So Many Dietitians Are Against Low-Carb Diets
Click for details. Briefly:
1. They think it’s dangerous.
2.They believe the diet-heart hypothesis.
3. They think the diet is unbalanced.
4. They think no one will follow it long term.
Franziska debunks these ideas one by one.
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Dr. Georgia Edes Raves About Her Ketogenic Diet Experience
Click for details. Here’s her version of a ketogenic diet:
My diet consists almost entirely of roasted chicken (with skin), duck (with skin), duck fat, turkey, fish, chicken liver, zucchini, spinach, plantain chips, berries, lettuce, small amounts of black coffee, and salt. I’ve been avoiding chocolate entirely. Every once in a while I eat beef, pork, or a very small amount of cheese, or when at a restaurant might order something that includes a cream, wine, or butter-based sauce, but these don’t usually agree with me, so I keep them to a minimum, and most days I completely avoid them. I steer clear of preserved, smoked, cured, aged, fermented, canned, and processed foods whenever possible.
Most folks will enter ketosis when they get their daily digestible carbohydrate consumption below 30-50 grams. My favorite method is the Ketogenic Mediterranean Diet.
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Is Exercise Twice a Week as Good as Six Sessions?
If you’re not familiar with weight training, a personal trainer is an great idea
Weight Maven Beth Mazur found evidence in favor of the fewer days, at least in post-menopausal women.
I don’t like to exercise. Sometimes I find excuses to avoid even my twice weekly 40-minute workouts. I do enjoy hiking; I even hiked to the bottom of the Grand Canyon and back out last May. But that’s not exercise, it’s more recreation.
You may well have good reasons to exercise every day. Maybe you’re a competitive athlete or enjoy exercise. If you just want the health benefits of exercise, I’m increasingly convinced that twice a week is enough.
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Amputations in Diabetics Drop By 25% Over Last Decade
Which is great news from DiabetesHealth. I have noticed this in my own practice. One potential contributor to lower amputations not mentioned in the article is improved blood flow through angioplasty and other high-tech options.
A quote from DiabetesHealth:
According to Dr. Bill Releford, founder of the Releford Foot & Ankle Institute in Beverly Hills, as many as 75 percent of all amputations are preventable. He offered the following tips in a recent press release:
* Do not smoke.
* Exercise daily
* Control your cholesterol.
* Dry in between all toes after bathing.
* Always control your diabetes and blood pressure.
* Always wear shoes made from natural sources such as calfskin or soft leathers.
* Never pull or pick skin from your feet.
* Eat at least five colors of fruits and vegetables every day.
* Never cut toenails or trim calluses if you have diabetes or poor circulation. See a podiatrist for routine foot care.
* Never go barefoot if you have diabetes,even at home.
Also important is to inspect your feet for problems daily, or have someone do it for you. See your doctor or podiatrist if something doesn’t look right.
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Medicare Is Changing the Rules On Home Glucose Testing Supplies
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Diabetic Mediterranean Diet 