The epidemic is spreading throughout the world, in both low- and high-resource countries. Prevention is a key aspect in the battle against the disease and obstetricians play a critical role in the fight. Prevention starts in utero—for the diabetic mother, her infant, and future generations. The postpartum period should not be neglected because it provides another window of opportunity to address prevention.
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Read information and advice about losing weight. Type 2 diabetes usually gets worse over time. Making lifestyle changes, such as adjusting your diet and taking more exercise, may help you control your blood glucose levels at first, but may not be enough in the long term. Initially, this will usually be in the form of tablets and can sometimes be a combination of more than one type of tablet. It may also include insulin or another medication that you inject. Metformin is usually the first medicine used to treat type 2 diabetes. It works by reducing the amount of glucose your liver releases into your bloodstream.
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It also makes your body's cells more responsive to insulin. If you're overweight, it's also likely you'll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldn't cause additional weight gain. However, it can sometimes cause mild side effects, such as nausea and diarrhoea , and you may not be able to take it if you have kidney damage. You may be prescribed one of these medicines if you can't take metformin or if you aren't overweight.
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Alternatively, you may be prescribed sulphonylurea and metformin if metformin doesn't control blood glucose on its own. Sulphonylureas can increase the risk of hypoglycaemia low blood sugar because they increase the amount of insulin in your body. They can also sometimes cause side effects, including weight gain, nausea and diarrhoea. Pioglitazone is a type of thiazolidinedione medicine TZD , which make your body's cells more sensitive to insulin so more glucose is taken from your blood.
It's usually used in combination with metformin or sulphonylureas, or both. It may cause weight gain and ankle swelling oedema. You shouldn't take pioglitazone if you have heart failure or a high risk of bone fracture. GLP-1 helps the body produce insulin in response to high blood glucose levels, but is rapidly broken down. By preventing this breakdown, the gliptins linagliptin, saxagliptin, sitagliptin and vildagliptin prevent high blood glucose levels, but don't result in episodes of hypoglycaemia.
Complications of diabetes in men and women
You may be prescribed a gliptin if you're unable to take sulphonylureas or glitazones, or in combination with them. They're not associated with weight gain. SGLT2 inhibitors work by increasing the amount of glucose excreted in urine. They may be considered to treat type 2 diabetes if metformin and DPP-4 inhibitors aren't suitable. Each medication is taken as a tablet once a day. The main side effect is a higher risk of genital and urinary tract infections.
GLP-1 agonists acts in a similar way to the natural hormone GLP-1 see the section on gliptins, above. Acarbose helps prevent your blood glucose level increasing too much after you eat a meal. It slows down the rate at which your digestive system breaks carbohydrates down into glucose. Acarbose isn't often used to treat type 2 diabetes because it usually causes side effects, such as bloating and diarrhoea. Nateglinide and repaglinide stimulate the release of insulin by your pancreas.
They're not commonly used, but may be an option if you have meals at irregular times. This is because their effects don't last very long, but they're effective when taken just before you eat. Nateglinide and repaglinide can cause side effects, such as weight gain and hypoglycaemia low blood sugar. If glucose-lowering tablets aren't effective in controlling your blood glucose levels, you may need to have insulin treatment.
This can be taken instead of or alongside your tablets, depending on the dose and the way you take it. For example, some last up to a whole day long-acting , some last up to eight hours short-acting and some work quickly but don't last very long rapid-acting.
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If you need to inject insulin, your diabetes care team will advise you about when you need to do it. They will show you how to inject it yourself, and will also give you advice about storing your insulin and disposing of your needles properly. Insulin injections are given using either a syringe or an injection pen, also called an insulin pen auto-injector. Most people need between two and four injections of insulin a day. Your GP or diabetes nurse will also teach a relative or a close friend how to inject the insulin properly.
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You can read more about insulin and how to inject it on the Diabetes UK website. If you have type 2 diabetes that's controlled using insulin or certain types of tablets, you may experience episodes of hypoglycaemia. Mild hypoglycaemia a "hypo" can make you feel shaky, weak and hungry, but it can usually be controlled by eating or drinking something sugary.
If you have a hypo, you should initially have a form of carbohydrate that will act quickly, such as a sugary drink or glucose tablets. This should be followed by a longer-acting carbohydrate, such as a cereal bar, sandwich or piece of fruit. In most cases, these measures will be enough to raise your blood glucose level to normal, although it may take a few hours. If you develop severe hypoglycaemia, you may become drowsy and confused, and you may even lose consciousness. If this occurs, you may need to have an injection of glucagon into your muscle or glucose into a vein.
Glucagon is a hormone that quickly increases your blood glucose levels.
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If you have type 2 diabetes, your risk of developing heart disease , stroke and kidney disease is increased. To reduce your risk of developing other serious health conditions, you may be advised to take other medicines, including:. Diabetic kidney disease is identified by the presence of small amounts of albumin a protein in your urine.
If treated early enough, it may be reversible. If you have type 2 diabetes, your GP or diabetes care team will need to take a reading of your blood glucose level about every two to six months.
This will show how stable your glucose levels have been in the recent past and how well your treatment plan is working. HbA1c is a form of haemoglobin, the chemical that carries oxygen in red blood cells, which also has glucose attached to it. A high HbA1c level means that your blood glucose level has been consistently high over recent weeks, and your diabetes treatment plan may need to be changed.
How does diabetes affect women?
Your diabetes care team can help you set a target HbA1c level to aim for. If you have type 2 diabetes, as well as having your blood glucose level checked by a healthcare professional every two to six months, you may be advised to monitor your own blood glucose levels at home.
Even if you have a healthy diet and are taking tablets or using insulin therapy, exercise, illness and stress can affect your blood glucose levels.
Other factors that may affect your blood glucose levels include drinking alcohol, taking other medicines and, for women, hormonal changes during the menstrual cycle. A blood glucose meter is a small device that measures the concentration of glucose in your blood. If blood glucose monitoring is recommended, you should be trained in how to use a blood glucose meter and what you should do if the reading is too high or too low.
High blood sugar during pregnancy can also increase the chance that your baby could:.
What You Can Do: Work with your health care team to get your blood sugar levels in your target range and establish good habits such as eating healthy and being active. Your blood sugar levels can change quickly, so check them often and adjust your food, activity, and medicine as needed with guidance from your doctor. Any woman can have gestational diabetes, but some are at higher risk , including those who are overweight or have obesity, are more than 25 years old, or have a family history of type 2 diabetes.
Careful management is important to ensure a healthy pregnancy and healthy baby. You may need diabetes medicine or insulin shots to keep you and your baby healthy. Gestational diabetes usually goes away after your baby is born. Ask your doctor about participating in the CDC-led National Diabetes Prevention Program , which includes a lifestyle change program scientifically proven to prevent or delay type 2 diabetes in people at risk. After menopause, external icon your body makes less estrogen, which can cause unpredictable ups and downs in blood sugar.
You may gain weight, which increases your need for insulin or other diabetes medicines. Hot flashes external icon and night sweats may disrupt your sleep, making managing blood sugar harder. This is also a time when sexual problems can occur, such as vaginal dryness or nerve damage. What You Can Do: Ask your doctor about ways you can manage menopause symptoms. Heart disease risk goes up after menopause, so make heart-healthy choices that also help manage your diabetes, such as eating healthy food and being active.
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