Tuesday, September 30, 2008

SPECIAL SITUATIONS

Surgery


Surgery is stressful, both physically and mentally. It can raise blood glucose levels even in someone who is careful about control.

To make sure that surgery and recovery are successful for someone with diabetes, a doctor will test blood glucose and keep it under careful control, usually with insulin. Careful control makes it possible for someone with diabetes to have surgery with little or no more risk than someone without diabetes.

To plan a safe and successful surgery, the surgeon and attending physicians must know that the person they're treating has diabetes. While tests done before surgery can detect diabetes, the patient should inform the doctor of his or her condition. A surgical team also will evaluate the possible effect of complications of diabetes, such as heart or kidney problems.


Pregnancy


Bearing a child places extra demands on a woman's body. Diabetes makes it more difficult for her body to adjust to these demands and it can cause problems for both mother and baby. Some woman may develop a form of diabetes during pregnancy called gestational diabetes. Gestational diabetes develops most frequently in the middle and later months of pregnancy, after the time of greatest risk for birth defects. Although this kind of diabetes often disappears after the baby's birth, treatment is necessary during pregnancy to make sure the diabetes doesn't harm the mother or fetus.

A woman who knows she has diabetes should keep her condition under control before she becomes pregnant, so that her diabetes won't increase the risk of birth defects. A woman whose diabetes isn't well controlled may have an unusually large baby. Diabetes also increases the risk of premature birth and problems in the baby, such as breathing difficulties, low blood sugar and occasionally, death.

Blood glucose monitoring and treatment with insulin can ensure that a baby born to a mother with diabetes will be healthy. Oral diabetes drugs aren't given during pregnancy because the effects of these drugs on the unborn baby aren't known. By following the advice of a doctor trained to treat gestational diabetes, the mother can make sure her blood glucose is normal and her baby is well nourished.

Approximately half of women with gestational diabetes will no longer have abnormal blood glucose tests shortly after giving birth. However, many women with gestational diabetes will develop noninsulin-dependent diabetes later in their lives. Regular check-ups can ensure that if a woman does develop diabetes later, it will be diagnosed and treated early.