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Question:

From Mississippi, USA:

I had a baby two years ago, and during my last trimester I developed gestational diabetes. We tried controlling it with diet, but it wasn't enough and I had to take insulin shots twice a day. After the baby was born, I stayed on my ADA diet to lose 15 pounds. I went from a pre-pregnancy weight of 154 to a weight of 135. (I am 5'4", 27 years old.)

I have several questions that I have never been able to get answered, so I will try to break them down here.

  1. I keep hearing rumors of a replacement for insulin shots, such as a patch or a pill. I can't find anything concrete about it, though. Could you fill me in?

  2. Exactly how much stress can gestational diabetes put on the pancreas? Everything I read said that most women do not remain diabetic after the baby is born. However, almost everyone I have heard about had remained diabetic after the birth of their last child, and are now on insulin shots for the rest of their lives.

  3. It seems to me that these women are now insulin dependent because their pancreas is "exhausted" and can no longer produce any usable insulin. Does that happen? Otherwise, if they just needed a little insulin "boost," they would be taking a pill instead of a shot, right?

  4. Exactly what happens when your body is metabolizing food? You eat food containing carbohydrates, fats, and proteins. Insulin goes to work to metabolize the carbohydrates so that they can be used as energy. What breaks down the fats and proteins? If you don't have enough insulin, your blood sugar becomes very high. However, if you use up all the energy provided by carbohydrates, you begin to burn fat. This is also what happens when a diabetic has lots of sugar in their blood, but no insulin to turn it into energy: they begin to burn fat. What is it that turns the fat into usable energy? And why does your body not require insulin to burn the fat once it is converted to sugar?

Any help you can give me will be greatly appreciated, since this is a matter that concerns me greatly -- especially with the possibility of another pregnancy still in front of me.

Answer:

There are a number of oral medications that are used for different forms of diabetes in different stages. Insulin itself has been tried orally and as a nasal spray and it has been suggested that it could be given through a patch by a process called iontophoresis. The oral and nasal approach is not reliable enough for routine use and require very much larger amounts of insulin. The patch remains a pipe dream. If you actually need insulin, there is no alternative to daily subcutaneous injections. Transplants may one day become more feasible; but not for gestational diabetes.

The stress on the islet cells from pregnancy would be possible to measure if a series of tests were done to measure C-peptide response to a glucose load; but it is both expensive and unnecessary. Whether diabetes persists after a gestational onset is largely dependant on what has caused the underlying insufficiency of the insulin producing cells. If this is Type 1 Diabetes, the immunological damage will continue after pregnancy as it will have done for several years before. Pregnancy just hastens the process. In conventional adult onset diabetes, immediate recovery is likely although long term diet, oral medication or insulin may be required. With some of the genetic forms of adult onset or maturity onset diabetes in the young (MODY) there is a permanent limitation of insulin production, which in the absence of further stress may nonetheless continue to meet daily requirements.

Where there is an ongoing marginal supply of insulin, it does seem as though the cells get 'exhausted.' Oral treatment can sometimes spur insulin production for a time, modify the liver's contribution to blood sugar or increase peripheral sensitivity to insulin; but if the process continues insulin will still be needed.

To summarise the complicated interplay of carbohydrate, protein and fat metabolism is really beyond the scope of this method of reply. Very briefly, insulin not only has a role in controlling the entry of glucose into the cell; but also in the assembly of proteins and in the peripheral storage of fat. When fat is broken down it enters the energy cycle as something called acetyl coenzyme A and produces energy through a process called the Krebs Cycle. This is at a point beyond the role of insulin.

If you really want to get to work on this, you should start off with a nutrition or even a biochemistry text in your local public or medical library.

DO'B

Original posting 16 Jan 97

  
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Last Updated: Tuesday April 06, 2010 15:08:52
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