What It Is
Diabetes is a disease in which the body does not produce or properly use insulin (a hormone needed to convert sugar, starches and other food into energy). The cause of diabetes continues to be unclear, although both genetics and environmental factors such as obesity and lack of exercise play a role. There are four distinct types of diabetes: (1) Type 1 diabetes, which results from the body's failure to produce insulin. It is estimated that 5 to 10 percent of Americans who are diagnosed with the disease have type 1 diabetes. (2) Type 2 diabetes, which results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes. (3) Gestational diabetes occurs in pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy. Gestational diabetes affects about 4 percent of all pregnant women. Immediately after pregnancy, 5 to 10 percent of women with gestational diabetes are found to have diabetes, usually type 2. (4) Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes.
Who Gets It
Nearly 8 percent of the population (23.6 million children and adults in the United States) have diabetes. While an estimated 17.9 million people have been diagnosed with the disease, millions more are unaware that they have it.
Diabetes often goes undiagnosed because many of its symptoms seem harmless, such as frequent urination, excessive thirst, extreme hunger, unusual weight loss, increased fatigue, irritability, and blurry vision.
How It's Diagnosed/Detected
In order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a fasting plasma glucose test (FPG) or an oral glucose tolerance test (OGTT). Both tests measure sugar levels in the blood.
How It Affects Fertility (And Pregnancy)
Diabetes is not a threat to fertility in the usual way. It most likely won’t prevent conception, unless the disease is way out of control. What happens instead is that high glucose levels in a woman’s system can damage embryonic cells, causing an early miscarriage. If a woman doesn’t know she has diabetes, or she’s managing her diabetes poorly, she’s at risk for recurrent miscarriages. Her body may spontaneously abort the developing embryo just days after conception, before a period has even been missed, leading some women with diabetes to believe they’re having trouble conceiving and are having fertility problems. High blood sugar impairs the ability of the fetus to implant in the uterus. Miscarriage rates among women with poorly controlled diabetes can be as high as 30 to 60 percent during that crucial first trimester of pregnancy. The risk of birth defects is high, and also stems from uncontrolled blood sugar levels around the time of conception.
In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and individuals with the disease need insulin shots in order the process the glucose contained in meals. People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes can keep their disease controlled with diet and other lifestyle measures. Other people need medication or insulin shots to help their bodies use glucose for energy. Insulin cannot be taken as a pill, but must instead be injected into the fat under the skin for it to enter the blood stream.
Women with diabetes face special challenges getting—and staying—pregnant. To help prevent miscarriage and diabetes-related birth defects, women with the disease should make planning for pregnancy a high priority. Experts advise that a woman should maintain tight glycemic (blood sugar) control for three to six months before going off contraceptives and trying to conceive. A woman should work with her endocrinologist or internist along with an obstetrician familiar with high-risk pregnancies. A dietitian and diabetes educator can also provide vital pre-pregnancy advice. Women who’ve been diagnosed with diabetes know that they have to take special care before conceiving and throughout pregnancy. But any woman with risk factors for the disease—excess weight, family history, or past history of metabolic problems—should be checked before getting pregnant. Happily, medicine has come a long way since the days when women with diabetes were routinely advised to forget about having children at all.
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