Home' Trinidad and Tobago Guardian : May 21st 2015 Contents B4
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testinal tract. So insulin is always given as
an injection. It is not something many
women are pleased about, especially having
to self-administer three times a day. The
reason for this is to ensure their blood glu-
cose levels are very tight all the time. So
the patient has to learn how to self-admin-
ister, and measure and store insulin properly,
otherwise there can be problems. If they
take too much insulin, their blood sugar is
going to drop too low. And of course if they
take too little, glucose levels will get too
Now, once we start a patient on insulin,
once again we have to make sure that there
is good control. So we try to get patients
more involved by encouraging them to buy
their little glucose meters and a notepad,
and we educate them on how to monitor
their blood glucose levels at home. So that
when they come to the clinic, the nurses
or doctors can peruse the values and make
the necessary adjustments if need be. If the
blood glucose levels aren t very fully con-
trolled, then that patient needs to be read-
mitted to hospital to stabilise.
Apart from insulin, there are many tablets
for diabetes outside of pregnancy. We do
use some tablets for diabetes during preg-
nancy, but one must be careful because
there is very limited experience in terms of
the safety. The practice is relatively new.
For instance in North America, many studies
have shown that the problem with taking
these tablets during pregnancy is that the
baby might come out fine, but they can
suffer adverse effects in their later life.
What happens after
pregnancy: can a mother
develop diabetes permanently?
I did not do that long-term study, but
one of our professors followed up about
360 women who had confirmed gestational
diabetes. We had managed those patients
in their pregnancies.
What she did, she took it a step further
and brought those women back on a yearly
period after they gave birth. She found that
out of the 360 women who had gestational
diabetes, 50-60 per cent had already devel-
oped diabetes mellitus. So it means that
one in every two women who had gestational
diabetes will end up with diabetes mellitus.
If you look at Hispanic women in the US,
they behave the very same way. About 50
per cent of those women who had gesta-
tional diabetes go on to develop diabetes
mellitus in three to five years.
So our population somehow mimics the
But when you compare this to Caucasian
women---20 per cent develop diabetes mel-
litus after pregnancy---it means one in five
women will develop diabetes mellitus in 20
years. So it tells you how our population
must be at genetic predisposition to develop
diabetes. And, of course, gestational diabetes.
Many studies are currently going on to
see what can be done to delay or to prevent
the onset of diabetes mellitus. Studies such
as appropriate weight for your height; ...a
woman generally gains 28 pounds, which
is the average weight gain during a preg-
nancy. If she can lose that weight and main-
tain a safe one, she may be able to delay
Some studies were even done using met-
formin. These women were not diabetic,
but placed on the tablet to see if it could
delay the onset. The studies so far are
A group even went further, giving a small
amount of insulin to women who did not
have diabetes, but that study had to be
aborted because their blood glucose levels
were falling too much.
So it seems we might be able to delay
the onset of diabetes mellitus by proper
weight management, appropriate diet, exer-
cise and maybe the use of metformin.
What can help?
How can we change the practice and beliefs among
patients and healthcare providers? I tell you, it is not
something that anyone of us can just advocate for,
and see an immediate change tomorrow.
I think it must come from our fraternity, the Min-
istry of Health, but I also believe that women must
be the best advocates for women s health. The drivers
have to be women, they are much more educated
and involved in their pregnancies, fortunately, com-
pared to when I became a doctor 30 years ago.
I think there is going to be a change. Maybe it s
taking too long, because we are still losing babies at
term as a result of this condition.
From the university side, we are very much involved
in teaching, training and research. So we are training
a new cadre of doctors. When they take over, hopefully
they will realise that we cannot have selective screen-
ing. Gestational diabetes is too common in this pop-
ulation, and carries too many serious implications
for screening to be continued in an ad hoc way. We
have to adopt a universal method. Every pregnant
woman should be screened so that if we pick up on
this early, we can treat it, and we can win.
Bassaw: Women must be best
advocates for women's health
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