DIABETES MELLITUS (DM) IN

PREGNANT WOMEN

Dr. Shamanthakamani NarendranMD (Pead), PhD (Yoga Science)

How yoga helps?

Pregnancy induced DM

Gestational Diabetes Mellitus is glucose intolerance during pregnancy.

Prevalence of DM among women of childbearing age is increasing.

Sedentary lifestyles - changes in diet.

Childhood and adolescent - obesity.

Pregnancy induces progressive changes in maternal carbohydrate metabolism.

As pregnancy advances insulin resistance and diabetogenic stress due to placental hormones necessitate compensatory increase in insulin secretion.

When this compensation is inadequate gestational diabetes develops.

Women diagnosed to have GDM are at increased risk of future diabetes predominantly type 2 DM as are their children. Thus GDM offers an important opportunity for the development, testing and implementation of clinical strategies for diabetes prevention.Timely action taken now in screening all pregnant women for glucose intolerance, achieving euglycemia in them and ensuring adequate nutrition may prevent in all probability, the vicious cycle of transmitting glucose intolerance from one generation to another.

Women and diabetes

Diabetes no longer means

Abstinence

Amenorrhea

Inability to conceive

Inability to deliver healthy children

Death during pregnancy

Diabetes and fertility

Delayed menarche in T1

Menstrual abnormalities

Premature Ovarian Failure

PCOD

Diabetes in pregnancy

Placental structure and function is affected

Early IUGR as high BG inhibits trophoblast proliferation

Hypertension, renal disease more frequent

High glycogen content in placenta

Fetal morbidity in GDM

Miscarriages

Growth restriction

Fetal macrosomia

Newborn complications

Birth defects

Birth injury

Polycythemia

Hypoglycemia

Hypocalcemia

Hyperbilirubinemia

Respiratory problems

Maternal morbidity

Diabetic retinopathy

Renal complications

Chronic hypertension

Preeclampsia

Screening for GDM

WHO: FBG and 2h PPBG or 2h post-75 g glucose BG

1 h post- 50 g glucose load BG [GCT]

ADA: FBG, 1 h, 2 h, 3 h post- 75 or 100 g glucose BG

One-step or two-step protocol

At first visit; reassess at 24 – 28 weeks

Screening for GDM

1 hr GCT140 mg %

130 mg %

75 g GTT 2 h: 155 mg %

100 g GTT1 h: 180 mg %

2 h: 155 mg %

3 h: 140 mg %

Any time of dayNo regards to meals

Criteria for diagnosis of GDM with 100 gm oral GTT

Time Whole blood (mg %) Plasma

Fasting 90 105

1 hour 165 190

2 hours 145 165

3 hours 125 145

In any two or more values are elevated, the glucose tolerance test result must be considered abnormal

Criteria for diagnosis of impaired glucose tolerance and diabetes with 75 gm (WHO) oral glucose

Time Normal Impaired glucose tolerance

Diabetes

Fasting <105 105 to <140

>/= 140

2 hours post glucose

< 160 160 to <200

>/= 200

Venous whole blood values are 15% less than the plasma

m mol/L = mg% x 0.0555

Management

Dietary therapy

Glucose monitoring

Insulin therapy

Oral hypoglycemic agents –Metformin

Timing of delivery

Management of delivery

Referred to well equipped hospital to prevent maternal and fetal complications.

Medical Nutrition Therapy

6 meal pattern

Substantial night snack; light breakfast

Encourage complex carbohydrates, fruits

30 cal/kg/day = 1500 cal for a 50 kg lady

Avoid starvation/ketosis

Increase intake in 3rd trimester

Weight reduction if BMI > 27

Avoid

High fiber foods – fresh fruits and vegetables, whole grain breads, cooked dried beans and bran cereals.

Beverages with added sugar, corn syrup, honey, maple syrup, jams and jellies.

Read the labels of packaged foods to find the grams of carbohydrate a serving has in it.

Calorie Intake

Needs about 300 extra calories per day in the second and third trimesters to gain enough weight. This equals about 16 to 17 calories per pound of ideal body weight.

An extra 10 to 12 grams of protein per day helps baby grow normally. It helps to get 45-60% of calories from carbohydrates, 15-25% from protein and 20-30% from fat.

Food Selection Pyramid

PreferBajra, Jowar, Wheat flour mixed with black channa flour whole, Split & sprouted pulses, Green leafy vegetables & fresh fruits, Skimmed milk & curd, Light tea, Vegetable juices.

Food Selection Pyramid

LimitRice,

Biscuts,

Naan & food prepared with maida,

Roots & tubers – potato, arbi jimikand & sweet potato,

Whole milk,

Tea & coffee

Food Selection Pyramid

AvoidFat,

Sweets,

Pastries,

Fruits like – mango, grape, banana, chiku dates, custard apple,

Cold drinks & alcoholic drinks,

Non-veg food stuffs,

All nuts & oil.

Yoga practices

Hands in & out Breathing

Hands stretch breathing

Ankle stretch breathing with wall support

Side twist breathing

Instant relaxation technique [IRT]

Yoga practices

Leg raise breathing

Hip raise breathing

Spine & abdominal stretch breathing

Cycling in the supine pose

Tiger breathing

Yoga practices

Ankle rotation

Kneecap contraction

Yoga practices

Eye exercises

Alternate nostril breathing

Shavasana in left lateral position.

AvoidJogging

Suryanamaskar

Kapalabhathi & Bhastrika

Ankle Stretch Hands In & Out

Group practice

Tiger Stretch Side Stretch

Loosening Exercises

Backward Bending Forward Bending

Sitting Postures

Vajrasana Ardha Matsyendrasana

Badha Konasana Squatting

Uphavista Konasana

Sasankasana

Supine Postures

Viparita Karani

Viparita Karani with

Wall Support

1. Mastery over Prana – Slowing of breath – Awareness of breathing – Balance between the two

nostrils.

2. There is intimate connection between mind and Prana.

Pranayama

Cooling Pranayamas

Sitkari (Folded – up – Tongue Pranayama)

Sitali (Beak – Tongue Pranayama)

Sadanta (Suck – through – Teeth Pranayama

Relaxation Techniques

Instant Relaxation Technique (IRT)

Quick Relaxation Technique (QRT)

Deep Relaxation Technique (DRT)

Meditation

Omkar Meditation

Mudra

Aswini Mudra