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Special insoles prevent foot ulcers in diabetics
By Megan Rauscher
NEW YORK (Reuters Health) - If a woman develops diabetes during
pregnancy -- that is, gestational diabetes mellitus (GDM) -- she
may need insulin to keep blood sugar levels under control. This
is usually decided when her blood glucose levels exceed a certain
cut-off point, but German researchers say a better way may be to
keep a check on the size of the baby.
Babies tend to be become overly large when the mother has diabetes.
Carefully monitoring the baby's abdominal circumference on a sonogram
is a good way to decide if mom needs insulin -- and it can in fact
spare many women insulin injections.
That's according to a report in the medical journal Diabetes Care,
from Dr. Ute M. Schaefer-Graf from Vivantes Medical Center Neukoelln
in Berlin, Germany, and colleagues.
The standard "glucose-only" approach to handling GDM
entails intensive glucose monitoring and insulin therapy in about
one-third of cases, Dr. Schaefer-Graf told Reuters Health.
But a given blood glucose level does not necessarily mean trouble
for the baby, the researcher explained, especially when blood glucose
levels are only moderately high.
To see whether the mother's blood sugar level or the baby's size
was the best way to manage GDM, the team allocated 99 women with
GDM to an ultrasound group and 100 to a standard (maternal glucose)
group.
In the ultrasound group, insulin was given only when the fetal
abdominal circumference exceeded the upper range of normal, regardless
of the mother's blood sugar level. In the standard group, insulin
therapy was started when fasting glucose levels surpassed 90, or
120 after a meal.
Pregnancy outcomes were the same using either strategy. However,
insulin was not given to 34 percent of the women in the sonogram
group who would have been treated with insulin according to the
standard protocol.
Summing up, the researcher said that monitoring the baby's growth
is a way to concentrate intensive insulin therapy where it's needed
-- on GDM pregnancies where the baby is at risk for problems.
SOURCE: Diabetes Care, February 2004.
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