Major Complications of Diabetes
It is always better to know and prevent a disease than to have it. This article discusses the complications of diabetes. One can avoid these complications by the yearly (or half-yearly) checkup of eyes, kidney, heart and feet by the qualified specialists so that these complications, if present, can be diagnosed at an early stage and effectively treated before it becomes too late.
Acute Complications of Diabetes
Hypoglycemia – Hypoglycemia is defined as a condition in which there is blood glucose concentration of less than 45 mg/dl. Sweating, trembling, hunger, confusion drowsiness, in-coordination and nausea are some of the symptoms of hypoglycemia.
The common causes are unpunctual or inadequate meals, unexpected or unusual exercise and ingestion of alcohol. Patients should be taught that if unusual exercise is anticipated the preceding dose of insulin should be reduced and extra carbohydrate ingested. All patients taking insulin should carry with them glucose tablets.
Ketoacidosis – Any form of stress, particularly an acute infection or neglect of treatment due to carelessness can lead to ketoacidosis. There is intense thirst and polyuria. Constipation, muscle cramps and altered vision are common. Hyperventilation with low blood pressure and acetone may be smelt in the breath and finally it may lead to coma. Glycosuria and ketonuria would be present. Blood glucose levels may be as high as 360-720 mg/dl and low plasma bicarbonate and blood pH.
The condition should be treated with the utmost urgency in hospital. Intravenous fluid replacement is required since, even when the patient is able to swallow, fluids given by mouth may be poorly absorbed. If 6 to 8 units of insulin per hour is given, blood glucose level comes down. 13-20 mMol of potassium per 0.51 infusion fluid should be started from the outset. Intracellular fluid is replaced once the blood glucose has fallen below 250 mg/dl by infusing glucose solution. Intensive medical care is needed and the blood glucose, pH, electrolytes and ketones have to be monitored, hourly at first.
I hope this article has covered some of the major complications of diabetes. Knowing these complications will help you to prevent them.
Control your blood sugar for having more control on life!
Disclaimer: This article is not meant to provide health advice and is for general information only. Always seek the insights of a qualified health professional before embarking on any health program.
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February 19th, 2010 at 8:31 pm
What are the main complications with delivery of macrosomic baby?
I am 36.5 weeks & my baby is already measuring to be 9.5-10lbs. I had an amnio yesterday and the baby’s lungs are not quite mature enough for an induction. Both of my boys were born, vaginal deliveries, at 36.5 weeks weighing 7lbs 1 oz and 7lbs 11oz w/ stays in the NICU due to lungs. I do not have gestational diabetes & doctors don’t see anything wrong with the baby other than genetics has made him large for gestational age. I have read about some of the complications w/ macrosomic deliveries and I am scared that somehow my baby or myself might die or suffer from major complications. Should I try vaginal or just opt for c section?
February 20th, 2010 at 1:33 am
If you feel the C-section is safer , go for the C-Section. If you do the vaginal way, they might have to make an uncomfortable cut ‘down there’ to make room for the baby’s head…Do what you feel is safer for both you and the baby. Don’t worry about the vaginal delivery if you’re not feeling too safe about it. It doesn’t make you any less of a mom if you have a C-Section..
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February 20th, 2010 at 1:35 am
Well, I had gestational diabetes, and my daughter was estimated to be near 11 pounds, so they did a c-section. She was 7 lbs 11 oz, just had a big head, as part of her genetics.
It’s hard to tell you what to do, but I’d probably discuss it w/ the OB and get their opinion on which they’d prefer. Personally, I’d probably go for vaginal, but that might not be viable in your case. I’m stuck w/ c-sections since my medical providers don’t do VBACs, so if you’re planning more kids, take that into consideration as well.
Good luck with your decision.
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February 20th, 2010 at 1:37 am
Whatever you decide request that after delivery the baby’s umbilical not be cut until it stops pulsating. I’ve read articles linking cutting the cord within moments of delivering causes breathing problems in all infants; it’s because blood that is supposed to be in the baby is still in the cord and placenta- it’s this blood that helps oxygenate their lungs allowing unhindered breathing. So, if you let that blood get into the baby they will almost definitely have an easier time breathing.
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February 20th, 2010 at 1:39 am
So, let’s start with this – ultrasounds and fundal heights are EXTREMELY unreliable near the end for measuring fetal size, no ifs ands or buts, unreliable.
Even if the baby is 9 lbs 15 oz, that’s not macrosomatic, 10lbs and up is. Even if the baby is 10lbs most mothers can deliver a 10lb baby vaginally, it’s when they have large shoulders that it’s a problem – and that, well, that is usually due to gestational diabetes not from being big.
So the one problem with macrosomatic babies is shoulder dystocia, where the shoulder gets stuck on the pelvic bone and that can be a true emergency as it’s stressful for the baby to be in the birth canal for too long and their oxygen supply can be compromised at that point. Sometimes the fetus has to have it’s shoulder broken to be delivered, this is preferable to death of course, sometimes there is nerve damage. A broken shoulder is nothing, it heals rapidly in a newborn and should not mean further problems.
If you delivered a normal weight infant, you more then likely can do a 10lb baby – I know I did, normal pushing and a 10lb 5 oz, he had no shoulder dystocia becuase I had no gestational diabetes. Let your body give it a try, you’ll have a healthier baby if you have at least a trail of labor with this one.
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February 20th, 2010 at 1:41 am
The main complications of a large baby are shoulder dystocia, his head is too big too fit through the pelvis, you’ll need more time to labor and deliver the baby which if your membranes are broken, can make you and baby higher risk of infection.
As far as I am concerned you should try a vaginal delivery. C-section is major surgery which requires a substantial amount of recovery time. With two boys running around you won’t have that time. You and baby are pretty safe scince you will be giving birth in a hospital around trained nurses and doctors. They will wheel you into the O.R. at the slightest hint of of trouble. Unless of course you would rather get a c-section for what ever reason, try to give birth vaginally. Good Luck!
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February 20th, 2010 at 1:43 am
doctors don’t really know how much your baby will weigh till its born.they guesstimate.i had sons 9pds3oz,9pds5ozs,9pds7ozs,9pds2ozs9pds11ozs and 9pds.i was induced with all my boys .i had to get stitches and hemmoraged pretty bad with them but that was about it.i had each of them at 36 wks as well.i was not diabetic but have good genetics2out of the 6 had problems with lungs and jaundice.other than the cut i wouldn’t worry if i was you.best of luck and god bless.babies are a beautiful thing.
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February 20th, 2010 at 1:45 am
http://www.plus-size-pregnancy.org/Prena...
Many OBs are fixated on the supposed "dangers" of a big baby (officially known as macrosomia). Definitions of what constitutes a "big" baby differ, but most research chooses one of the following three cutoffs: 4000 g (just under 9 lbs.), 4500 g (9 lbs. 14 oz.), or 5000 g (about 11 lbs.). The average size for babies is somewhere around 7 and a half pounds, but babies vary widely around that and are still born just fine. Although most research considers babies above 4000g to be macrosomic, the American College of Obstetricians and Gynecologists considers 4500g to be a better cutoff for macrosomia.
Although the risks for shoulder dystocia (baby getting stuck at the shoulders) and birth injuries are increased somewhat among big babies, in actuality MOST big babies are born vaginally without any problems. But because a few big babies have problems, and because doctors tend to get sued over these types of cases often, they fixate on whether the baby is big or not, in hopes of preventing shoulder dystocia and birth trauma.
This worry leads to one of the most dubious uses of ultrasound—-an ultrasound for estimating fetal weight. This practice is very controversial. Research clearly shows that ultrasounds for estimating fetal weight are often quite inaccurate, and especially so at the extremes of size (extra-small or extra-large). Doing ultrasounds for estimating fetal weight is a very questionable policy, but many providers routinely do it anyhow.
The accuracy of ultrasound for detecting macrosomia seems to run generally from 50% to 65% or so, very low accuracy to be the basis for so much intervention. For example, Pollack et al. (1992) found that only 64% of the babies estimated to be macrosomic (big) actually were. Levine et al. (1992) found that HALF of the ultrasound predictions of fetal weight were incorrect. Delpapa and Mueller-Heubach (1991) found that 77% of ultrasound fetal weight predictions exceeded actual birthweight and only 48% were even within 500g (about one pound) of the actual birth weight. Furthermore, 23% were more than 1 pound overestimated, and 50% of the babies predicted to be macrosomic weren’t macrosomic at all.
Notice that predicting macrosomia through estimated fetal weight is as accurate or only slightly more accurate than tossing a coin! It is not very good science. Yet doctors routinely continue to order ultrasounds to estimate fetal size, particularly in large women. And these incorrect predictions continue to result in huge amounts of intervention, which have major health implications.
For example, when the baby is predicted to be ‘big,’ the doctors often induce labor early in the mistaken belief that this will be more likely to result in vaginal birth and to avoid birth injuries. Or they strongly pressure women (especially big women) to have an elective cesarean, which brings its own set of substantial risks, both for this pregnancy and any future pregnancy the woman may have. Unfortunately, research shows that early induction and/or elective cesarean for macrosomia are NOT justified in non-diabetic women, and may be questionable in some diabetic women too.
In many cases, induction strongly raises the chance of a cesarean (instead of lowering it), and may increase the risk for birth trauma as well. Levine (1992) found that inducing for macrosomia increased the cesarean rate from 32% to 53%, and Weeks (1995) found that inducing increased cesarean rates from 30% to 52%. Leaphart (1997) found that inducing for macrosomia increased the cesarean rate from 17% to 36% in a facility with a generally low cesarean rate, and Combs (1993) found that inducing for macrosomia increased the cesarean rate from 31% to 57%!
Even when inducing early did not increase the cesarean rate (Gonen 1997), it did not improve fetal outcome or lower the rate of shoulder dystocia. In fact, in some studies, inducing early actually increased the rate of shoulder dystocia (Combs 1993, Jazayeri 1999, Nesbitt 1998). So although most OBs have been taught that early induction for macrosomia will decrease the chances for cesarean and lower the risks for birth injuries, research actually shows that the opposite is true.
Even simply the PREDICTION of macrosomia by estimated fetal weight significantly changes the way the doctor perceives and handles the labor, and strongly increases the rate of induction and/or cesarean. Weeks (1995) studied the effect of the label of predicted macrosomia. Those women who had been predicted to have big babies had a 42% induction rate, and a 52% cesarean rate! Yet the big babies in the study who were NOT predicted to be big had only a 27% induction rate and a 30% cesarean rate. There was no difference in size between groups; the only difference between groups was the PREDICTION of a big baby. The authors concluded, " Ultrasonography and labor induction for patients at risk for fetal macrosomia should be discouraged."
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