Dawn phenomenon, somogyi effect & honeymoon phase

Dawn phenomenon

Somogyi effect

Honeymoon phase

However, some of the patient may not need the exogenous insulin (insulin not produced within the body) during this phase. But then, the destruction of beta-cell is still occurred. Therefore, this period might come to an end. In addition, the honeymoon period is varied for different individuals. This phase may last for weeks, months and even years.

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Glycemic index vs glycemic load

What is Glycemic index?

Glycemic index (GI) is a system that ranking the foods on how carbohydrate in foods may affects the levels of blood glucose. It will measure how quickly or slowly the carbohydrate in the foods digested. There are three categories of GI foods which are low GI, intermediate GI, and high GI. Foods that are categories as low GI are foods that are slowly digested and absorbed while food with high GI are foods quickly digested and absorbed. This concept have been introduced by Dr. David J. Jenkins around 1980-1981 in Toronto University. Eat more low GI food and less high GI food.

What is Glycemic Load?

Glycemic load (GL) estimated the impacts of carbohydrates consumed on the blood glucose level by taking account the quantity of the carbohydrates consumed.  It can be calculated by multiplying the amount of carbohydrate contained in a specified serving size of the food with the GI value of that food, and then divided by 100. 

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Insulin sensitivity vs insulin resistance

Do you know what insulin is???

Insulin is produced by beta cells of pancreas. It functions to convert glucose to glycogen.

Insulin resistance

When the insulin resistance occurred, our body cannot utilize glucose well where the body cannot respond either to exogenous or endogenous insulin. So, this condition can increase the chance of developing type 2 diabetes and heart disease. Lastly, abnormally low insulin sensitivity is also called as insulin resistance.

Causes of Insulin Resistance:

Tips to increase insulin sensitivity:

• Choose carbohydrate wisely.
• Focussed on healthful fats and avoid saturated and processed fats.
• Moderate protein intake
• Moderately exercise

Insulin resistance vs insulin sensitivity

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Gestational Diabetes Mellitus (GDM)

Definition

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy (Metzger BE, 1998).

Gestational diabetes occurs when pancreatic function is not sufficient to overcome the insulin resistance created by changes in diabetogenic hormones (estrogen, prolactin, human chorionic somatomammotropin, cortisol, and progesterone) during pregnancy.

Pathophysiology

The characteristic of GDM is increasing in insulin resistance. Insulin resistance is a normal phenomenon that present in the second trimester of pregnancy. Pregnancy hormones are thought to disrupt the action of insulin as binding to the insulin receptor. The disruption probably occurs at the level of the cell signalling pathway behind the insulin receptor. Since insulin promotes the entry of glucose into most of the cells, insulin resistance prevents glucose from entering the cells properly. As a result, glucose remains in the bloodstream, where glucose levels rise. More insulin injection is needed to overcome this resistance.

Risk Factor

• A previous diagnosis of gestational diabetes or pre-diabetes, impaired glucose tolerance, or impaired fasting glycaemia

• A family history revealing a first-degree relative with type 2 diabetes
• Maternal age - a woman's risk factor increases as she gets older (especially for women over 35 years of age).
• Ethnic background
• Being overweight, obese or severely obese
• A previous pregnancy which resulted in a child with a macrosomia (baby with large size)
• Previous poor obstetric history

Complication

Mother

• The risk largely related to uncontrolled high blood glucose levels and its consequences.
• Increases with higher blood glucose levels.
• Higher risk for congenital malformations (a defect that is present in birth).
• Still unclear whether women with GDM have a higher risk of preeclampsia. (High blood pressure and excess protein in the urine after 20 weeks of pregnancy for women who previously had normal blood pressure.)

Baby

• Growth abnormalities and chemical imbalances after birth, which may require admission to a neonatal intensive care unit.
• Macrosomia in turn increases the risk of instrumental deliveries (e.g. forceps, ventouse and caesarean section) or problems during vaginal delivery.              

 Ventouse

 Forceps

                      

• Increased risk of low blood glucose (hypoglycemia), jaundice (a condition with yellow color of the skin, mucus membranes, or eyes), high red blood cell mass (polycythemia) and low blood calcium (hypocalcemia) and magnesium (hypomagnesemia).
• Not been clearly shown to be an independent risk factor for birth defects because birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy.

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Type 2 Diabetes Mellitus (NIDDM)

Definition

Type 2 diabetes is a chronic (lasting) disease with the condition of hyperglycemia (high level of glucose in the blood). It results from insulin resistance and relative insulin deficiency. The body is unable to respond to either endogenous or exogenous insulin to reduce blood glucose level. This condition causes the body cells cannot able to take up the glucose and utilize it.

Pathophysiology

The level of insulin that arising from the body or derived within the body (endogenous insulin) may be normal, decreased or even elevated. Nevertheless, this insulin production usually is not sufficient to overcome the insulin resistance. 

Increased blood glucose level first appears after meal (postprandial) and then followed by an elevation in fasting glucose concentration. This condition happens because of the decreased insulin secretion accompanied by increased glucose production by the liver.

Besides that, insulin resistance which happens on fat cells can causes high amount of lipids in the blood. At this time, lipolysis (the process of breaking down of lipid, particularly triglycerides into fatty acids and glycerol) will take place frequently. This free fatty acid (FFA) will be transported to the liver. This influx of FFA to the liver will further increase in insulin resistance. High level of free fatty acids will impair the function of pancreas to secrete insulin and increase the glucose production by the liver.

Risk factor

• Age greater than 45 years
• Experience previous diabetes during pregnancy
• Excessive body weight especially around the waist.

• Born a baby weighing more than 9 pounds (4.1kg).
• HDL cholesterol (good cholesterol help in transportation of bad cholesterols) which is under 35 mg/dL.
• High blood levels of triglycerides, a type of fat molecule (250 mg/dL or more)
• High blood pressure (greater than or equal to 140/90 mmHg)
• Impaired glucose tolerance (IGT) - High blood glucose level but is below the level of diabetic patient. This is associated with the insulin resistance and abnormal insulin secretion.
• Low activity level (exercising less than 3 times a week)
• Metabolic syndrome (a group of risk factors that increases the risk for heart disease, diabetes, stroke and other diseases.)
• Polycystic ovarian syndrome - a condition in which a woman has an imbalance sex hormones regulation which causes difficulty to get pregnant. It happens mostly among obese people.
• Acanthosis nigricans (presence of dark and thickened skin around the neck or armpits.)

• Ethnic background including African Americans, Hispanic Americans, Asian Americans, and Native Americans. 

Source: 

http://www.nlm.nih.gov,2012.

National Library of Medicine  National Institutes of Health

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