It’s best for any adult to be screened for diabetes, health experts say. However, it’s mandatory for pregnant women to be tested to rule out gestational diabetes, which is common during pregnancy. John Muganda, a gynaecologist at Harmony Clinic in Kigali, says gestational diabetes is an illness that occurs during pregnancy, it means a woman has high blood sugar levels, however, those levels were normal before she was pregnant. He says that at a certain stage during pregnancy, a woman should be screened for diabetes. He adds that this kind of diabetes usually occurs in the second trimester, and that it’s ideal to find out if a woman has gestational diabetes between weeks 24 and 28 of the pregnancy. “When we talk of gestation diabetes, it means that sometimes it’s easy for a physician to confuse it with underlying diabetes before pregnancy, therefore, it’s mandatory for any pregnant woman to be screened for diabetes even if they don’t have it,” he says. HOW IT COMES ABOUT Muganda says that one may have the underlying problems before even getting pregnant, which makes it hard to rule out if it’s gestation diabetes, or if they had diabetes before. He adds that to know this well, with proper treatment, and if the problem stops as soon as a woman delivers, it can be confirmed to be gestational diabetes. Iba Mayale, an obstetrician/gynaecologist at Doctors Plaza in Kimironko, says there are many causes that bring about gestational diabetes. He explains that during pregnancy, the placenta makes hormones that can lead to a build-up of glucose in the blood. “In the normal sense, the pancreas can make enough insulin to handle that. If not, the blood sugar levels will rise, which can cause gestational diabetes,” he says. Those who are at risk of developing gestational diabetes, he says, are those who were overweight before they got pregnant and have high blood sugar levels, but not high enough to be diabetes. He adds that those with a family history of diabetes, had gestational diabetes before, have high blood pressure, or other medical complications, or have given birth to a big baby before, have a high risk of developing gestation diabetes. Mayale, however, says that if the mother has high blood sugar, it affects the baby as well, because they get nutrients from the mother’s blood; where the baby stores that extra sugar as fat, which can make them grow larger than normal. TREATMENT Dr Theodomir Sebazungu, a gynaecologist at University Teaching Hospital Kigali (CHUK), advises that if it’s confirmed, treatment should be commenced immediately. “It’s not easy to treat diabetes during pregnancy because it’s treated using only insulin, as tablets are not recommended. This is due to the side effects caused by tablets as treatment,” he says. During pregnancy, he says, to control blood sugar is not easy because at this time, a physician is not only treating the mother but also the foetus. He says that to stabilise the blood sugar for one person is difficult, so it’s even worse if when it’s two, because it requires close monitoring. He adds that here, apart from just treatment, a nutritionist should recommend the required diet. “The blood sugar should be well stabilised, if not, the foetus can die in the womb leading to complications,” he warns. Muganda notes that proper treatment of this condition requires multidisciplinary care where gynaecologists work closely with dietitians, endocrinologists and nurses. Muganda says that prevention lies in the checking of blood sugar. Ideally, he says, all adults should be screened for blood sugar because everyone is at risk of getting diabetes due to what they are exposed to. A nurse examines a woman pregnant with her first child. It’s mandatory for pregnant women to be tested during antenatal visits to rule out gestational diabetes /TheGlobalFund WHAT ARE THE COMPLICATIONS? Mayale says that in most cases, a pregnant woman will rarely show symptoms of gestational diabetes, and the only way to find out is by regular screening. However, he notes that feeling extremely tired, thirsty very often and passing urine frequently, are some of the signs of the condition. However, Mayale says that this can be tricky because one can confuse a serious condition for normal pregnancy signs. Mayale says that all the complications of diabetes can occur if one has gestational diabetes. For instance, a woman can have a problem with vision, high blood pressure, and kidney and urinal failure, among others. Sebazungu says that managing blood glucose levels during pregnancy is extremely important for the health of the mother and the foetus. For some women, he says, gestational diabetes can usually be managed with changes in diet and physical activity, but, in most cases, medications, including injecting insulin, are required. “Monitoring the blood levels of pregnant women reduces the risk of complications and increases chances of one having a healthy pregnancy,” Sebazungu says. When it comes to gestational diabetes, he says if it isn’t managed properly, it can put a mother at an increased risk of developing further complications. For instance, Sebazungu says continuous high blood glucose levels can lead to induced labour, a caesarean section, giving birth to a larger than normal baby, and many others. Also, he says, the new-born may also have low blood glucose levels (neonatal hypoglycaemia) or the baby could die around the time of birth. Muganda says that another complication is that the baby may have a higher risk of being overweight or obese, thus developing type 2 diabetes later in life. Experts share their views Specific exercise programmes, manual therapy, massage and electrical devices can be used in physiotherapy management to help treat musculoskeletal conditions which can develop with diabetes. Celestine Karangwa, Physiotherapist *********************** With type 2 diabetes which is linked to lifestyle, the only way to avoid it is by quitting bad lifestyle habits, such as smoking; stick to a healthy lifestyle and get involved in physical activities. This will prevent gestation diabetes as well. Iba Mayale, Gynaecologist *********************** Following a strict diet recommended by a nutritionist, such as eating reasonable portions and avoiding sugary drinks, among others, is important. It helps control blood sugar levels. Joseph Uwiragiye, Nutritionist *********************** Women with diabetes are at a higher risk of other infections. In fact, more women are likely to get a urinary tract infection as a result. Oliver Habiyaremye, General practitioner editorial@newtimes.co.rw
