Insulin therapy for children and pregnant womenBy Nemencio A. Nicodemus Jr. MD
Philippine Daily Inquirer
Not too long ago, the common type of diabetes in children and teens was type 1, a chronic condition in which the pancreas produces little or virtually no insulin. Today, no thanks to obesity brought on by physical inactivity and unhealthy eating habits, more and more young individuals are developing type 2 diabetes, the more common form that occurs when the body becomes resistant to the actions of insulin apart from not making enough insulin.
Aside from the multi-organ damage caused by long-term uncontrolled diabetes, pediatric patients are also at risk of retardation in normal growth parameters such as height, weight and height velocity. Children and teens with type 1 diabetes require insulin therapy. Insulin therapy ensures catch-up growth and helps children with diabetes achieve mean growth and development rates similar to their peers.
Type 2 diabetes may be controlled with intensive diet and structured exercise. In the past, if lifestyle modification alone is unable to control type 2 diabetes, then oral antidiabetes medications will be added. More recent guidelines recommend early initiation of oral agents and even insulin therapy together with lifestyle changes if blood glucose targets are not achieved within 3 to 6 months.
Diabetes in pregnancy can either be preexisting (type 1 or type 2) or gestational diabetes, which is first recognized only during pregnancy. The placenta, during pregnancy, produces hormones that impair the actions of insulin. The placenta is a structure that develops at the inner side of the uterus during pregnancy and provides oxygen and nutrients to the growing baby and removes waste products from the baby’s blood.
Pregnancies of women with diabetes are considered high-risk for both the mother and the baby. Uncontrolled diabetes puts a woman at risk of various complications, such as pregnancy-induced hypertension (preeclampsia and eclampsia), premature labor leading to emergency cesarean section, obstructed labor, maternal infection and blood clots. The baby is at increased risk of excessive birth weight that may require a cesarean section, pre-term birth, respiratory distress syndrome, jaundice (yellowish discoloration of the skin and sclerae of the eyes), hypoglycemia (low blood sugar) shortly after birth (which can provoke seizures) and even fetal death.
More researches of longer duration are needed to confirm that oral drugs are as safe and as effective as injectable insulin to control diabetes in pregnant women. Insulin therapy is the treatment of choice for diabetes in pregnancy. Insulin is injected under the skin, usually with a fine needle and syringe or via an insulin pen.
Insulin therapy provides more predictable and flexible blood glucose control with the capability of adjusting doses in relation to the patient’s diet, activity and illness. With optimal blood glucose control, the risks of complications to both mother and baby are significantly reduced.
Many types of insulin are available. Endocrinologists and other physicians who take care of patients with diabetes, will prescribe the insulin or combination of insulins that is best for a child, adolescent or pregnant woman with diabetes. Insulin detemir is a long-acting insulin analog that is safe and proven to control blood glucose in adults and children 2 years and older with type 1 diabetes and adults with type 2 diabetes. It is also the first and only long-acting insulin analog with a randomized clinical trial showing the safety and efficacy of this insulin in pregnancy without increasing the risk of harm to the unborn child.
CONTEST: What type of diabetes develops during pregnancy? E-mail your answer to email@example.com and get the chance to win a prize! Congratulations to Annielyn dela Cruz! Your correct answer to the question in the Aug. 3, 2013 column was chosen as this week’s winner in the Diabetes Trivia Contest. You will receive an e-mail on how to claim your prize.
Dr. Nemencio A. Nicodemus Jr. is an endocrinologist and an associate professor at the University of the Philippines-College of Medicine and Ateneo School of Medicine and Public Health. The “Changing Diabetes” column commemorates the 92nd anniversary of insulin’s discovery. It aims to increase awareness on diabetes prevention, diagnosis and management. Novo Nordisk supports “Changing Diabetes.” Headquartered in Denmark, Novo Nordisk is a global healthcare company with 90 years of innovation and leadership in diabetes care. For questions or comments, e-mail firstname.lastname@example.org.