Diabetes and Pregnancy

Most major organ systems are formed in the growing fetus during the first seven weeks after conception. This phase -- when some women do not know that they are pregnant -- is widely considered the most critical time of development in the entire human lifespan. The early weeks of pregnancy are especially critical for women with diabetes. 

The extra precautions described here mainly apply to women with diabetes who become pregnant, rather than women who develop gestational diabetes during pregnancy. During pregnancy, gestational diabetes does not carry the same risk of maternal complications as type 1 or type 2 diabetes.
How Should Women With Diabetes Prepare for Pregnancy?
Women with diabetes should have a complete physical examination before becoming pregnant. As part of the examination, they should provide their doctors with a complete medical history, including duration and type of diabetes, medications and supplements taken, and any history of diabetic complications, such as neuropathy, nephropathy, retinopathy and cardiac problems. 

It is also important for women with diabetes to plan ahead and maintain excellent blood sugar control before conceiving, as high blood sugar levels during the first trimester can lead to miscarriage or congenital anomalies, which are abnormal changes during fetal development in the uterus. 

Before becoming pregnant, women with diabetes should also have their kidney function tested. Although pregnancy does not worsen diabetic nephropathy (kidney disease), pregnant women with advanced kidney disease are more prone to high blood pressure, which can affect nearly all body systems and ultimately endanger the fetus. 
What Special Care or Tests Are Required for Pregnant Women With Diabetes?
Pregnant women with diabetes need to carefully monitor eye care, including a full retinal examination before, during and after pregnancy, as diabetic retinopathy (damage to the retina’s blood vessels) can worsen during pregnancy. This complication occurs particularly in women who have poor blood glucose (sugar) control. 

During pregnancy, women should measure their blood glucose several times daily: before and after meals, at bedtime, and at night if there is a concern about nighttime hypoglycemia (low blood sugar). The American Diabetes Association recommends pre-meal glucose measurements of 80 to 110 mg/dL (milligrams per deciliter) and post-meal glucose measurements below 155 mg/dL. 

If a pregnant women with diabetes has a blood glucose measurement around 180 mg/dL, her urine should be checked for ketones (acids) to rule out ketoacidosis, which can sometimes cause a miscarriage. Ketoacidosis occurs when the body lacks insulin. 
Why Is Managing Blood Sugar Especially Important for Pregnant Women With Diabetes?
In a 1989 study, women with a prepregnancy A1C value (a blood test that measures glucose levels) that was greater than 9.3% had the highest risk of miscarriages and birth to babies born with congenital anomalies. Studies have indicated that A1C values of up to 6% (with 5% being considered normal) carry the same risk of miscarriage and fetal anomalies as a nondiabetic pregnancy. 

Women with higher than normal blood sugar levels, whether they have gestational, type 1 or type 2 diabetes, also tend to have larger babies. This leads to a greater risk of injuries of the shoulder and brachial plexus (the nerves connecting the spine with the arm and shoulder) to the infant during childbirth. 

Poorly controlled diabetes is also associated with pre-eclampsia (high blood pressure) and premature delivery. 

There is very little information about the effect of hyperglycemia (high blood sugar) on long-term development of the fetus.
Are There Diabetes Medications That Should be Avoided During Pregnancy?
Women with type 2 diabetes who take oral medications for blood sugar control should switch to using insulin before becoming pregnant and throughout pregnancy. While some oral antidiabetic medications have been studied and were found to be safe in pregnancy, insulin is the best and safest method for controlling blood sugar throughout pregnancy. 

Many blood pressure medications can be dangerous for the fetus; therefore, usually these medications should be stopped before pregnancy if blood pressure can be maintained below 130/80 mmHg with dietary salt control alone. If blood pressure medications are absolutely necessary, women may have to be switched to a new medication prior to pregnancy. In particular, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are excellent for blood pressure control in nonpregnant women with diabetes; however, these are not safe when used by a woman who is diabetic and pregnant. Similarly, cholesterol-lowering medications should also be stopped during pregnancy. 
How are Diet and Exercise Managed for Pregnant Women With Diabetes?
Nutrition is vitally important for pregnant women with type 1 and type 2 diabetes. In general, pregnant and nursing women with diabetes should ingest 15 to 17 calories per pound of body weight daily, although this may vary from person to person and should be discussed with the diabetes care team before, during, and after pregnancy and nursing. 

Important nutritional concerns in type 1 diabetes include consistent day-to-day food intake and consumption of a bedtime snack, and adjusting insulin according to activity and food content to prevent high or low blood sugar levels to carefully treat hyperglycemia and hypoglycemia, respectively. 

Nutrition is the most important means of blood glucose control in type 2 diabetes. Pregnant women with type 2 diabetes should talk with their diabetes care providers, and ideally a diabetes nutritionist, to determine their goals for daily calories, carbohydrates, nutritional balance in foods, and timing of eating throughout the day. 

Exercise is beneficial for pregnant women with type 2 diabetes, as it helps improve the body’s response to insulin. Women with type 1 diabetes who exercised prior to pregnancy can probably continue to exercise during pregnancy. However, women with type 1 diabetes who are not accustomed to exercise are more prone to hypoglycemia with exercise during pregnancy; for this reason, these women are not advised to begin an exercise regimen when pregnant.

Common Rashes With Blisters

Do you know what's causing those blisters? Should you see a doctor or can you take care of it on your own? Take a look at some common rashes with blisters and see if you can find yours.

Chicken Pox:

Chicken pox is a highly contagious viral infection caused by the varicella virus. The word chickenpox comes from the Old English word "gican" meaning "to itch" or from the Old French word "chiche-pois" for chickpea, a description of the size of the lesion.

Who Gets Chicken Pox
Chickenpox is a disease of childhood - 90% of cases occur in children aged 14 years and younger. Before widespread vaccination, the incidence of chicken pox in the United States approached the annual birth rate, averaging between 3.1 and 3.8 million cases per year. Chicken pox can occur at any time, but occurs most often in March, April, and May in temperate climates.

Varicella Virus
The varicella virus is an enveloped, double-stranded DNA virus. It attaches to the wall of the cell it invades, and then enters the cell. The virus uncoats and is transported to the nucleus where the viral DNA replicates creating new virions that are eventually released from the cell to infect other cells.

Acquiring Chicken Pox
Chicken pox is acquired by direct contact with infected blister fluid or by inhalation of respiratory droplets. When a person with chicken pox coughs or sneezes, they expel tiny droplets that carry the varicella virus. A person who has never been exposed to chicken pox inhales these droplets and the virus enters the lungs, and then is carried through the bloodstream to the skin where it causes a rash. While the virus is in the bloodstream (before the rash begins) it causes typical viral symptoms like fever, fatigue, joint pains, headache, and swollen glands. These symptoms usually resolve by the time the rash develops. The incubation period of chicken pox averages 14 days with a range of 9 to 21 days.

Appearance of Chicken Pox
The chicken pox rash begins on the trunk and spreads to the face and extremities. The chicken pox lesion starts as a 2-4 mm red papule which develops an irregular outline (rose petal). A thin-walled, clear vesicle (dew drop) develops on top of the area of redness. This "dew drop on a rose petal" lesion is very characteristic for chicken pox. After about 8-12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after 7 days sometimes leaving a craterlike scar. Although one lesion goes through this complete cycle in about 7 days, another hallmark of chicken pox is the fact that new lesions crop up every day for several days. Therefore, it may take about a week until new lesions stop appearing and existing lesions crust over. Children are not sent back to school until all lesions have crusted over.

Poison Ivy:

Poison ivy is known in medical terms as Rhus Dermatitis which is a type of contact dermatitis. As the name implies, a contact dermatitis is an irritation of the skin caused by contact with a specific irritant. In the case of poison ivy, the irritant is called urushiol which is a resin found in the plants in the Anacardiaceae family and the Rhus genus. Plants included in this classification are poison ivy, poison oak, and poison sumac. Also included are the cashew nut tree, mango tree, Japanese lacquer tree, and marking nut tree.

Poison Ivy
The appearance of poison ivy, oak, and sumac varies by regions and season. Poison ivy leaves are most likely to be in groups of three and notched, although they can be smooth edged. Poison ivy is usually found east of the Rocky Mountains growing as vines or shrubs.

Poison Oak
Poison oak leaves come in groups of three, five, or seven. They are smaller than poison ivy leaves and have smooth, rounded edges. Poison oak is usually found west of the Rocky Mountains as a small bushy plant or climbing vine.

Poison Sumac
Poison sumac has seven to thirteen leaves on one stem angled upward. They are smooth edged, oval and about 10 cm long. Poison sumac is found in boggy areas in the south.

Interesting Facts About Poison Ivy
In the United States poison ivy, poison oak, and poison sumac cause more cases of contact dermatitis than any other agents combined. Rhus dermatitis accounts for 10% of the US Department of Agriculture and Forestry Services lost time injuries. Twenty-five million to 40 million Americans require medical attention after being exposed to one of these plants.

Poison Ivy occurs from contact with the leaf or internal parts of the stem or root of the plant. Eight to 48 hours after exposure to urushiol the characteristic rash appears. This rash is typically red, contains blisters, and is in a linear or circular pattern. Urushiol can be found under fingernails, on clothing, and on tools unless it is deliberately removed. The resin itself can be active and cause a new rash for up to 3 weeks after exposure. Urushiol is not found in blister fluid and not responsible for spreading the rash. If untreated, the rash usually resolves in 3 weeks.

Treatment of Poison Ivy
The most common sites on the body for poison ivy are exposed areas on the arms, legs, and face. The intensity of the rash varies depending on the sensitivity of the person, and the amount and extent of exposure.

• Washing the skin with soap and water inactivates and removes the resin. Washing is most effective if it is done within 15 minutes of exposure.
• Cold, wet compresses are effective in the blistering stage. They should be used for 15 to 30 minutes several times a day for the first 3 days.
• Steroid creams or ointments are helpful to reduce redness and itching. Hydrocortisone can be used on the face, but is usually not strong enough for more than mild cases on the arms or legs. Typically, a prescription strength steroid is needed for these areas.
• Oral steroids are used for severe cases of poison ivy but must be used for at least a week.
• Short, cool tub baths with colloidal oatmeal (Aveeno) can be soothing and help control inflammation.
• Calamine lotion helps control itching but used too long can cause excessive drying of the skin and more inflammation.
• Antihistamines help reduce itching and the older types such as diphenhydramine (Benadryl) help encourage sleep.
• Any exposure to the eyes or eyelids or the development of a honey-colored crust should be evaluated by a health care provider.

Prevention of Poison Ivy

• Desensitization is not effective either by chewing leafs or having commercially prepared extracts injected.
• The most effective prevention is using a barrier to protect the skin. Clothing serves as an effective barrier but since the urushiol remains on the clothing, it must be removed carefully and laundered without contacting the skin.
• Urushiol can penetrate latex gloves but not rubber gloves.
• A lotion containing 5% quaternium-18 bentonite (IvyBlock) can be applied to the skin and provides a barrier for 4 to 8 hours. It must be washed off and reapplied for continued exposure.

The First Genital Herpes Outbreak:

Most people who are infected with the herpes simplex virus do not have symptoms. Of those who do develop symptoms, the first outbreak of genital herpes is worse than recurrences. The first outbreak is also associated with general symptoms aside from the rash. Women are at risk

of having a herpes infection that does not cause the usual symptoms.

Genital Herpes and Herpes Simplex Viruses
In the past, genital herpes was caused mainly by the herpes simplex virus type 2 (HSV-2). But now, new genital herpes infections are caused equally by the herpes simplex virus type 1 (HSV-1) and the herpes simplex virus type 2 (HSV-2). The majority of people who are going to get a primary outbreak will do so between 3 days to 2 weeks after exposure.

The First Genital Herpes Outbreak
The rash of herpes is a cluster of vesicles on a red base. In moist areas like the vagina, herpes may cause ulcerations instead of blisters. In women, the first outbreak of genital herpes can occur on the vulva, cervix, vagina, urethra, anus, buttocks, or thighs. Men usually get an outbreak on the tip of the penis or the shaft, but rarely around the base. Men who have sex with men may also get blisters in or around the anus. The rash in men is usually mild -- only 6 to 10 blisters. The blisters in men and women are painful and contain a large number of viral particles; therefore, they are very contagious.

Other Symptoms With the First Genital Herpes Outbreak
Seventy-nine percent of people get general symptoms with the first outbreak that usually resolve within a week. Some common general symptoms include:

• Fever to 102 degrees
• Headache
• Muscle aches
• Fatigue
• Swollen lymph nodes

Women and the First Genital Herpes Outbreak
Women are four times more likely to be infected with HSV-2 than men. For some reason, women have more severe disease and more complications during the first infection than men. If a woman gets a herpes outbreak on the cervix or vagina and not externally, she may develop vaginal discharge, pelvic pain, or burning with urination. With the first outbreak, some women may get a second round of blisters or ulcers in the second week.

How Long the First Genital Herpes Outbreak Lasts
The first herpes infection usually lasts for 2 to 3 weeks, but skin pain can last for 1 to 6 weeks. The blisters dry out and crust over. When the crusts fall off, the area is usually not contagious anymore. There is evidence that some people have low levels of virus present even when they do not have symptoms.

STROKE VICTIM COMES TO THE AID OF FELLOW SUFFERERS

Walk Easy is the comfortable solution to ‘dropped foot’ and similar disabling complaints

For many stroke victims the most frustrating reminder of their attack is dropped foot - the inability to flex an ankle whilst walking. London architect Marshall Walker tried various appliances following his stroke, but to no avail - so designed his own. He has now developed his invention, for which he acquired a USA patent, and has brought the Walk Easy Dorsiflexion/Eversion Assistor to the aid of other sufferers from the effects of strokes, Multiple Sclerosis and other neurological problems which result in dropped foot

It is a simple device that fits either leg and helps the wearer keep the sole of the foot parallel to the ground, thus aiding comfortable walking or permitting climbing stairs without the discomfort of a stubbed toe or a trip. It has also helped 'dropped foot' sufferers drive, dance, play golf and bowl in comfort.

The Walk Easy, which is completely adjustable, is washable and consists of an upper band, which is a garter-like device which fits around the calf, a tensioner, and a lower band. The lower band has a connecting cord and shoe attachments. The wearer is not restricted to the same pair of shoes as a connecting cord and special adhesive shoe attachment may be fitted to several different pairs so that any one of them may be used when the cord is joined together with the main body of the Walk Easy. Being Dynamic in use it allows the foot and ankle to flex so permitting muscular movement which thereby aids a rapid re-development of adversley affected motor responses.

Two adhesive shoe attachments and two connecting cords are supplied with the initial purchase; packs of replacement parts are available with five shoe attachments and two connecting cords.

The Walk Easy was designed to meet three criteria demanded by Marshall Walker’s physiotherapist: to allow unrestricted ankle movement during the weight-bearing phase of walking; to be fully adjustable; and to allow control of the position of the forefoot during the swing-through phase. All three aims have been met.

In walking, as the patient steps forward with the affected leg (the swing-through phase), the connecting cord pulls taut, causing the lower part of the tensioner to react to the pull, helping to keep the sole of the foot parallel to the ground. As the heel strikes the ground, the lower elasticated tensioner becomes taut, dorsiflexing the foot and preventing it from dropping. With each step the tensioner becomes slack and taut, to allow the patient a safe and normal gait.

Following a trial on eight patients from Barnet General Hospital in North London, all patients reported increased confidence, two were able to discard the device indoors after two months use and two others experienced higher tone and stronger associated reactions.

Physiotherapists have also found it useful in the treatment of patients with multiple sclerosis, early motor neurone disease, diabetic neuropathy, peripheral neuropathy and even leprosy. A mother whose daughter suffers from spina bifida reports that one fitted to each leg had enabled her daughter to walk more easily. All reports from users indicate that the Walk Easy is more comfortable and less restricting than the standard ankle foot orthosis (AFO) or other devices designed to assist sufferers from 'dropped foot'.