Effects of Type 1 Diabetes on Pregnancy

Effects of guinea pigcast 1 Diabetes on motherhoodIntroductionDiabetes mellitus is a serious endocrine trouble haved by a deficiency or atrophied effectiveness of the hormone insulin and is categorized into two sub-categories, suit 1 and event 2, together with the lesser cognize variant gestational diabetes (Burden, 2003, pp30-32). Type 1 diabetes is sight to be a genetically controlled autoimmune disorder that presents in childhood and is also know as juvenile onset diabetes or insulin dependent diabetes. Type 2 diabetes usually occurs in older, obese individuals however, this type of diabetes is becoming increasingly more common among children and adolescents. Debatably, this is because of the amplification in childhood obesity because of the sedentary lifestyle some children be adopting in todays society. There is also an genetical predisposition to type 2 diabetes. If one or twain p atomic number 18nts accept type 2 diabetes the offspring is at an change magnitude risk of getting the turn back (Rosenbloom et al, 1999, pp345). It is important to differentiation that gestational diabetes that is a complication of motherhood is different from the preexisting diabetes in pregnancy that pull up stakes be discussed in this essay.It is thought that round third to five portion of pregnancies are complicated by type 1 diabetes. During pregnancy diabetes mellitus groundwork behave a damaging detrimental affect on both maternal and foetal wellness. Conversely, diabetes is affected by the physiological changes that take place during pregnancy (Bewley, 2002, pp47-48).This essay provide examine the effects of type 1 diabetes on a seventeen year old (Carol) that is six-spot workweeks pregnant. The essay leave behind start by investigating the prevalence of diabetes mellitus in order to acquire a global picture of the illness. The aetiology and physiology of type 1 diabetes go away then be discussed. This essay will then go on to consider the signs and symptoms of the condition and its effects on Carol now and in the future. Next the complications of diabetes in general and during pregnancy will be discussed, considering the effects on Carol and her unborn child. The effects of type 1 diabetes on the developing embryo, foetus and mother will be addressed. Finally, the hereditary link for type 1 diabetes will be considered and the essay will then be concluded.EpidemiologyDiabetes mellitus is a growing global and public health problem. The World Health Organisation (2006, p1) estimates that the problem could escalate to an estimated three hundred cardinal people by 2025. It is thought that approximately one and a half million people in the United Kingdom have diabetes mellitus. Type 1 accounts for approximately twenty percent of cases of diabetes mellitus. Type 2 diabetes accounts for more than eighty percent of cases with more than one million people diagnosed in the United Kingdom (Burden, 2003, pp30-32).The aetiology and physiology of type 1 diabetes mellitusThis section focuses on the causes of disease and the biological aspects of diabetes mellitus. As mentioned type 1 diabetes results from the complete absence of the hormone insulin that is involved in glucose metabolism. It is thought that it is an autoimmune disease in which the probosciss immune system attacks and destroys the beta cells in the islets of Langerhans that are embedded in the tissues of the pancreas (See draw 1). plot 1, this shows the islets of Langerhans that are deeply embedded with the tissues of the exocrine pancreas (http//cal.man.ac.uk/student_projects/2000/mnby7lc2/pancreas.htm). plot 1The pancreas has two functions the exocrine cells contract digestive fluids and the endocrine cells produce hormones. It is the endocrine insulin producing beta cells that are important in the role of diabetes mellitus. The beta cells (see diagram 2) make insulin and when the bodys immune system attacks it results in the destruction of these cells. As the cells die insulin take assures and the consequences of this are impairment in function of, and dam date to many of the organs in the body.Diagram 2 shows the insulin producing beta cells that are found in the islets of Langerhans (http//cal.man.ac.uk/student_projects/2000/mnby7lc2/pancreas.htm). Diagram 2It is not kn experience hardly what triggers this immune attack, but susceptibility to the disease dexterity be hereditary. The autoimmune attack whitethorn be triggered by reaction to a virus infection. The attack is thought to be carried out by the T cells of the immune system (Waugh and Grant, 2001, p234).In Diabetes mellitus there is too much glucose in the origin. When carbohydrates are eaten they are wiped out(p) down into glucose. This process is known as gluconeogenesis and occurs in the liver and kidneys. The level of glucose in the blood is set by the naturally occurring hormone insulin. Insulin promotes transport and entry of glucose into t he bodys cell and tissues. Glucose is essential to the proceeds of energy within the cells and without it cellular finish will occur (Tortora and Grabowski, 2003, p627).Signs and symptoms of type 1 diabetes mellitusThis section will examine the signs and symptoms that Carol would have exhibited before diagnosis and during the course of the condition. The initial clinical indication of untreated diabetes relates to elevated blood sugar levels, and loss of glucose in the urine. When there are excessive amounts of glucose in the urine, water system is taken out of the body in large amounts by the process of osmosis (Waugh and Grant, 2001, p235). This results in polyuria (increased urine output) and that leads to dehydration. dehydration causes polydipsia (increased thirst) leading to increased fluid consumption. The inability to utilise glucose energy eventually leads to weight loss patronage excessive hunger (polyphagia). Dramatic weight loss would have been a clinical sign exhibit ed by Carol. Some patients also complain of fatigue, nausea and vomiting. Patients with diabetes are prone to developing infections of the bladder, skin, and vaginal areas this is because hyperglycaemia skunk disrupt the action of phagocytes that are help to fight infection. The immune system in diabetes sufferers is suppressed and this limits the bodys ability to resist invasion by bacteria or viruses. Fluctuations in blood glucose levels can lead to blurred vision and extremely elevated glucose levels can lead to lethargy. Diabetic ketoacidosis is a serious medical condition resulting from uncontrolled diabetes. Ketoacidosis is caused by lack of insulin and occurs when the body uses fat as an energy source and ketones build up in the blood. Ketoacidosis starts slowly and builds up to a stern condition that can result in coma and assertable death (Burden, 2003, pp30-32).Carol may have exhibited all or some of these symptoms when scratch line diagnosed and she is exhibiting symp toms of weight loss, tiredness and mood changes at present. Debatably, this is because here blood glucose levels are uncontrolled due to her pregnancy. Having said this however, research has found that adolescents (in particularly girls) are not nimble in all aspects of managing their condition. Having a certain level of hyperglycaemia will enable a psyche to eat, yet remain thin. In todays society that is obsessed with thinness teenage girls might undertake such an action (Carson, 2000, pp36-37).Complications of diabetes mellitus in general and during pregnancyThere are many long clinical complications of diabetes that affect various systems and organs of the body. Having diabetes mellitus increases the risk of developing irreversible microvascular or macrovascular disease. Microvascular diseases include retinopathy, kidney disease and neuropathy and macrovascular diseases include ischemic heart disease, stroke and peripheral vascular disease. These disease are all a result of poor glycaemic control (Donnelly et al., 2000, pp1062-1066). Diabetic retinal and renal disease will be discussed in more detail as pregnancy can result in further complications and poor pregnancy outcome.Diabetic retinopathy is an eye disease that can lead to blindness. The longer a person is diabetic, the higher the chances are of developing the condition. It is thought that prolonged periods of hyperglycaemia cause damage to the blood vessels in the retina at the bum of the eye. Diabetic retinal disease can deteriorate during pregnancy and poor glycaemic control in the first trimester is associated with the progression of retinopathy (Hill, 2004, p40-44, Donnelly et al, 2000, pp1062-1066). Carol should have her retinas examined at the start of her pregnancy to establish if she has pre-existing retinopathy. If retinopathy is diagnosed than Carol will need to have regular eye tests to monitor the condition. Continuous good glycaemic control will stop the condition from progressing .Diabetic renal disease or nephropathy is again caused by hyperglycaemia resulting in damage to the capillaries in the kidneys. The kidneys are then unable to undertake filtration of amino acids and this leads to hypertensive disease. Women who have pre-existing nephropathy are at an increased risk of poorer pregnancy outcomes. This is because high blood pressure as a direct result of nephropathy can cause pre-eclampsia. This in turn can cause premature delivery and maternal death (Donnelly et al, 2000, pp1062-1066, Hill, 2004, pp40-44). It is important therefore, that Carols blood pressure is monitored passim her pregnancy as hypertension is a sign of pre-eclampsia (Bewley, 2002, p50).Effects of type 1 diabetes on the developing embryo, foetus and motherIt is suggested that type 1 diabetes mellitus in pregnancy puts the foetus and the developing babe at far greater risk than is imposed on the mother. Various, potentially damaging problems can hold water from foetal reactions to maternal glucose levels. Therefore, if a mothers glucose levels are high, the foetus will have correspondingly high levels (Bewley, 2002, p51).If a mothers blood glucose levels are continuously high (hyperglycaemia) during the first-trimester there is an increased risk of congenital anomalies such as neural tube defects that include spina bifida, abnormalities of the heart and anatomical abnormalities of the bones (Confidential Enquiry into Maternal and Child Health, CEMACH, 2005, p37). neuronal tube defects are major bloodline defects of a babys brain or spine. They go along when the neural tube (that later turns into the brain and spine) does not develop in a correct anatomical manner resulting in damage to the brain or spine (Tortora and Grabowski, 2003, p1073). This happens within the first few weeks that a woman is pregnant, often before a woman knows that she is pregnant.Another condition that is attributed to maternal diabetes is that of Polyhydramnios. This is the medica l condition of too much amniotic fluid in the amniotic sac. Polyhydramnios is generally due to maternal diabetes and is thought to be caused by increased foetal urination. This is caused by the elevated amount of glucose in the mothers blood that sail the placenta and makes the blood of the foetus hyperglycaemic. This results in increased urine output from the foetus. In pregnancies affected by Polyhydramnios, approximately twenty percent of the neonates are born with a congenital anomaly of some type. There are a number of risks that are increased in polyhydramnios including cord prolapse, placental abruption and perinatal death (Pilu Nicolaides, 2006)Other adverse neonatal conditions that are attributed to maternal diabetes are neonatal mortality, premature birth, hypoglycaemia and an increased risk of respiratory distress syndrome (Bewley, 2002, p51). There is also an increased risk of macrosomia that can lead to an increase possibility of shoulder dystocia and an assisted del ivery. Macrosomia is related to maternal hyperglycaemia and is characterised by larger-than-normal birth weight in a newborn at over 4500 grams (10 pounds). High levels of glucose in the mothers blood readily pass done the placenta to the developing baby stimulating insulin production in the baby. Insulin is a potent growth hormone and so fat is deposited which can result in a large baby. This can cause shoulder dystocia and birth trauma because the baby will not easily fit through the birth canal. Postpartum, the newborn continues to produce excessive quantities of insulin that can result in the infant being hypoglycaemic.The mother has an increased prevalence of pre-eclampsia, postnatal infection, postpartum bleeding, and caesarean section (Reece et al, 2004, p169) .It appears from the research indicated that Carol needs to have optimum glucose control for her own health and for that of her baby. Women with type 1 diabetes should have a pre-conception glucose level within normal limits that is an HbA1c of below 7 percent. The management of pregnancies complicated by pre-existing diabetes mellitus should begin prior to conception (Reece et al, 2004, pp481). However, at seventeen it is rather possible that Carols pregnancy was unplanned.Is type 1 diabetes mellitus hereditary?It is thought that there may be a genetic or inherited susceptibility to diabetes. If a parent has type 1 diabetes, the chance that their children will be affected is about twenty-five to forty percent. In the instance of type 1 diabetes various genes have been indentifyed that might predispose an individual to the disease. Therefore, it is suggested that this genetic mutation might submit an individual to diabetes. It is debated that a genetic element is not, in itself enough to cause autoimmunity. It is suggested that external influences such as a viral infection are thought to trigger the disorder. It can be said that type 1 diabetes is an immunological disease that has a genetic ba ckground cause (Littorin, 2001, pp1033-37). It is possible therefore, that Carol has inherited a genetic susceptibility to type 1 diabetes from her mother, but environmental factors might activate the true(a) disease.ConclusionDiabetes is an increasingly common disease that if not controlled can cause a number of disenable lasting complications that can have a destructive influence on both quality and bar of life. Type 1 diabetes is thought to be an autoimmune disease that leads to the complete destruction of the insulin producing beta cells in the pancreas. Insulin is needed to help glucose enter the cells of the body. Glucose is required in the cells to produce energy for normal cell function. It is possible that there is an hereditary link that predisposes an individual to the condition.As Carol was diagnosed with type 1 diabetes mellitus at the age of seven and she has had difficulty in controlling her blood glucose levels, she is at an increased risk of developing diabetic c omplications. It appears that her pregnancy will also intensify the effects of some of the complications affecting both her own health and that of her baby. It is suggested that Carol needs to attain good glycaemic control for her own health and for the health of her baby.BibliographyBewley C (2002) Diabetes in pregnancy. nurse Standard, 16, 25, 47-52.Burden M (2003) Diabetes signs, symptoms and making a diagnosis. Nursing Times, 99, 1,30-32.Carson C (2000) Managing adolescents with type 1 diabetes. Nursing Times, 96, 45, 36-37Confidential Enquiry into Maternal and Child Health Pregnancy in Women with Type 1and Type 2 diabetes in 2002-03, England, Wales and Northern Ireland. London CEMACH 2005.Diagram 1 and Diagram 2 http//cal.man.ac.uk/student_projects/2000/mnby7lc2/pancreas.htm, date accessed 23/11/2006.Donnelly R, Emslie-Smith AM, Gardner ID and Morris AD (2000) Vascular complications of diabetes. British Medical Journal, 320, 1062-1066.Hill J (2004) Identifying and managing the complications of diabetes. Nursing Times, 100, 34, 40-44.Littorin B (2001) Family Characteristics and Life Events originally the Onset of Autoimmune Type 1 Diabetes in Young Adults A nationwide study. 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