Tag Archives: Diabetes

Your Menstrual Cycle And Insulin : Watch For Changes

A woman’s monthly hormone cycle can change the amount of insulin she needs. Don’t be surprised — or caught without as much medicine as your body requires.

Many women find they need more insulin in the days just before they start to menstruate, and that their insulin needs go back to normal when their periods begin. This ebb and flow is completely normal. Estrogen levels rise just before a woman’s period begins, and estrogen increases insulin needs. That doesn’t mean you can simply boost your dose a set amount. Everyone is different. Your menstrual cycle might have a tremendous effect on your glucose levels or it might have none at all. The fluctuation tends to be most dramatic in young women, for example.

Women should be encouraged to use available self-monitoring technology to identify possible cyclical variations in blood glucose that might require clinician review and insulin dosage adjustments. The menstrual cycle can be challenging for most women, but particularly to women with diabetes, and this is because the hormonal fluctuations that occur during the menstrual cycle do affect blood sugar levels.

What is typically see in clinical practice is that the week before a woman starts to menstruate, these hormonal changes increase what we call ‘insulin resistance,’ and so, the insulin that either the woman makes or that she takes by injection doesn’t work quite as well. Then, when menstruation begins, the blood sugar levels tend to drop a little bit.

So, there are a variety of strategies that women can use to improve blood glucose control during the pre-menstrual period. If a woman is not taking insulin, she could try a greater emphasis on diet to control blood glucose levels or even more exercise, which also can relieve some other pre-menstrual symptoms. If a woman is on insulin,  she can take a little bit more of the basal, or background insulin during that pre-menstrual week, to help control blood glucose levels. And, of course, if a woman wants to change her therapy, she should consult her primary care provider or her diabetes care provider and present the pattern of symptoms and of blood sugar levels that she’s experiencing that are related to her menstrual cycle.


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Couple Celebrate Their Miracle Baby

A mother has become the first in Britain to have a successful pregnancy after receiving a double organ transplant.

Emma Smith, 37, from Little Wymondley gave birth to healthy 6lb baby Oliver at the end of last month despite having a donor pancreas and kidney. 

It is extremely rare because anti-rejection drugs, which must be taken for life, can cause infertility or complications during pregnancy. 

Ms Smith, who lives with her boyfriend Steve, said: “After my transplants I did wonder if I would ever be able to have kids. When I found out it was a complete surprise. The suppressants lower fertility and it is very rare to get pregnant and to go on to have a birth without complications. 

“They didn’t have any data about being pregnant on the drugs I was on, but they didn’t want to take the risk of changing them and damaging my organs so they kept me on the same drugs and monitored me very carefully. 

“I’m thinking of having another baby now. This one has gone so well, I’m quite reassured about it. 

“I hope it shows other people who have had a transplant that they can have children – if it gives them hope then that’s great.” 

Emma was diagnosed with type 1 diabetes when she was 11 and had to have daily injections of insulin. Because of the disease her organs deteriorated until it was necessary to have the transplants five years ago. 

She gave birth at St Mary’s Hospital, London, under the care of leading surgeon Professor Nadey Hakim. 

Prof Hakim said: “It’s special because the fact of having had a transplant you need to be on anti-rejection therapy. Any medication could be detrimental to the foetus and these are very potent drugs. 

“With this little small baby we had to be very careful to have just enough medication on board so the baby doesn’t get damaged. 

“It should encourage patients who’ve had transplants to have a normal life – people will not say ‘I’ve had a transplant I can’t get pregnant’.

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Diabetes and male infertility

Researchers have found that diabetes may affect sperm quality, after a study comparing the DNA in sperm from diabetic and non-diabetic men found more DNA damage in the sperm cells of the diabetic men.


The study, conducted by the research group at Queen’s University Belfast, with findings published in the journal Human Reproduction, found that around 52 per cent of the DNA in the sperm cells of diabetic men was fragmented, compared with only 32 per cent for the non-diabetic men. Fragmentation of the DNA in sperm is one of the main causes of male infertility, because it prevents the sperm from delivering intact genetic information to the egg, which is required for the creation of a viable embryo.


The study compared the sperm from 27 diabetic men with that from 29 non-diabetic men in their early 30s. Dr Ishola Agbaje, who lead the research project, said, ‘Our study identifies important evidence of increased DNA fragmentation of nuclear DNA and mitochondrial DNA deletions in sperm from diabetic men’. He stated that these findings would have implications for male fertility, which has already been decreasing over the last 50 years. The increasing global incidence of diabetes could further propel the decline in male fertility.


Professor Sheena Lewis, director of the Reproductive Medicine Research Group, and co-author of the paper, said that the study was very small, and so served to highlight a possible concern. She stated that ‘our study shows increased levels of sperm DNA damage in diabetic men. From a clinical perspective this is important, particularly given the overwhelming evidence that sperm DNA damage impairs male fertility and reproductive health’.


Transcription is the synthesis of RNA under the direction of DNA, and is the first step towards gene expression, where the information from the gene becomes a product such as a protein translating the genetic information into a cellular function. If there are errors in transcription, there will also be errors in the function of the gene.

 Sperm DNA quality is known to be associated with decreased embryo quality, low embryo implantation rates, higher miscarriage rates, and some serious childhood diseases, in particular some childhood cancers. Over the years possible causes for sperm DNA fragmentation have been suggested but to date the exact mechanism for the damage remains unknown, say the scientists.

 Professor Lewis said that further research would be needed to quantify the exact nature of the DNA damage caused by diabetes, and whether there were additional health effects for the children of diabetic fathers. Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, stressed the importance of the quality of sperm DNA, and further said that ‘it would be important to understand the mechanism by which this damage occurs so that if it can be avoided we can work out how to do this’.


Matt Hunt, science information office at Diabetes UK, called for further research, after labelling the findings alarming. He said ‘this is the first research to suggest DNA damage may be occurring at a cellular level and that it is a cause for great concern’.




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Artificial sweeteners

There is a lot of concern about diet and nutrition during pregnancy. One of these concerns is regarding artificial sweeteners and their use during pregnancy. Many women will cut sugar out of their diet, only to replace it with foods and drinks that are artificially sweetened.

These guidelines provide information from research done on the safety of these sweeteners. As with most things in pregnancy, it is always best to consult with your health care provider about what artificial ingredients are safe for you to use during your pregnancy.

What are artificial sweeteners?

Artificial sweeteners are ingredients that add sweetness to foods. Sweeteners are ingredients in soft drinks, desserts, candies and pastries. There are two categories of sweeteners: nutritive (contain calories) and non-nutritive (without calories).

What artificial sweeteners are considered safe during pregnancy?

Nutritive sweeteners (such as table sugar) contain what is called “empty” calories. These additives contribute calories to the diet, but they contain few vitamins or minerals. When used in moderation, nutritive sweeteners are considered safe for consumption during pregnancy assuming they are not contributing to excess weight gain. However, women with carbohydrate intolerance such as gestational diabetes, diabetes mellitus, or insulin resistance need to limit their use of nutritive sweeteners. Nutritive sweeteners include sugars such as sucrose, dextrose, honey, corn sugar, fructose, and maltose. Sugar alcohols are also nutritive sweeteners that are often found in foods labeled as “sugar free.” Technically, sugar alcohols are not sugars, but they do have calories which can be converted into fat. Examples of sugar alcohols include: Sorbitol, Xylitol, Isomalt, Mannitol, and Hydrogenated Starch.

Non-nutritive Sweeteners are added in very small amounts to foods for a significant sweetening effect and have been approved for use in dietetic or reduced calorie foods and beverages. Research is limited on the safety of the use of non-nutritive sweeteners during pregnancy. The following are non-nutritive sweeteners that are considered safe during pregnancy:

Acesulfame Potassium:  This sweetener is added to baked goods, frozen desserts, sugar free gelatins, puddings and beverages. Acesulfame Potassium has been deemed safe to use in moderation during pregnancy by the FDA.

Aspartame:  Aspartame is not effective in heat nor for long periods in liquid form. It is often found as an additive to soft drinks, gelatin, desserts, pudding mixes, breakfast cereals, beverages, chewing gum, dairy products, and other foods and drugs. According to the Food and Drug Administration(FDA), Aspartame is safe for use during pregnancy and lactation. It is recommended to limit consumption to a moderate level.

Aspartame should not be used by anyone with PKU (a rare metabolic disorder), rare liver disease, or by pregnant women who have high levels of phenylalanine in their blood. Phenylalanine is a component of aspartame, and it may not metabolize correctly in anyone who has these conditions.

Sucralose:  This is non-caloric sweetener that is made from sugar. Sucralose has been approved for use in baked goods, baking mixes, non-alcoholic beverages, chewing gum, coffee and tea products, confections and frostings, fats and oils, frozen dairy desserts and mixes, fruit juices, sugar substitutes, sweet sauces, toppings and syrups. It can also be used as “table-top sweetener.” Sucralose has no effect on blood sugar, offers no calories, and is deemed safe during pregnancy and lactation. According to the Food and Drug Administration (FDA), sucralose is safe for everyone to consume, including pregnant women.

What artificial sweeteners are questionable or NOT safe to use during pregnancy?

Saccharin:  Although it is not used as much today as in the past, it still appears in many foods, beverages and other substances. The FDA does consider saccharin to be safe to use for the general public. Former studies that had linked saccharin to an increased risk of developing bladder cancer have been dismissed by the National Toxicology program. But studies do show that saccharin crosses the placenta and may remain in fetal tissue, so its use for pregnant women still remains in question.

Stevia: This sweetener is derived from a South American shrub. It can add sweetness to foods, but has not been approved by the FDA to be sold as a sweetener. Stevia can be sold as a “dietary supplement” but not as a sweetener because its safety has been questioned when used as a food additive. The safety of Stevia is unknown when used as a sweetener by pregnant or lactating women.

Cyclamate: This sweetener has been linked to cancer and is currently banned in the United States. Cyclamate is not considered safe for anyone including pregnant women.

If you use artificial sweeteners and are pregnant, it is always best to talk with your care provider on which sweetener you are using and how much you are consuming. 

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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Pregnancy and Diabetes

In the past, women with diabetes suffered many problems during pregnancy, including a high rate of miscarriages and birth defects. Today, however, with good prenatal care and careful self-management, there’s no reason women with type 1 or type 2 diabetes can’t have a safe pregnancy and a healthy baby.

Risks involved 
While it’s common for diabetic women to have relatively trouble-free pregnancies, some risks still exist for both mother and child. In general, the more diabetic complications you’ve had before pregnancy, the more likely they’ll worsen significantly during pregnancy. Women with severe kidney and eye complications, for instance, can expect that these conditions will be aggravated by a pregnancy. The damage often reverses after delivery, but women with these conditions should discuss potential dangers with their doctors before conceiving. 

Consistently high blood glucose levels increase the chances of miscarrying or going into premature labor. They may also cause the baby’s organs to form abnormally. Historically, diabetes has been associated with a threefold increase in severe malformations. Some examples include neural tube defects (incomplete development of the brain or spinal cord), anencephaly (absence of the brain or spinal cord), and spina bifida (failure of the backbone to fuse over the spinal cord).

Women with diabetes are also more likely to have large babies, with birth weights of 9–12 pounds. This condition can cause a difficult delivery. Doctors will often induce labor a few weeks early or perform a cesarean section if the fetus seems to be too large.

 Other problems can also result. The baby may have immature lungs (respiratory distress syndrome) or low blood levels of calcium and glucose at birth.

 Getting proper care for your diabetes before you become pregnant is an important step toward having a healthy baby. According to the National Institute of Diabetes and Digestive and Kidney Diseases, the rate of major congenital malformations in babies born to women who already had diabetes before conceiving is 5% or less when the mothers received preconception care. But for diabetic women who don’t receive preconception care, the rate jumps to 10%.

Many women with severe diabetes are opting for IVF with surrogacy. 

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd


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New Method to Diagnose Blockage that Causes Male Infertility

Almost as common as diabetes, male infertility affects 15% of reproductive age men in India. Many cases of infertility are caused by blockages within the male sex organs that result in low sperm counts or no sperm counts. These blockages are often reversible and therefore important to diagnose as couples may be able to conceive naturally afterward. To date, one such type of blockage, termed ejaculatory duct obstruction, has been difficult to diagnose as a cause of infertility. Last month, Dr. Paul Turek, a Professor Emeritus in Urology at UCSF, published a paper in The Journal of Urology that dramatically simplifies this diagnosis. “All prior tests for this diagnosis involve simply looking at the system and trying to guess how it works, but this new test actually ‘pokes’ at the system and watches how it responds,” says Dr. Turek, a nationally recognized microsurgeon and male infertility specialist.

“We simply applied the same principles that have been used to assess urination issues in urology for the past 30 years, termed urodynamics, to the male sex organs, and call it ‘vasodynamics.'”

For the study, 2 groups of men were compared: normal fertile men and infertile men suspected of having ejaculatory duct obstruction. In addition to taking ultrasound pictures of the reproductive tract system in both groups, which is the current standard diagnostic test, he did something else. By injecting harmless, colored dye into the system through a fine needle and measuring the pressure and flow characteristics of the dye as it progressed through the ejaculatory ducts, he found large differences between the fertile and infertile groups of men.

In fertile men, it took 33 cm of water pressure to cause flow in the ejaculatory ducts, whereas in the infertile men with suspected obstruction, it took 4 times that pressure or 116 cm water pressure. “With this hydraulic technique, we can actually measure the degree of blockage in the male sex organs, which has never been done before,” says Dr. Turek of the new technique. Not only that, after surgery was performed to relieve the obstruction in the blocked men, the injection procedure was repeated and the water pressures fell into the range of the normal fertile men. This response also corresponded well with improvements in semen quality after the treatment.

“For several decades, the diagnosis of ejaculatory duct obstruction has involved a lot of guesswork. Vasodynamics now removes the guessing and replaces it with real information that can be used to reliably improve male fertility potential,” says Dr. Turek.

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