The prevalence of diabetes type 2 has reached epidemic proportions worldwide and it is projected to still increase dramatically. Diabetes type 2 is caused by insulin resistance (decreased responsiveness to insulin) in the body cells mainly in the liver, skeletal muscle and adipose tissue, or it can also be caused by a reduced level of insulin secretion by the pancreas, or a mixture of both.

Moreover, the prevalence of insulin resistance (poor response of body cells to insulin) which is a major causative factor in the early development of type 2 diabetes is even more widespread.

Although dietary modification and increased physical activity provide some level of control, this is often insufficient and most diabetics will still require some form of drug treatment.

Presently there are 5 different types of oral anti diabetic drugs used for treating type 2 diabetes;

a - Sulfonyureas

b - Meglitinides

c - Biguanides

d - Thiazolidinediones

e - Alpha - glucosidase inhibitors

Sulfonylureas

These drugs are derived from sulfunic acid urea. They have been the cornerstone of type 2 diabetes treatment since the 1950’s

- They have proven efficacy in most patients.

- Low incidence of side effects.

- They act by directly stimulating insulin production in pancreatic B cells.

- Major side effects include hypoglycemia (over reduced and low blood sugar levels} and weight gain.

- Dosage is started from low doses.

- Examples include 1st generation drugs like chlorpropamide (diabenese}, tolbutamide, and acetohexamide.

2nd generation drugs like glyburide, glypizide and glimepiride

Biguanides

This drug is a synthetic analogue of guanidine

- This drug has surpassed sulfonylureas as the most prescribed oral antidiabetic drug in the US and in the European markets it is the second most prescribed antidiabetic drug after glyburide.

- It is recommended as the 1st line of treatment in newly diagnosed diabetics.

- It acts by suppressing basal hepatic glucose production (glucose production in the liver).

- It also improves whole body insulin stimulated glucose metabolism (it makes the body cells more responsive to insulin).

- It also has reduces the levels of triglycerides (fat} and free fatty acids in the body.

- Side effects include gastrointestinal disturbances like diarrhea, abdominal pain, it also causes lactic acidosis occasionally.

- It should not be taken by people with poor kidney function, and in people with liver disease.

- The most common example is metformin.

Diabetes mellitus is a group of diseases characterized by the deficiency or insensitivity or both, to insulin leading to the exposure of organs to excessive blood glucose. Gestational diabetes can be defined as any degree of glucose intolerance{poor handling of glucose}first diagnosed in pregnancy. It complicates about 4-6% of all pregnancies.

Complications

If not properly treated gestational diabetes leads to:

-recurrent spontaneous abortions

-Infections like urinary tract infection, candidal vaginitis

-a serious complication called eclampsia which results in convulsions and death of both baby and mother.

-too much fluid in the uterus{hydraminos}

-pre-term labor

-ketoacidosis

-excessively big babies {macrosomia} leading to trauma during delivery and increasing chances of caesarian section.

Risk Factors For Developing Gestational Diabetes

a}age-women older than 25years are more prone than younger women

b}excessive weight, obesity and women with body mass index greater than 25 are more prone

c}women that having been giving birth to big babies or babies born with malformations

d}previous history of stillbirths

e}previous history of gestational diabetes.

Women that are high risk cases are screened twice in pregnancy

1-At first medical contact in pregnancy

2-In the second trimester {26-36 weeks of pregnancy}

Diagnostic criteria for Gestational Diabetes

-fasting blood sugar=or> 126mg/dl {7.0mmol/l}

-random blood sugar=or> 200mg/dl {11.0mmol/l}

Management

There are 3 key factors in managing gestational diabetes:

a} Good glycaemic control -blood sugar levels should be kept within normal range, control is achieved by use of insulin

b} Excellent monitoring of blood glucose levels

c} Early delivery is the standard ,pregnancy MUST not be allowed to go beyond 37 completed weeks.