Diabetes can occur temporarily during pregnancy, and reports suggest that it occurs in 2% to 10% of all pregnancies. Significant hormonal changes during pregnancy can lead to blood sugar elevation in genetically predisposed individuals. Blood sugar elevation during pregnancy is called gestational diabetes. Gestational diabetes usually resolves once the baby is born. However, 35% to 60% of women with gestational diabetes will eventually develop type 2 diabetes over the next 10 to 20 years, especially in those who require insulin during pregnancy and those who remain overweight after their delivery. Women with gestational diabetes are usually asked to undergo an oral glucose tolerance test about six weeks after giving birth to determine if their diabetes has persisted beyond the pregnancy, or if any evidence (such as impaired glucose tolerance) is present that may be a clue to a risk for developing diabetes.
The pain of diabetic nerve damage may respond to traditional treatments with certain medications such as gabapentin (Neurontin), phenytoin (Dilantin), and carbamazepine (Tegretol) that are traditionally used in the treatment of seizure disorders. Amitriptyline (Elavil, Endep) and desipramine (Norpraminine) are medications that are traditionally used for depression. While many of these medications are not indicated specifically for the treatment of diabetes related nerve pain, they are used by physicians commonly.
Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that it has not been approved for. However, a doctor can still use the drug for that purpose. The FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. Therefore, your doctor can prescribe a drug however they think is best for your care.
Around 75% of people with diabetes have type 2 diabetes mellitus. This was earlier termed non-insulin dependent diabetes mellitus (NIDDM) or maturity-onset diabetes mellitus. The number of people with type 2 diabetes is rapidly increasing. In type 2 diabetes, not enough insulin is produced or the insulin that is made by the body is insufficient to meet the needs of the body. Obesity or being overweight predisposes to type 2 diabetes.
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Pain has been shown to interfere with self-management activities, sleep, physical functioning, work, family relationships, mood, and quality of life. To make matters worse, pain is often invisible to others, so family members, coworkers, and health-care professionals often have no idea what a person in pain is going through. Many people feel that their physicians don’t understand and tell them they “just have to live with it.”
According to Christine Sullivan, founder of Real Help for Chronic Pain, an online pain management program, “Chronic pain is almost never merely a physical thing. We can see from brain mapping that chronic pain uses very different nerve paths from acute pain. In fact, the brain maps of chronic pain look just like the brain maps of intense emotions like anger, or sadness, or fear.”
Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco. Control of blood pressure and maintaining proper foot care are important for people with the disease. Type 1 DM must be managed with insulin injections. Type 2 DM may be treated with medications with or without insulin. Insulin and some oral medications can cause low blood sugar. Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM. Gestational diabetes usually resolves after the birth of the baby.