During pregnancy, a woman’s insulin requirements increase, and between the 24th and 28th weeks of pregnancy, her insulin requirements rise sharply. In some women, insulin production is limited, and the demand for insulin exceeds the supply, resulting in hyperglycemia. After delivery, insulin supply and demand return to normal.

Between the 24th and 28th weeks of pregnancy, all women should have an oral glucose tolerance test to detect gestational diabetes. Detecting this condition and controlling blood glucose levels reduce the woman’s risk of complications, including pregnancy-induced hypertension, hydramnios, premature delivery, and cesarean delivery. Risks to the fetus include hypoglycemia, respiratory distress syndrome, hypocalcemia, polycythemia, hyperbilirubinemia, and intrauter­inedeath.

The chances that a woman will develop gestational diabetes increase with these risk factors- advanced age, obesity, previous gestational diabetes, a family history of diabetes, and a previous still­born delivery, spontaneous abortion, or delivery of an abnormally large baby. Women who develop gestational diabetes have an increased risk of developing Type 2 diabetes within 15 years. A small percentage of women develop Type 1 diabetes.

Secondary diabetes

Diabetes also can result from pancreatic disease and surgery, endocrine disorders, such as acromegaly, pheochromocytoma, and Cushing’s syndrome, and therapy with drugs, such as glucocorticoids, streptozocin, pentamidine, and estrogen. Secondary diabetes usually resolves after the primary condition is treated successfully.

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Patients with Type 2 diabetes aren’t prone to DKA, but like those with Type 1 diabetes, they’re at risk for developing vascular complications. Because the signs and symptoms of Type 2 diabetes develop over time, the disease may go unnoticed for many years.

The cause of Type 2 diabetes isn’t known. As with Type 1 diabetes, genetic susceptibility and environmental triggers, such as viruses, seem to playa role. However, there’s no evidence that autoimmunity or islet cell antibodies play any role.

Severe obesity significantly increases a patient’s risk of developing Type 2 diabetes. Other risk factors include age, a sedentary lifestyle, a highfat diet, stress, and a family history of diabetes. Type 2 diabetes occurs more commonly in women who have been pregnant more than once and who have a history of gestational diabetes. Also, it commonly appears in the children of women who develop gestational diabetes.

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