What is Gestational Diabetes?

Diabetes is a common condition in which the body’s cells are unable to effectively obtain glucose from the bloodstream. Glucose is required to provide the body with energy for day-to-day activities. The hormone insulin moves glucose from the blood into the body’s cells, where it can be used for energy. When the movement of glucose into the cells is delayed, blood glucose levels rise, causing diabetes to develop.

Gestational diabetes is a form of diabetes that occurs during pregnancy and usually goes away after the baby is born. Over 10% of pregnant women will develop gestational diabetes and this usually occurs around the 24th to 28th week of pregnancy.

In pregnancy, the placenta produces essential hormones that help the baby grow and develop. These hormones also partly stop insulin working which is called insulin resistance. Usually pregnant women naturally increase their insulin levels to overcome this block. If the body is unable to produce the extra insulin or becomes more resistant, gestational diabetes develops.

Diagnosis of GDM is based on a fasting 75-g oral glucose tolerance test (OGTT) at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. This test can be performed earlier if there are significant risk factors present or there is a clinical indication.

Once a diagnosis of GDM is made, careful planning for the ongoing management of your pregnancy is important.

How does GDM affect the baby?

As the mother’s excess glucose crosses the placenta into the baby’s bloodstream, untreated or uncontrolled GDM may result in complications for your baby such as:

•   Being born very large and with extra fat, thus may make delivery difficult and more dangerous for the baby

•   Low blood glucose levels after birth

•   Breathing problems

•   Requiring admission to a special care nursery

•   Problems maintaining body temperature

•   An increased risk of developing diabetes or obesity later in life.

How to Treat Gestational Diabetes?

The management and treatment of GDM is a team effort, involving the woman and her partner, her obstetrician, endocrinologist, diabetes educator, dietitian and midwife.

Special attention is paid to home blood glucose monitoring, diet and physical activity. Sometimes insulin injections may be needed. Your treating doctor will discuss with you which treatment option is more suitable for you.

•   Start treatment quickly because gestational diabetes can hurt you and your baby.

•   Special meal plans and scheduled physical activity

•   Daily blood glucose testing

•   Insulin injections if needed

Home blood glucose monitoring

Self-monitoring blood glucose (SMBG) is a valuable tool in helping manage GDM. These simple finger prick blood tests will give you an indication on what your blood glucose levels are.

Your diabetes nurse will teach you how to perform home blood glucose monitoring. You will require:

•   A blood glucose meter

•   Lancet device – for pricking finger

•   Testing strips

•   Diary to record blood glucose levels.

Blood glucose meters, lancet device and testing strips may be purchased at your local or online pharmacy.

Target of Glucose Control

The blood glucose checks you do at home are a key part of taking good care of yourself and your baby before, during and after pregnancy

Both American Diabetes Association and Chinese Diabetes Society recommend glucose targets for women with GDM are as follows:

Food and Exercise

During pregnancy, you may need to change your meal plan to avoid problems with low and high blood glucose levels. For most women, the focus of a good meal plan during pregnancy is improving the quality of foods you eat rather than merely increasing the amount of food eaten. A good meal plan is designed to help you avoid high and low blood glucose levels while providing the nutrients your baby need to grow.

Exercise is a key part of diabetes treatment. Discuss your exercise plans with your diabetes team and ask for guidance. Just as you need to get your blood glucose under control before getting pregnant, it's best to get fit before you get pregnant.

In general, it's not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming, or water aerobics. Regular physical activity is not only safe for pregnant women, it benefits health by offsetting some of the problems of pregnancy, such as varicose veins, leg cramps, fatigue and constipation. Exercise after meals may help the muscles use the glucose in the bloodstream, and help keep your blood glucose levels in your target range.

Medication (if needed)

For women with gestational diabetes, meal planning and exercise often work to keep blood glucose levels in control; however, if blood glucose levels are still high, your doctor will probably start you on insulin.

What is type 1 diabetes? 

Type 1 diabetes is a disease that affects how your child's body makes insulin and uses glucose (sugar). Normally, when the blood sugar level increases, the pancreas makes more insulin. Insulin helps move sugar out of the blood so it can be used for energy. Type 1 diabetes develops because the immune system destroys cells in the pancreas that make insulin. The pancreas cannot make enough insulin, so the blood sugar level continues to rise. A family history of type 1 diabetes may increase your child's risk for diabetes.

What are the signs and symptoms of type 1 diabetes? 

•  More thirst than usual 

•  Frequent urination or unexplained bedwetting

•  Feeling hungry most of the time

•  Weight loss without trying 

How is type 1 diabetes diagnosed? 

•  An A1c test shows the average amount of sugar in your child's blood over the past 2 to 3 months. Your child's doctor will tell you the level that is right for your child. The goal is usually below 7.5%. Your provider can help you make changes if your child's A1c is too high

•  A fasting plasma glucose test is when your child's blood sugar level is tested after he or she has fasted for 8 hours. Fasted means he or she has not eaten anything or had anything to drink except water

•  A 2-hour plasma glucose test starts with a blood sugar level check after your child has not eaten for 8 hours. Your child is then given a glucose drink. Your child's blood sugar level is checked after 2 hours

•  A random glucose test may be done any time of day, no matter how long it has been since your child ate

•  An antibody test may show that your child's immune system is attacking his or her pancreas

How is type 1 diabetes treated? 

Type 1 diabetes cannot be cured, but it can be controlled. The goal is to keep your child's blood sugar at a normal level. 

•  Your child will need insulin each day. Insulin can be injected or given through an insulin pump. Ask your child's doctor which method is best for your child. You and your child will be trained in the best method for him or her. Give your child insulin as directed. Too much insulin may cause his or her blood sugar level to go too low

•  You will also be taught how to adjust each insulin dose your child takes with meals. Always check his or her blood sugar level before the meal. The dose will be based on his or her blood sugar level, carbohydrates in the meal, and activity after the meal

How do I check my child's blood sugar level?

 You will be taught how to check a small drop of blood with a glucose monitor. You will need to check your child's blood sugar level at least 3 times each day. Ask your child's doctor when and how often to check during the day. Before meals, your child's blood sugar should be between 90 and 130 mg/dL. At bedtime, it should be between 90 and 150 mg/dL. You may need to check for ketones in your child's urine or blood if his or her level is higher than directed. Write down the results and show them to your child's doctor. The provider may use the results to make changes to your child's medicine, food, or exercise schedules. 

What should I do if my child's blood sugar level is too low?

Your child's blood sugar level is too low if it goes below 70 mg/dL. If the level is too low, have your child eat or drink 15 grams of fast-acting carbohydrate. These are found naturally in fruits and dairy products. Fast-acting carbohydrates will raise your child's blood sugar level quickly. Examples of 15 grams of fast-acting carbohydrate are 4 ounces (½ cup) of fruit juice or 4 ounces of regular soda. Other examples are 2 tablespoons of raisins or 3 to 4 glucose tablets. Check your child's blood sugar level 15 minutes later. If the level is still low (less than 100 mg/dL), give another 15 grams of carbohydrate. When the level returns to 100 mg/dL, have your child eat a snack or meal that contains carbohydrate and protein. This will help prevent another drop in blood sugar. Always carefully follow your doctor's instructions on how to treat low blood sugar levels. 

What do I need to know about nutrition for my child? 

A dietitian will help you create a meal plan to keep your child's blood sugar level steady. Do not let your child skip meals. His or her blood sugar level may drop too low if he or she takes insulin and does not eat.

•  Keep track of carbohydrates (sugar and starchy foods). Your child's blood sugar level can get too high if he or she eats too many carbohydrates. His or her dietitian will help you plan meals and snacks that have the right amount of carbohydrates

•  Give your child low-fat and low-sodium foods. Examples of low-fat foods are lean meat, fish, skinless chicken or turkey, and low-fat milk. Limit high-sodium foods, such as potato chips and soup. Do not add salt to food you cook. Limit your child's use of table salt

•  Give your child high-fiber foods. Foods that are a good source of fiber include vegetables, whole-grain bread, and beans

What else can I do to manage my child's type 1 diabetes? 

•  Go to all follow-up appointments. Your child may need to return to have his or her A1c checked at least 2 times each year. Your child may also need tests to check his or her blood pressure, cholesterol, eyes, and feet

•  Have your child exercise as directed. Exercise can help keep your child's blood sugar level steady. Encourage your child to exercise for at least 60 minutes on most days of the week. Help your child include activities 3 days each week that strengthen his or her muscles and bones. Work with your child's doctor to create an exercise plan:

·   Check your child's blood sugar level before and after exercise. Doctors may tell you to change the amount of insulin your child takes or food he or she eats. If the blood sugar level is high, check your child's blood or urine for ketones before you exercise. Do not let your child exercise if the blood sugar level is high and he or she has ketones

·   If your child's blood sugar level is less than 100 mg/dL, have him or her eat a carbohydrate snack before exercise. Examples are 4 to 6 crackers, ½ banana, 8 ounces (1 cup) of milk, or 4 ounces (½ cup) of juice. Have your child drink water or liquids that do not contain sugar before, during, and after exercise. Ask your dietitian or doctor which liquids your child should drink when he or she exercises

•  Help your child maintain a healthy weight. Ask your child's doctor how much your child should weigh. A healthy weight can help control your child's diabetes. Ask your child's doctor to help you create a weight loss plan for your child if he or she is overweight. The provider can help your child set reasonable weight loss goals

•  Check your child's feet each day for sores. Have your child's feet checked at least 1 time each year for problems that may develop if his or her diabetes is not controlled. Make sure his or her shoes and socks fit correctly. Ask your child's doctor for more details about foot care

What other care will my child need for type 1 diabetes? 

•  Make sure your child always wears medical alert jewelry or carries a card that says he or she has diabetes. Ask your child's doctor where to get these items

•  Give instructions to your child's school. Make sure your child's teachers know he or she has diabetes. Provide written instructions about what to do if your child has symptoms of high or low blood sugar levels at school

•  Do not smoke around your child. Do not let others smoke around him or her. Do not let your older child smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Cigarette smoke can worsen the problems that occur with diabetes. Ask your doctor for information if you or child currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your doctor before you or your child use these products

What is an insulin pen? 

An insulin pen is a device used to inject insulin. The pen contains a cartridge of insulin. The pen may be reusable or disposable. You may need a different pen for each type of insulin you use. 

How do I get the insulin ready to use? 

•      Check the label and color of the insulin. Check that you have the correct type and strength of insulin. Insulin pens are available as U100 and U500 strengths. Also check the expiration date on the label. Use a new cartridge or pen if the expiration date has passed. Short or rapid-acting insulin should be clear, colorless, and free of particles or clumps. Use a new cartridge or pen if the insulin does not look right. Follow the pen manufacturer's instructions for inserting a new cartridge into a reusable pen

•      Mix cloudy insulin. Gently roll the pen back and forth between the palms of your hands. Repeat this 10 times. Do not shake the pen. This can make the insulin clump together. Next, gently tip the pen up and down 10 times. Do not use the insulin if there are clumps in it after you mix it

How do I get the pen ready to use? 

•      Remove a new pen from the refrigerator 30 minutes before you use it. Insulin should be injected at room temperature

•      Wash your hands. Use soap and water or an alcohol-based hand rub. This will help decrease your risk for an infection

•      Remove the cap from the pen. Wipe the needle attachment area with an alcohol swab

•      Attach a needle to the pen. Remove the tab from the needle. Do not remove the outer cap on the needle. Push the needle straight onto the pen. Turn the needle clockwise until you cannot turn it more. Make sure the needle is straight

•      Remove the needle caps. Remove the outer cap and save. Remove the inner cap and throw it away

•      Remove air from the pen. Air may cause pain during injection. Turn the dial to 2 units. For most insulin pens, you will hear a click for each unit of insulin that you dial. Hold the pen and point the needle up. Gently tap the pen to move air bubbles to the top of the pen. Press the injection button. You should see a drop of insulin on the tip of the pen. If you do not see a drop, change the needle and repeat this step. If you do not see a drop after you repeat this step 3 times, use a new pen

•      Select the correct dose on the pen. Turn the dial to the number of units you need to inject. The pointer on the side of your pen should line up with your dose. The dial can be turned in either direction to choose the correct dose. You cannot choose a dose larger than the number of units left in the cartridge. Insert another cartridge or use another disposable pen if there is not enough insulin. Instead you can inject part of your dose with the insulin that is left. Next, you can use a new cartridge or pen to inject the rest of your dose

Where do I inject insulin? 

•      You can inject insulin into your abdomen, upper arm, buttocks, hip, and the front or side of the thigh. Insulin works fastest when it is injected into the abdomen

•      Do not inject insulin into areas where you have a wound or bruising. Insulin injected into wounds or bruises may not get into your body correctly

•      Use a different area within the site each time you inject insulin. For example, inject insulin into different areas in your abdomen. Insulin injected into the same area can cause lumps, swelling, or thickened skin

How do I inject insulin with a pen? 

•      Clean the skin where you will inject the insulin. You can use an alcohol pad or a cotton swab dipped in alcohol. Let the area dry before you inject. This will decrease pain

•      Grab a fold of your skin. Gently pinch the skin and fat between your thumb and first finger

•      Insert the needle straight into your skin. Do not hold the syringe at an angle. Make sure the needle is all the way into the skin. Let go of the pinched tissue

•      Push the injection button to inject the insulin. Continue to press on the injection button. Keep the needle in place for 10 seconds

•      Pull out the needle. Replace the needle cap. Press on your injection site for 5 to 10 seconds. Do not rub. This will keep insulin from leaking out 

•      Remove the needle from the pen.Twist the capped needle counter clockwise. Place the needle in a heavy-duty laundry detergent bottle or a metal coffee can. The container should have a cap or lid that fits securely

•      Replace the pen cap. Store the pen as directed

What should I do with my used needles? 

Ask your local waste authority if you need to follow certain rules for getting rid of your needles. Bring your used needles home with you when you travel. Pack them in a plastic or metal container with a secure lid. 

How do I store an insulin pen? 

Do not store your pen with a needle attached. Follow the storage directions on the label or package insert that came with the insulin. Unopened pens can be stored in the refrigerator until you are ready to use them. Most insulin pens can be opened and kept at room temperature. Store your pen in a cool, dry place. Do not keep your pen in direct sunlight or in your car. Throw away pens that have been frozen or exposed to temperatures above 85° F (30° C). If you travel, keep the pen in a cool pack. 

When should I contact my healthcare provider? 

•      You feel or see hard lumps in your skin where you inject your insulin

•      You think you gave yourself too much or not enough insulin

•      Your injections are very painful

•      You see blood or clear fluid on your injection site more than once after you inject insulin

•      You have questions about how to give the injection

•      You cannot afford to buy your diabetes supplies

•      You have questions or concerns about your condition or care

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

What is type 2 diabetes? 

Type 2 diabetes is a disease that affects how your child's body uses glucose (sugar). Normally, when the blood sugar level increases, the pancreas makes more insulin. Insulin helps move sugar out of the blood so it can be used for energy. Type 2 diabetes develops because either the body cannot make enough insulin, or it cannot use the insulin correctly. After many years, your child's pancreas may stop making insulin. 

What increases my child's risk for type 2 diabetes?

 Your child has a higher risk for type 2 diabetes if he or she is overweight, and at least 2 of the following are true: 

•     A member of your child's family has type 2 diabetes

•     Your child is Native American, African American, Latino, Asian American or Pacific Islander

•     Your child has high blood pressure, high cholesterol, or is female and has polycystic ovary syndrome

What are the signs and symptoms of type 2 diabetes? 

Your child may have high blood sugar levels for a long time before symptoms appear. Your child may have any of the following: 

•     More hunger or thirst than usual

•     Frequent urination

•     Weight loss without trying

How is type 2 diabetes diagnosed? 

Your child may need tests to check for type 2 diabetes by the time he or she is 10 years old: 

•     An A1c test shows the average amount of sugar in your child's blood over the past 2 to 3 months. Your child's healthcare provider will tell you the level that is right for your child. The goal is usually below 7.5%. Your provider can help you make changes if a check shows your child's A1c is too high

•     A fasting plasma glucose test is when your child's blood sugar level is tested after he or she has fasted for 8 hours. Fasted means your child has not eaten anything or had anything to drink except water

•     A random glucose test can be done any time of day, no matter how long ago your child ate

•     An oral glucose tolerance test starts with a fasting blood sugar level check. He or she is then given a glucose drink. His or her blood sugar level is checked again after 2 hours. Healthcare providers look at how much your child's blood sugar level increases from the first check

•     Genetic testing may be done to check for genes that may cause diabetes 

How is type 2 diabetes treated? 

Type 2 diabetes can be controlled. The goal is to help keep your child's blood sugar at a normal level. He or she must eat healthy foods, and exercise regularly. Your child may also need medicine by mouth or insulin if blood sugar levels cannot be controlled with nutrition and exercise. 

How do I check my child's blood sugar level?

You will be taught how to check a small drop of blood with a glucose monitor. You may need to check your child's blood sugar level at least 3 times each day. Ask your child's healthcare provider when and how often to check during the day or night. Before meals, your child's blood sugar should be between 90 and 130 mg/dL. At bedtime, it should be between 90 and 150 mg/dL. You may need to check for ketones in your child's urine or blood if the level is higher than directed. Write down the results and show them to your child's healthcare provider. Your provider may use the results to make changes to your child's medicine, food, or exercise schedules. 

What do I need to know about nutrition for my child? 

A dietitian will help you create a meal plan to keep your child's blood sugar level steady. Do not let your child skip meals. His or her blood sugar level may drop too low if he or she takes insulin and does not eat.

•     Keep track of carbohydrates (sugar and starchy foods). Your child's blood sugar level can get too high if he or she eats too many carbohydrates. Your child's dietitian will help you plan meals and snacks that have the right amount of carbohydrates

•     Give your child low-fat and low-sodium foods. Examples of low-fat foods are lean meat, fish, skinless chicken or turkey, and low-fat milk. Limit high-sodium foods, such as potato chips and soup. Do not add salt to food you cook. Limit your child's use of table salt

•     Give your child high-fiber foods. Foods that are a good source of fiber include vegetables, whole-grain breads, and beans

What else can I do to help my child manage type 2 diabetes? 

•     Go to all follow-up appointments. Your child may need to return to have his or her A1c checked at least twice a year. Your child may also need tests to check his or her blood pressure, cholesterol, eyes, and feet

•     Have your child exercise as directed. Exercise can help keep your child's blood sugar level steady. Encourage your child to exercise for at least 60 minutes on most days of the week. Help your child include activities 3 days each week that strengthen his or her muscles and bones. Work with your child's healthcare provider to create an exercise plan:

  ○   Check your child's blood sugar level before and after exercise. Healthcare providers may tell you to change the amount of insulin your child takes or food he or she eats. If the blood sugar level is high, check your child's blood or urine for ketones before you exercise. Do not let your child exercise if the blood sugar level is high and your child has ketones

  ○   If your child's blood sugar level is less than 100 mg/dL, have him or her eat a carbohydrate snack before exercise. Examples are 4 to 6 crackers, ½ banana, 8 ounces (1 cup) of milk, or 4 ounces (½ cup) of juice. Have your child drink water or liquids that do not contain sugar before, during, and after exercise. Ask your dietitian or healthcare provider which liquids your child should drink when he or she exercises

 •     Help your child maintain a healthy weight. Ask your child's healthcare provider how much your child should weigh. A healthy weight can help control your child's diabetes. Ask your child's healthcare provider to help you create a weight loss plan for your child if he or she is overweight. The provider can help your child set manageable weight loss goals

•     Check your child's feet each day for sores. Have your child's feet checked at least once each year for problems that may develop if his or her diabetes is not controlled. Make sure his or her shoes and socks fit correctly. Ask your child's healthcare provider for more details about foot care

What other care will my child need for type 2 diabetes? 

•     Make sure your child always wears medical alert jewelry or carries a card that says he or she has diabetes. Ask your child's healthcare provider where to get these items

•     Give instructions to your child's school. Make sure your child's teachers know he or she has diabetes. Provide written instructions about what to do if your child has symptoms of high or low blood sugar levels at school

•     Do not smoke around your child.Do not let others smoke around him or her. Do not let your older child smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Cigarette smoke can worsen the problems that occur with diabetes. Ask your healthcare provider for information if you or child currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you or your child use these products

•     Ask about vaccines. Your child has a higher risk for serious illness if he or she gets the flu or pneumonia. Ask your child's healthcare provider if your child should get a flu or pneumonia vaccine, and when to get the vaccine

What are the risks of type 2 diabetes in children? 

Uncontrolled diabetes can damage your child's nerves and arteries. Long-term high blood sugar levels can damage his or her eyes and kidneys. Diabetes is life-threatening if it is not controlled. Control your child's blood glucose levels to prevent complications.

When should I seek immediate care? 

•     Your child has a low blood sugar level and it does not improve with treatment

•     Your child's blood sugar level is above 240 mg/dL and does not come down after a dose of insulin

•     Your child has ketones

•     Your child has a fever

•     Your child has nausea or is vomiting and cannot keep any food or liquid down

•     Your child has symptoms of a low blood sugar level, such as trouble thinking, sweating, or a pounding heartbeat

•     Your child has blurred or double vision

•     Your child's breath has a fruity, sweet smell, or his breathing is deep and labored

•     Your child's heartbeat is fast and weak

When should I contact my child's healthcare provider? 

•     Your child's blood sugar levels are higher than his or her target goals

•     Your child often has low blood sugar levels

•     Your child has abdominal pain, diarrhea, or is vomiting

•     Your child has numbness in his or her arms or legs

•     Your child has warm, red patches of skin or a wound that does not heal

•     Your child gets easily irritated

•     Your child is anxious or depressed

•     You have questions or concerns about your child's condition or care

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

What is type 2 diabetes?

Type 2 diabetes is a disease that affects how your body uses glucose (sugar). Normally, when the blood sugar level increases, the pancreas makes more insulin. Insulin helps move sugar out of the blood so it can be used for energy. Type 2 diabetes develops because either the body cannot make enough insulin, or it cannot use the insulin correctly. After many years, your pancreas may stop making insulin. 

What increases my risk for type 2 diabetes? 

•     Obesity

•     Physical inactivity

•     Older age

•     High blood pressure or high cholesterol

•     A history of heart disease, gestational diabetes, or polycystic ovary syndrome 

•     A family member with diabetes

•     Being African American, Latino,Native American, Asian American, or Pacific Islander

What are the signs and symptoms of type 2 diabetes? 

You may have high blood sugar levels for a long time before symptoms appear. You may have any of the following: 

•     More hunger or thirst than usual 

•     Frequent urination 

•     Weight loss without trying 

•     Blurred vision 

How is type 2 diabetes diagnosed? 

You may need tests to check for type 2 diabetes starting at age 45. You may need any of the following: 

•     An A1c test shows the average amount of sugar in your blood over the past 2 to 3 months. Your healthcare provider will tell you the A1c level that is right for you. The goal for your A1c is usually below 7%. Your provider can help you make changes if a check shows the A1c is too high

•     A fasting plasma glucose test is when your blood sugar level is tested after you have not eaten for 8 hours

•     A 2-hour plasma glucose test starts with a blood sugar level check after you have not eaten for 8 hours. You are then given a glucose drink. Your blood sugar level is checked after 2 hours 

•     A random glucose test may be done any time of day, no matter how long ago you ate

How is type 2 diabetes treated? 

Type 2 diabetes can be controlled to prevent damage to your heart, blood vessels, and other organs. The goal is to keep your blood sugar at a normal level. You must eat the right foods, and exercise regularly. You may need 1 or more hypoglycemic medicines or insulin if you cannot control your blood sugar level with nutrition and exercise. You may also need medicine to lower your risk for heart disease. An example includes medicine to lower or control your cholesterol. 

How do I check my blood sugar level? 

You will be taught how to check a small drop of blood in a glucose monitor. You will need to check your blood sugar level at least 3 times each day if you are on insulin. Ask your healthcare provider when and how often to check during the day. If you check your blood sugar level before a meal, it should be between 80 and 130 mg/dL. If you check your blood sugar level 1 to 2 hours after a meal, it should be less than 180 mg/dL. Ask your healthcare provider if these are good goals for you. Write down your results, and show them to your healthcare provider. Your provider may use the results to make changes to your medicine, food, and exercise schedules.

What should I do if my blood sugar level is too low? 

Your blood sugar level is too low if it goes below 70 mg/dL. If the level is too low, eat or drink 15 grams of fast-acting carbohydrate. These are found naturally in fruits. Fast-acting carbohydrates will raise your blood sugar level quickly. Examples of 15 grams of fast-acting carbohydrate are 4 ounces (½ cup) of fruit juice or 4 ounces of regular soda. Other examples are 2 tablespoons of raisins or 3 to 4 glucose tablets. Check your blood sugar level 15 minutes later. If the level is still low (less than 100 mg/dL), eat another 15 grams of carbohydrate. When the level returns to 100 mg/dL, eat a snack or meal that contains carbohydrates. This will help prevent another drop in blood sugar. Always carefully follow your healthcare provider's instructions on how to treat low blood sugar levels. 

Keep track of carbohydrates (sugar and starchy foods). 

Your blood sugar level can get too high if you eat too many carbohydrates. Eat fruits, legumes, vegetables, and whole grains. Your dietitian will help you plan meals and snacks that have the right amount of carbohydrates

What do I need to know about nutrition?

A dietitian will help you make a meal plan to keep your blood sugar level steady. Do not skip meals. Your blood sugar level may drop too low if you have taken diabetes medicine and do not eat. 

•     Eat low-fat foods, such as skinless chicken and low-fat milk

•     Eat less sodium (salt). Limit high-sodium foods, such as soy sauce, potato chips, and soup. Do not add salt to food you cook. Limit your use of table salt. You should have less than 2,300 mg of sodium per day

•     Eat high-fiber foods, such as vegetables, whole-grain breads, and beans

•     Limit alcohol. Alcohol affects your blood sugar level and can make it harder to manage your diabetes. Limit alcohol to 1 drink a day if you are a woman. Limit alcohol to 2 drinks a day if you are a man. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor 

How much exercise do I need? 

Exercise can help keep your blood sugar level steady, decrease your risk of heart disease, and help you lose weight. Stretch before and after you exercise. Exercise for at least 150 minutes every week. Spread this amount of exercise over at least 3 days a week. Do not skip exercise more than 2 days in a row. Include muscle strengthening activities 2 to 3 days each week. Older adults should include balance training 2 to 3 times each week. Activities that help increase balance include yoga and tai chi. Work with your healthcare provider to create an exercise plan.

•     Check your blood sugar level before and after exercise. Healthcare providers may tell you to change the amount of insulin you take or food you eat. If your blood sugar level is high, check your blood or urine for ketones before you exercise. Do not exercise if your blood sugar level is high and you have ketones

•     If your blood sugar level is less than 100 mg/dL, have a carbohydrate snack before you exercise. Examples are 4 to 6 crackers, ½ banana, 8 ounces (1 cup) of milk, or 4 ounces (½ cup) of juice. Drink water or liquids that do not contain sugar before, during, and after exercise. Ask your dietitian or healthcare provider which liquids you should drink when you exercise

•     Do not sit for longer than 30 minutes. If you cannot walk around, at least stand up. This will help you stay active and keep your blood circulating 

What else can I do to manage type 2 diabetes? 

•     Check your feet each day for sores. Wear shoes and socks that fit correctly. Do not trim your toenails. Ask your healthcare provider for more information about foot care 

•     Maintain a healthy weight. Ask your healthcare provider how much you should weigh. A healthy weight can help you control your diabetes and prevent heart disease. Ask your provider to help you create a weight loss plan if you are overweight. Together you can set manageable weight loss goals

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid's job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

Hyperthyroidism

The term hyperthyroidism refers to any condition in which there is too much thyroid hormone produced in the body. In other words, the thyroid gland is overactive.

What are the symptoms of hyperthyroidism?

Since hyperthyroidism increases your metabolism, every function of the body tends to speed up:

•     Nervousness, irritability, increased sweating, heart racing, hand tremors, anxiety, difficulty sleeping, tired is very common

•     Thinning of the skin, fine brittle hair and weakness in muscles, especially in the upper arms and thighs

•     More frequent bowel movements, but diarrhea is uncommon

•     Lose weight despite a good appetite

•     For women, menstrual flow may lighten and menstrual periods may occur less often

•     Enlarged eyes and swelling of the front of the neck

What causes hyperthyroidism?

The most common causes include Graves disease (GD), toxic multinodular goiter, toxic adenoma and painless thyroiditis.

How is hyperthyroidism diagnosed?

•     Indicated symptoms and physical examinations

•     Confirm by laboratory tests that measure the amount of thyroid hormones

•     Measure levels of thyroid autoantibodies

•     Imaging of thyroid glands

How is hyperthyroidism treated?

Hyperthyroidism can be effectively cured by anti-thyroid drugs, oral radioactive iodine capsule or surgical removal of all or most of thyroid gland. However, no single treatment is be st for all patients with hyperthyroidism. The appropriate choice of treatment will be influenced by the patient's age, the type of hyperthyroidism, the severity of hyperthyroidism, other medical conditions that may affect the problems, and the patient's own preference. It may be a good idea to consult with an endocrinologist who is experienced in the treatment of hyperthyroid patients. 

Are other family members at risk?

Because hyperthyroidism, especially Graves' disease, may run in families, examinations of the members of your family may reveal other individuals with thyroid problems.

Hypothyroidism

Hypothyroidism (underactive) is an underactive thyroid gland. Hypothyroidism means that the thyroid gland can't make enough thyroid hormone to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in the blood. Common causes are autoimmune disease (Hashimoto's thyroiditis), surgical removal of the thyroid, and radiation treatment.

What are the symptoms of hypothyroidism?

When thyroid hormone levels are too low, the body's cells can't get enough thyroid hormone and the body's processes start slowing down. As the body slows, you may notice that you feel colder, you tire more easily, your skin is getting drier, you're becoming forgetful and depressed, and you've started getting constipated. Because the symptoms are so variable and nonspecific, the only way to know for sure whether you have hypothyroidism is with a simple blood test for TSH.

Keeping other people informed:

•     Tell your hypothyroidism to your relatives and encourage them to get periodic TSH tests

•     Tell your other doctors and your pharmacist about your hypothyroidism and the drug and dose with which it is being treated

•     If you start seeing a new doctor, tell the doctor that you have hypothyroidism and you need your TSH tested every year

•     If you are seeing an endocrinologist, ask that copies of your reports be sent to your primary care doctor

What can you expect over the long term?

•     There is no cure for hypothyroidism, and most patients have it for life. There are exceptions: many patients with viral thyroiditis have their thyroid function return to normal, as do some patients with thyroiditis after pregnancy

•     Hypothyroidism may become more or less severe, and your dose of thyroxine may need to change over time. You have to make a lifetime commitment to treatment. But if you take your pills every day and work with your doctor to get and keep your thyroxine dose right, you should be able to keep your hypothyroidism well controlled throughout your life

•     Your symptoms should disappear and the serious effects of low thyroid hormone should improve. If you keep your hypothyroidism well-controlled, it will not shorten your life span

What causes hypothyroidism?

There can be many reasons why the cells in the thyroid gland can't make enough thyroid hormone. Here are the major causes, from the most to the least common:

•     Autoimmune disease

•     Surgical removal of part or all of the thyroid gland

•     Radiation treatment

•     Congenital hypothyroidism (hypothyroidism that a baby is born with)

•     Thyroiditis

•     Medicines which prevent the thyroid gland from being able to make hormones

•     Too much or too little iodine

•     Damage to the pituitary gland

•     Rare disorders that infiltrate the thyroid

Thyroid Nodules

Thyroid nodules refer to an abnormal growth of thyroid cells that forms a lump within the thyroid gland. Although the vast majority of thyroid nodules are benign (noncancerous), a small proportion of thyroid nodules do contain thyroid cancer. In order to diagnose and treat thyroid cancer at the earliest stage, most thyroid nodules need some type of evaluation.

What are the symptoms of thyroid nodules?

The important points to remember are the following:

•     Thyroid nodules generally do not cause symptoms and mostly discovered incidentally

•     Thyroid function tests are very important, especially when you have symptoms

•     Thyroid function tests are most typically normal - even when cancer is present in a nodule

•     To determine a thyroid nodule is to make sure your doctor checks your neck

What causes thyroid nodules and how common are they?

The causes of most thyroid nodules is unknown even though they are extremely common. Fortunately, over 90% of such nodules are benign. Hashimoto's thyroiditis, which is the most common cause of hypothyroidism, is associated with an increased risk of thyroid nodules. Iodine deficiency or overload is also known to cause thyroid nodules.

How is a thyroid nodule evaluated and diagnosed?

•     Once the nodule is discovered, your doctor will try to determine whether the rest of your thyroid is healthy or whether the entire thyroid gland has been affected by a more general condition such as hyperthyroidism or hypothyroidism. Your physician will feel the thyroid to see whether the entire gland is enlarged and whether a single or multiple nodules are present

•     Since it's usually not possible to determine whether a thyroid nodule is cancerous by physical examination and blood tests alone, the evaluation of the thyroid nodules often includes specialized tests such as thyroid ultrasonography and fine needle biopsy. Thyroid ultrasound is a key tool and a painless test to obtain a picture of the thyroid and evaluate thyroid nodules

•     A fine needle biopsy of a thyroid nodule may sound frightening, but the needle used is very small and a local anesthetic may not even be necessary. For a fine needle biopsy, your doctor will use a very thin needle to withdraw cells from the thyroid nodule. The biopsy does not usually require any other special preparation (no fasting) and the patients typically return home or to work after the biopsy without even needing a bandaid

How are thyroid nodules treated?

•     All thyroid nodules that are found to contain a thyroid cancer or highly suspected should be removed by an experienced thyroid surgeon

•     Most thyroid cancers are curable and rarely cause life-threatening problems

•     Thyroid nodules that are benign by FNA or too small to biopsy should still be watched closely with ultrasound examination every 6 to 12 months and annual physical examination by your doctor

Fine Needle Aspiration (FNA) Biopsy of Thyroid Nodules

A fine needle aspiration (FNA) biopsy of a thyroid nodule is a simple and safe procedure. Typically, the biopsy is performed under ultrasound guidance to ensure accurate placement of the needle within the thyroid nodule. You will be asked to lie down on your back with your head tipped backwards, so that your neck is extended. Sometimes, a pillow is placed under your shoulders to help you get in right position for the biopsy.

During the procedure you may feel some neck pressure from the ultrasound probe and from the needle. You will be asked to remain as still as possible and avoid coughing, talking and swallowing during the biopsy.

How can you prepare for your thyroid FNA?

•     Most medications can be continued. However, anticoagulant often need to be stopped temporarily in anticipation of your thyroid biopsy for the increasing risk of bleeding caused by these drugs. It is common to receive specific instructions regarding when to stop taking medications from your doctor's office prior to the procedure

•     Generally, you will not be required to be fasting on the day of your appointment

•     During the thyroid biopsy, ultrasound gel will be applied to the neck to obtain ultrasound images. This gel is water soluble and non-toxic, but may get on clothing or jewelry. You may wish to wear comfortable clothing and take off any jewelry from around the neck for the procedure

How is a thyroid FNA performed?

•     The neck will first be cleaned with an antiseptic. A local or topical anesthetic may be applied. For the biopsy, your doctor will use a very thin needle to withdraw cells from the thyroid nodule. The needle used is smaller in diameter than those used in most blood draws. Your doctor will insert the needle through the skin and into the thyroid nodule. After the sampling, which only takes several seconds, the needle will be removed. New needles are used for additional samples. Several samples of cells will be obtained, by sticking a fine needle in various parts of the nodule usually between two and six times. This assures a better chance to find cancerous cells if they are present

•     If there is fluid in the nodule, a syringe may be used to drain it

•     Once the biopsy is completed, pressure will be applied to the neck. The procedure usually lasts less than 30 minutes

What should you expect after the procedure?

•     The procedure is usually performed using a local anesthetic and no medications are used that affect consciousness or thinking. After the procedure, you may be asked to sit up slowly to prevent you from getting lightheaded. Most patients typically leave feeling well. Because of this, it is not generally necessary to bring a companion to help or drive you home

•     Some neck discomfort at the site of the biopsy is expected following the procedure. Pain killer and ice compresses can be used to relieve discomfort

What happens to the biopsy material after the procedure?

The biopsy samples may be used to make slides immediately and/or collected in a solution to wash excess blood. Specially trained doctors, cytopathologists, then make slides from the material and examine them under a microscope to make a diagnosis.

How long does it take for the results to return?

Generally, it can take anywhere from 3-4 working days for the result to return.

With reference to the website of the American Thyroid Association: