Gestational diabetes mellitus

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life.

Though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A Caesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.

A 2008 study completed in the U.S. found the number of American women entering pregnancy with pre-existing diabetes is increasing. In fact, the rate of diabetes in expectant mothers has more than doubled in the past six years.This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential for the children of diabetic mothers to become diabetic in the future.

Type 2 diabetes mellitis

Type 2 diabetes mellitus is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus cases due to a known defect are classified separately. Type 2 diabetes is the most common type.

Type 2 diabetes mellitis

In the early stage of type 2, the predominant abnormality is reduced insulin sensitivity. At this stage, hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver.

Type 2 diabetes

Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance).

Insulin acts as a key unlocking the cells, so if there is not enough insulin, or it is not working properly, the cells are only partially unlocked (or not at all) and glucose builds up in the blood.

Type 2 diabetes usually appears in people over the age of 40, though in South Asian and black people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities.

Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin is often required.

Type 1 diabetes mellitus

Diabetes

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which beta cell loss is a T-cell-mediated autoimmune attack. There is no known preventive measure against type 1 diabetes, which causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults, but was traditionally termed "juvenile diabetes" because a majority of these diabetes cases were in children.

"Brittle" diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used. There are many reasons for type 1 diabetes to be accompanied by irregular and unpredictable hyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias, including an impaired counterregulatory response to hypoglycemia, occult infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's disease).These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes

Type 1 Diabetes

Type 1 diabetes develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin.

Insulin is the key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel. In Type 1 diabetes the body is unable to produce any insulin so there is no key to unlock the door and the glucose builds up in the blood.

Diabetes

Nobody knows for sure why these insulin-producing cells have been destroyed but the most likely cause is the body having an abnormal reaction to the cells. This may be triggered by a virus or other infection. Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially in childhood.

Type 1 diabetes accounts for between 5 and 15 per cent of all people with diabetes and is treated by daily insulin injections, a healthy diet and regular physical activity.

Diabetes mellitus

Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia(increased hunger).

There are three main types of diabetes mellitus (DM).

• Type 1 DM results from the body's failure to produce insulin, and presently requires the person to inject insulin or wear an insulin pump. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".
• Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. This form was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or "adult-onset diabetes".
• The third main form, gestational diabetes occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level. It may precede development of type 2 DM.

Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

Complications of constipation

For most people constipation rarely causes any complications, but people with long-term constipation can develop:

• haemorrhoids (piles)
• fecal impaction (where dry, hard stools collect in the rectum)
• fecal incontinence (the leakage of liquid stools)

How to prevent constipation

Although constipation is common, you can take several steps to prevent it, including making diet and lifestyle changes.

Fiber

Make sure you have enough fiber in your diet. Most adults do not eat enough fiber  You should have approximately 18g of fiber a day. You can increase your fiber intake by eating more:

• fruit
• vegetables
• wholegrain rice
• wholewheat pasta
• wholemeal bread
• seeds
• nuts 
• oats

Eating more fiber will keep your bowel movements regular because it helps food pass through your digestive system more easily. Foods high in fiber also make you feel fuller for longer.

If you are increasing your fiber intake, it is important to increase it gradually. A sudden increase may make you feel bloated. You may also produce more flatulence (wind) and have stomach cramps.

Read more information about eating a healthy, balanced diet.

Fluids

Make sure that you drink plenty of fluids to avoid dehydration and steadily increase your intake when you are exercising or when it is hot. Try to cut back on the amount of caffeine, alcohol and fizzy drinks that you consume.

Toilet habits

Never ignore the urge to go to the toilet. Ignoring the urge can significantly increase your chances of having constipation. The best time for you to pass stools is first thing in the morning, or about 30 minutes after a meal.

When you use the toilet, make sure you have enough time and privacy to pass stools comfortably.

Exercise

Keeping mobile and active will greatly reduce your risk of getting constipation. Ideally, do at least 150 minutes of physical activity every week.

Not only will regular exercise reduce your risk of becoming constipated, but it will also leave you feeling healthier and improve your mood, energy levels and general fitness.

Causes for Constipation

Most cases of constipation are not caused by a specific condition and it may be difficult to identify the exact cause.

However, several factors can increase your chances of having constipation, including:

• not eating enough fibre, such as fruit, vegetables and cereals
• a change in your routine or lifestyle, such as a change in your eating habits
• having limited privacy when using the toilet
• ignoring the urge to pass stools
• immobility or lack of exercise
• not drinking enough fluids
• being underweight or overweight
• anxiety or depression
• psychiatric problems, such as those brought on by sexual abuse, violence or trauma

Medication

Sometimes, constipation may be a side effect of a medicine that you are taking. Common types of medication that can cause constipation include:

• aluminium antacids (medicine to treat indigestion)
• antidepressants 
• antiepileptics (medicine to treat epilepsy)
• antipsychotics (medicine to treat schizophrenia and other mental health conditions)
• calcium supplements
• codeine, found in some types of painkiller
• diuretics (water tablets)
• iron supplements

If your constipation is caused by medication, the condition usually eases once you stop taking the medicine. However, under no circumstances should you stop taking your medication unless your GP advises you to.

Speak to your GP if you experience constipation due to a medicine. They may be able to prescribe an alternative.

Pregnancy

About 40% of women experience some form of constipation during their pregnancy, mostly during the early stages of their pregnancy.

Constipation occurs during pregnancy because your body produces more of the female hormone progesterone which acts as a muscle relaxant.

Your bowel normally moves stools and waste products along to the anus by a process known as peristalsis. This is when the muscles that line the bowel contract and relax in a rippling, wave-like motion. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products along.

If you are pregnant, there are ways that you can safely treat constipation without harming you or your baby. Read more information about treating constipation.

Other conditions

In rare cases, constipation can be a sign of an underlying condition, such as:

• colon or rectal cancer 
• diabetes
• hypercalcaemia, when there is too much calcium in the bloodstream
• underactive thyroid 
• muscular dystrophy, a genetic condition that causes muscle wasting
• multiple sclerosis, a condition that affects the nervous system
• Parkinson's disease, a brain condition that affects the co-ordination of body movements
• spinal cord injury
• anal fissure, a small tear of the skin just inside the anus
• inflammatory bowel disease, a condition that causes the intestines to become inflamed (irritated and swollen)
• irritable bowel syndrome (IBS)

Babies and children

Constipation in babies and children is quite common. About one in three British parents report constipation at some time in their child's life. Poor diet, fear about using the toilet and poor toilet training can all be responsible.

Poor diet

Children who are over-fed are more likely to have constipation, as are those who do not get enough fluids. Babies who have too much milk are also more likely to get constipation. As with adults, it is very important that your child has enough fiber in their diet.

Toilet training

Make sure that you do not make your child feel stressed or pressured about using the toilet. It is also important to let your children try things by themselves (when appropriate). Constantly intervening when they are using the toilet may make them feel anxious.

Toilet habits

Some children can feel stressed or anxious about using the toilet. They may have a phobia about using the toilet, or feel that they are unable to use the toilets at school.

This fear or phobia may be the result of your child experiencing pain when passing stools. This can lead to poor bowel habits, where children ignore the urge to pass stools and instead withhold them for fear of experiencing pain and discomfort. However, this will mean that their condition only worsens.

Other conditions

In rare cases, constipation in babies and children can be a sign of an underlying condition such as:

• Hirschsprung's disease, which affects the bowel, making it difficult to pass stools
• anorectal malformation, where the baby's anus and rectum do not form properly
• spinal cord abnormalities, including rare conditions such as spina bifida and cerebral palsy
• cystic fibrosis, a genetic condition that causes the body to produce thick and sticky mucus, which can lead to constipation

Causes for Constipation

It's often difficult to identify the cause. However, there are a number of things that increase the risk of constipation, including:

Causes for Constipation

• not eating enough fiber, such as fruit, vegetables and cereals
• a change in your routine or lifestyle, such as a change in your eating habits
• ignoring the urge to pass stools
• side effects of certain medication
• not drinking enough fluids
• anxiety or depression

In children, poor diet, fear about using the toilet and poor toilet training can all be responsible.

Constipation

Constipation is a common condition that affects people of all ages. It can mean that you are not passing stools (poo) regularly, or you are unable to completely empty your bowels.

Constipation

Constipation can also cause your stools to be hard, lumpy, large or small.

The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a chronic (long-term) condition that causes significant pain and discomfort and affects quality of life.