Polycystic Ovarian syndrome (PCOS)

The cause of polycystic ovarian syndrome is unknown but most experts think that several factors including genetics could play a role.

Polycystic ovarian syndrome affects millions of women around the world. Its prevalence is much higher in women of South Asian origin. It is one of the leading causes of fertility problems in women and runs in families.

It is also thought that insulin may be involved in the development of polycystic ovarian syndrome. Many women with PCOS have insulin resistance. When tissues are resistant to the effects of insulin the body has to produce more insulin to compensate. The high levels of insulin found in the bodies of women with PCOS and insulin resistance stimulate the ovaries to produce large amounts of testosterone which results in many of the symptoms of the condition.

It is estimated that 10% of women who are obese and have PCOS develop T2DM by 40 years.  A higher proportion develops impaired glucose tolerance by this age. Because of its link to diabetes, if PCOS not managed properly, it can lead to additional health problems in later life.

(Source - balance – Mar-April 2013)

Know Your Diabetes Numbers

Target blood glucose for most people with diabetes:

In the morning before eating and before meals, it should be ≥ 70 mg/dl  and ≤120 mg/dl.

1 ½  - 2 hours after eating, it should be ≤160 mg/dl.

What level of blood glucose is too low?

Less than 70 mg/dl

What level of blood glucose is too high?

Over 180 mg/dl : Talk to your doctor on next visit.

Over 300 mg/dl for 2 or more readings over 12 – 24 hours:  call your doctor.

Over 500 mg/dl: Call your doctor immediately or go to emergency room.

Always check your blood glucose levels: 

• Every day when you get up in the morning and at least one more time during the day
• If you take pills for your medication, check before breakfast and 2 hours after your biggest meal of the day.
• If you take insulin for your diabetes, check before each meal and at bedtime.

Your doctor may ask you to check your blood glucose level at other times as well.

Check any time you feel like your sugar is too high or too low.

How do you feel if your blood glucose is low?

Sweaty, shaky, fast heart - beat, dizzy, headache, not thinking clearly, hungry, tired, blurred vision, confused, moody or angry.

How to treat low blood glucose 

First eat 15 g of fast acting carbohydrate such as 

½ cup fruit juice

1 cup skimmed milk

1 tablespoon honey or sugar

A sweet

Then, test your blood glucose.

Test your blood glucose again in 15 minutes.

If sugar is not over 70 mg/dl, eat another 15 gm of fast acting carbohydrate.

Eat some protein and carbohydrate as soon as you can to stop from going low again. Try eating half a sandwich of peanut butter, meat or chicken or have your next meal or the meal you missed.

How do you feel if your sugar is high?

Increased urination, increased thirst, tired, blurred vision, dry skin/dry mouth.

What to do if you think you have high blood glucose.

Check your blood glucose as soon as you can.

Some tips to help you keep blood glucose low 

• Eat 3-4 small meals a day.
• Eat your main meals 4 -5 hours apart.
• Do not skip meals.
• Eat less food.
• Avoid the second helping.
• Do not snack between meals.
• Do not drink fruit juice, sodas or sweet tea but drink calorie free liquids such as unsweetened tea or coffee, or just plain water.
• Avoid foods high in sugar such as cake, pie, sweetened cereals, honey, jam, jelly.
• Do not add sugar to food.

At MVH, we advise all people with diabetes to manage their diabetes well so that they can live a normal span of life in perfect health.

Prevent India from becoming the Diabetes Capital of the World

Are there other ways of tackling the problem? 

Life style modification and drug intervention in people with impaired glucose tolerance are Post primary prevention strategies which delay the development of Type 2 Diabetes mellitus. 

We need to concentrate on Primary prevention which is more important to reverse or halt the disease. 

One area of focus can be women with Gestational Diabetes Mellitus (GDM) who are an ideal group for primary prevention as they as well as their children are at increased risk of future Type 2 Diabetes Mellitus. 

Studies indicate that women with GDM have an increased lifetime risk of developing diabetes 16 years after the first pregnancy when compared with controls. One third of children born to mothers with GDM get evidence of IGT or T2DM. 

Pregnant women with glucose intolerance, due to decreased insulin secretion or action, have excess of glucose amino acids and lipids. When these elements cross the placenta, the foetus responds by secreting large quantities of insulin. This eventually causes decrease in foetal pancreatic reserve and results in risk for developing diabetes later.

So, screening for GDM is essential. 

Are we screening pregnant women at the right time?

Screening for glucose intolerance  is usually between 24 -28 weeks but foetal islets of Langerhans differentiate during 10th -  11th  weeks and begin to release insulin in response to nutrients as early as 11th  – 15th  weeks of gestation .

So undetected glucose intolerance in the early weeks of gestation influence foetal growth resulting in large babies for GDM mothers despite good glucose control in the third trimester.

Another area to focus on is the occurrence of T2DM within families. 

Is the familial nature of T2DM only due to genetic factors?

The genetic factor may be due to the major role played by maternal mitochondrial DNA in the transmission of the disease. A study revealed that children exposed to maternal diabetes before birth are at higher risk of obesity and diabetes than their unexposed siblings. This suggests that the increased risk is not only due to genetic causes.

Therefore, it is essential to focus on intrauterine environment, especially in our country. In India, both under -nutrition and over- nutrition exist during pregnancy. Both, nutritional deprivation or nutritional plenty can result in changes in pancreatic development and response to insulin that may lead to adult onset GDM or T2DM. So, both small – for date infants and large for date infants are at risk for future diabetes.

The aim should be to help pregnant women to have infants born with weight that is appropriate for gestational age by both sufficient and fitting nutrition and good blood glucose control.  (Fasting - < 90 mg/dl and peak < 120 mg/dl.)

(Ref: Transgenerational Transmission of Diabetes – Sesiah.V, Balaji.V, Balaji, Madhuri.S, Das, Ashok.K)