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. Patients 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 the patient's
future risk for developing diabetes.
"Secondary" diabetes refers to elevated blood sugar
levels from another medical condition. Secondary diabetes may develop when the
pancreatic tissue
responsible for the production of insulin is destroyed by disease, such as
chronic pancreatitis
(inflammation of the pancreas by toxins like excessive alcohol), trauma, or surgical removal of the pancreas.
Diabetes can also result
from other hormonal disturbances, such as excessive growth hormone production
(acromegaly) and
Cushing's syndrome. In acromegaly, a pituitary gland tumor at the base of the
brain causes excessive production of growth hormone, leading to hyperglycemia.
In Cushing's syndrome, the adrenal glands produce an excess of cortisol, which promotes blood sugar elevation.
In addition, certain medications may worsen diabetes
control, or "unmask" latent diabetes. This is seen most commonly when steroid
medications (such as prednisone) are taken and also with medications used in the
treatment of HIV infection (AIDS).
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