The sweetest disease…

We have all heard about it….the infamous disease of glucose metabolism…DIABETES MELLITUS. But what does the general population really know and understand about this complex and very serious disease? Please complete the poll before you continue reading!!

OK so now its time for some of the facts….

To start with, how about some background info? In order to understand how diabetes works, we need to get an idea about the mechanisms of metabolism (dont worry I’ll be brief…). We know that food is fuel for our bodies, but how does that happen? When we eat food, our body sends signals to the pancreas that there is food on board, so it starts to produce insulin, which is required to turn the food into a usable source of fuel for our body. The primary nutrient we are concerned with is glucose.
When we digest food, our body absorbs the glucose into the blood stream. However, the blood does not provide a direct way for the glucose in the blood to get to the cells (brain, muscle, etc) that need the energy. When the amount of glucose in the blood rises, the pancreas secretes insulin to bring the glucose to the cells. Its like trying to get to an island, and the only way to get there is by boat. Insulin is the boat.

When we are monitoring blood glucose, we are looking to see that there is a not an excess of glucose hanging around in the blood not getting transported to the cells. Think of it as if a bunch of people are waiting to get to the island. Normally, as more people come, more people should be taken to the island so there isnt a bunch of people waiting around. If we see that more and more people are coming and waiting around to get to the island, we should suspect a problem.

There might be a problem with the transporter (insulin), where there is not enough boats to take the people (glucose) to the island (the hungry cell). This situation is usually seen in  type 1 diabetes. In this case, insulin injections are required. On the other hand, if there are enough boats (insulin) available to transport people (glucose), but there is still a backup of people waiting, there might be a problem getting entry to the  island itself. This is usually the case with type 2 diabetes. The resources that are needed are available, for some reason, the cell doesn’t recognize the glucose. This is usually seen with older age, but is more frequently being seen with obesity in younger populations. Because insulin production is adequate in these individuals, insulin injections is generally not necessary. However, people with type 2 must adhere to strict diets in order to control blood sugars. It is critical to analyze the nutritional components of every single meal to avoid overconsumption of glucose products, that can skyrocket blood sugars and cause hyperglycemia. You may be wondering what all the fuss is about having high blood sugars. Is sugar really THAT bad? Ohhh yeah. Hyperglycemia is associated with a imbalances of the blood chemistry, resulting in a cascade of compensation mechanisms in attempt to return to homeostasis. By trying to compensate, the body must work harder to get rid of the excess sugar in the blood. The heart works harder to increase the blood pressure to filter more blood through the kidneys so glucose can be excreted in the urine. Thats the beauty of the body, right? It fixes itself. Until the next meal. Then it begins again. It may not be significantly damaging right away, but can you imagine the workload the body must endure every day, every meal? And dont think you are benefiting from burning calories. Remember the body is already having trouble getting the fuel it needs to function the right way. Because of the hyperglycemia, the body is demanding more energy requirements. But it is not going to use up all the precious stores of glycogen, no no that is reserved for the brain. Your body must find another source of energy, breaking down protein, storing fat, making more waste in the bloodstream. As if the body wasnt already working hard enough to filter the blood! Now, if the cells are not getting the right kind of fuel, they may not be able to function normally, leading to all sorts of chaos. More specifically, the heart may start becoming weaker from working so hard. The kidneys are becoming burnt out from all the filtering, and harmful waste products get left in the blood stream. In attempt to deliver more and more blood for filtration, blood pressure continues to rise, causing damage to the delicate vasculature of the brain, eyes, and capillaries and compromising circulation.

Blood flow to the distal extremities is impaired, and decreased oxygenation to the tissues often results in chronic pain (diabetic neuropathy), and decreased sensory abilities (leading to frequent injuries and skin infections).

As impaired oxygenation continues, tissue becomes ulcerated and necrotic, and very susceptible to serious infections. Because of the impaired sensation, tissue deterioration often goes unnoticed (particularly on the bottoms of the feet), and severe infection and necrosis has already taken place, requiring amputation. SUCKS.

So now that you are royally grossed out, what can you do to prevent diabetes? Sometimes, diabetes is inherited, especially type 1. But in all circumstances, adoption of a healthy lifestyle can significantly reduce your risk of disease.

Obesity is one of the most important factors associated with development of diabetes, and implementing a healthy diet and regular exercise to reach ideal body weight has been found to significantly improve outcomes, even when diabetes is already present. Reducing cholesterol and fat intake, treat high blood pressure, and for God’s sake quit smoking!

Another type of diabetes is Gestational diabetes, which is associated with many risks for pregnancy complications. Here is a great video I found from http://www.diabetes-ok.com/ that explains it nicely. 

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At your cervix…

 I originally put together this post to give a friend a visual explanation of how she could check her own cervix during labor…Hold on, she did WHAT?!Thats right people, it is possible to check your own cervix for dilation. Heck if I was in labor I’d probably check myself every 5 minutes (are we there yet? are we there yet?). Here’s the thing. Checking a cervix only tells you what your cervix is doing at this one very second. It will not tell us when you are going to go in labor (if you arnt already, please see blog my titled “When to know when to go”), or when you will deliver. Childbirth is a game of watchful waiting and PATIENCE!! But for the neurotic clock watchers out there like me that just cant seem to just wait and do NOTHINGGGggg, here is a way you can have an idea of whats going on, what your midwife is checking for, and have a better sense of the changes your body is going through. Additionally touching in and around yourself could help to stimulate labor.

I’m sure there is some debate amongst healthcare providers about women checking their own cervices. But honestly, if we recommend having sex to get labor going, then I dont see the harm in helping women to feel more empowered and by giving them better insight to their own bodies. The key thing to remember is that most of the time, as you are getting ready to go into labor, everything gets more tender down there, so feeling around and touching your cervix may be uncomfortable. More so, most women dont know what their cervix feels like, and even if they do find it, they probably wont know right away what they are looking for. So if it is uncomfortable, or you are having trouble, please don’t feel like you need to torture yourself; just wait until your midwife checks you so it is worth any discomfort. But if you are dying to do something and feel more active in managing your labor, make sure you wash your hands real good, and use a sterile lubricant to avoid any irritation.

When you insert your fingers, go straight back as far as you can reach, until you feel something sort of “sticking out.” Feel along the sides and into the little pockets to measure with the end of your finger how much it is sticking out. That is how you can get an idea of the effacement, or the “thinning out” of the cervix. In women in their first pregnancies, your cervix must thin out before it can dilate. So if you are in earlyyy stages of labor, this will probably be the most useful thing to check for.

When you feel that smooth surface, think about it in terms of where on the cervix you are feeling. The donut shaped cervix pic is what you would see if you opened up your vagina. Its like the big house on the end of a cul de sac. If you are standing, you will prbly feel the surface (where the frosting on top of a donut would be) facing towards the floor, but everyones cervix is different esp in preg so it can be tricky! If you use your finger tips and feel around the center surface, you will be able to feel a small hole, like a dimple thats the part that dilates. A really good way to think of when you are feeling for that “crater like” opening.

Here is a nice little description I found from  http://www.brooksidepress.org/Products/ed2/Enhanced/LaborandDelivery.htm

Use fingers to determine cervical dilatation

Cervical Dilatation and Effacement

Using sterile gloves and lubricant, perform a vaginal exam and determine the dilatation and effacement of the cervix. A small amount of bleeding during the days or hours leading up to the onset of labor is common and called “bloody show.”

Dilatation is expressed in centimeters. I have relatively large fingers, and for my hands, I make the following generalizations:

  • 1.5 cm: One finger fits tightly through the cervix and touches the fetal head.

  • 2.0 cm: One finger fits loosely inside the cervix, but I can’t fit two fingers in.

  • 3.0 cm: Two fingers fit tightly inside the cervix.

  • 4.0 cm: Two fingers fit loosely inside the cervix.

  • 6.0 cm: There is still 2 cm of cervix still palpable on both sides of the cervix.

  • 8.0 cm: There is only 1 cm of cervix still palpable on both sides of the cervix.

  • 9.0 cm: Not even 1 cm of cervix is left laterally, or there is only an anterior lip of cervix.

  • 10.0 cm: I can’t feel any cervix anywhere around the fetal head.

Effacement is easiest to measure in terms of centimeters of thickness, ie., 1 cm thick, 1.5 cm thick, etc. Alternatively, you may express the thickness in percent of an uneffaced cervix…ie, 50%, 90%, etc. This expression presumes a good knowledge of what an uneffaced cervix should feel like.

Always remember to talk to your healthcare provider and get their opinions/advice before you try anything. They most likely will have a better understanding of your body specifics than I do (I probably have not checked your cervix before), and she can probably give you better guidance on where your cervix is etc. Also, PLEASE do not try this if your water is already broke or you think it might have broke. We dont need to be introducing any risks of infection here. Remember that these blogs should not be substituted for medical advice, and this is a controversial topic and some providers are against self cervical exams, or you may have extenuating circumstances that may put you at increased risk of complications. Please be safe and know what your provider recommends first. Good luck!