Pathophysiology of Diabetes Mellitus in Pregnancy

Diabetes mellitus is characterized by hyperglycemia (elevated blood glucose) resulting from inadequate insulin production or use of insulin is not effective at the cellular level. Production of insulin in the beta cells of the islets of Langerhans in the pancreas responsible for transporting glucose into the cell. if insulin is not enough / not effective, glucose accumulates in the bloodstream and hyperglycemia occurs. Hyperglycemia causes hyperosmolarity in the blood, which attract the intracellular fluid into the vascular system, causing dehydration and increased blood volume. As a result, the kidneys secrete large volumes of urine (polyuria) as an attempt to regulate blood volume and secrete excess glucose that is not used (glycosuria). Cellular dehydration, causing excessive thirst (polydipsia). Weight loss due to the breakdown of fat and muscle tissue, tissue breakdown is causing hunger that makes people overeat (polyphagia). After a certain period of time, diabetes causes significant vascular changes. These changes mainly affect the heart, eyes and kidneys. Complications from diabetes include atherosclerosis, premature, retinopathy and nephropathy. Type 1 and type 2 diabetes is usually known as a syndrome caused by genetic factors. Diabetes is usually inherited as a recessive trait, but emerged as a dominant trait in some families. Genetic inheritance (genotype) diabetes mellitus does not necessarily mean that the individual will experience a diabetic glucose intolerance (phenotype). Many individuals who have the genotype, did not show a single symptom of diabetes until they experience one or more stressors or precipitation factors. Examples of these stressors are increasing age, a period of normal development, rapid hormonal changes, obesity, infection, surgery, emotional crises and pancreatic tumor or infection. Gestational diabetes (gestational diabetes) glucose intolerance during pregnancy, not grouped into NIDDM in mid-pregnancy increases the secretion of growth hormone and hormone chorionic somatomammotropin (HCS). This hormone increases to supply amino acids and glucose to the fetus.

In pregnancy endocrine and metabolic changes that support the carbohydrate supply of food for the fetus as well as preparation for breastfeeding. Glucose can be fixed diffuses through the placenta to the fetus so that levels in fetal blood is almost like the maternal blood levels. Insulin mother can not reach the fetus, thus affecting the mother's blood sugar levels in the fetus. Controlling blood sugar is mainly influenced by insulin, in addition to several other hormones such as estrogen, steroids and placental lactogen. As a result of the slow resorption occurs hyperglycemia food then relatively long and demanding needs insulin. Towards aterm increased insulin requirements so as to achieve 3 times than normal. This is referred to as diabetogenic pressure in pregnancy. In physiological insulin resistance has occurred, namely when he coupled with exogenous insulin it does not easily become hypoglycemic. However, if the mother is not able to increase the production of insulin, so it is relatively hipoinsulin that cause hyperglycemia or diabetes in pregnancy.

In gestational diabetes mellitus, in addition to these physiological changes, there will be a situation where the number / function of insulin to be not optimal. There were changes in the kinetics of insulin and resistance to the effects of insulin. As a result, the composition of energy sources increases in maternal plasma (high blood sugar levels, insulin levels remain high). Through a facilitated diffusion in the membrane of the placenta, where the fetal circulation also occurred composition abnormal energy sources. (causing the possibility of various complications). In addition there is also hyperinsulinemia so that the fetus also had metabolic disorders (hypoglycemia, hypomagnesemia, hypocalcemia, hyperbilirubinemia, and so on).

In gestational diabetes mellitus, in addition to the physiological changes occur in the hormonal and metabolic normal in pregnancy, obtained state number / function suboptimal maternal insulin. And there is also change the kinetics of insulin and resistance to the effects of insulin. The result is a composition of energy sources in maternal plasma is changed (high blood sugar levels, while insulin levels remain high).

Through a facilitated diffusion in the membrane of the placenta, the fetal circulation also occurred abnormal composition of energy sources that can lead to the possibility of various complications. In addition there is also hyperinsulinemia, hypokalsemia, hyperbilirubinemia, and so on). In case this happens a variety of disorders that cause various complications in the mother and fetus. In essence, diabetes mellitus in pregnancy can occur because of the pregnancy itself, but can also occur due to diabetes mellitus type 1 or 2 which was discovered during pregnancy. When diabetes mellitus occurs because of the pregnancy itself, postpartum blood sugar levels will return to normal within a few years later and the new possibilities will really settle into diabetes mellitus.

Diabetes mellitus in pregnancy can occur due to physiological metabolic changes that occur during pregnancy. Such changes lead to the development of insulin resistance. When the beta cells of the pancreas can not keep pace with these changes, there will be diabetes mellitus in pregnancy. After giving birth, because of physiological changes during pregnancy has been lost, then the mother will become normal again. But on the contrary, if the mother had previously been bearing the new known diabetes mellitus and diabetes mellitus.

In gestational diabetes mellitus, in addition to these physiological changes, there will be a situation where the number / function of insulin to be not optimal. There were changes in the kinetics of insulin and resistance to the effects of insulin. As a result, the composition of energy sources increases in maternal plasma (high blood sugar levels, insulin levels remain high).

Through a facilitated diffusion in the membrane of the placenta, where the fetal circulation also occurred composition abnormal energy sources. (causing the possibility of various complications). In addition there is also hyperinsulinemia so that the fetus also had metabolic disorders (hypoglycemia, hypomagnesemia, hypocalcemia, hyperbilirubinemia, and so on.