Dr. Lois Jovanovic
Exclusive Interview from AACE Orlando
This is a 5-section transcript. Part 1 | Part 2 | Part 3 | Part 4 | Part 5
Steve Freed: Exactly how a lot must we be concerned along with once it pertains to gestational diabetes?
Dr. Jovanovic: Actually gestational diabetes — and that’s where the ADA, AACE and the global congresses have actually all of been fighting regarding Exactly how you make the diagnosis — fairly frankly, probably 50% of all of pregnant women have actually some form of glucose intolerance. So we must be universal screening, [but] the ADA doesn’t do universal screening. They say there are risk factors for which you would certainly provide the drink between of the pregnancy. We actually have to do universal screenings for all of pregnant women, get hold of a sugar drink and have actually their blood-sugar measured after the drink and the cut off has actually to be pretty low, as you hear a blood sugar better compared to 1twenty [it] raises the risk of fat baby. So actually I’ve been yelling for years that we required to provide a 50 gram drink, a one hour test and any person along with a one hour test better compared to 1twenty we label as hyperglycemia in pregnancy; that cares regarding the word gestational? And we end up making the blood sugars below 120. So you see if you don’t usage the word gestational it’s not a problem, you merely make the blood sugars normal. And in truth a fantastic friend of mine that helped write the guidelines, obliterated the word “gestational” diabetes, and it’s now called hyperglycemia in pregnancy. So now you’ve got a brand-new term.
Steve Freed: Well we’ve seen some modifications once it pertains to the numbers over the… pretty recently obviously. Exactly what are your feelings, do you believe the numbers make much more sense?
Dr. Jovanovic: The glucose tolerance test has actually constantly been a problem since obstetricians worry that you see the two-step test makes a prevalence of gestational diabetes of regarding 9%. If you do the one-step test, my way, the prevalence of gestational diabetes goes up to 18%. Now that doubles the variety of women that have actually hyperglycemia in pregnancy. And obstetricians believe that’s going to abuse good health care costs, it’s going to take up also a lot time. Yet I constantly say, you understand it’s simpler to teach two women compared to one. If you’re going to teach a person and go to the effort of teaching well, isn’t it nice to have actually two people in the room, not one. So it doesn’t improve the cost if you double the variety of women along with the diagnosis of hyperglycemia in pregnancy. The controversy’s constantly been, well the obstetricians don’t want also lots of people labeled and the endocrinologists wish to handle everybody. So we’re still split, and it’s been that method because I’ve been in the technique of medicine.
Steve Freed: Coming up is the ADA, and everybody’s waiting for the news of the artificial pancreas. There’s a recent study that was merely done. I had a opportunity to talk to Dr. Bode and Exactly how specifically will certainly it affect pregnancy and diabetes for the gestational diabetic?
Dr. Jovanovic: Well very first of all of I wouldn’t usage an artificial pancreas on a woman along with gestational diabetes, since it’s a teachable moment for that woman to learn Exactly how to handle herself and steer clear of type 2 diabetes in the future. So to usage an artificial pancreas on her it actually is a waste of resources. In addition there’s constantly the concern regarding where do you put the needles, since as her tummy stretches and grows, she doesn’t have actually a great deal of actual estate, Bruce Bode likes to call it actual estate, to put the needle and make certain one device is talking to the other. The others concern is the continuous glucose monitor isn’t accurate enough in blood sugars much less compared to 70; now a typical blood sugar in a pregnant woman is 5five to 120. So if you don’t understand if your blood sugar is 5five or 70 along with a glucose sensor, you have actually no method to maintain blood sugars in typical range. So the glucose sensor is pretty difficult to usage and maintain good regulate on pregnancy merely since it isn’t accurate in the reduced ranges. So now you hear my thoughts on using an artificial pancreas in pregnancy. I believe the honest truth is as long as a woman is checking her blood sugars herself and making sure her insulin pump is functioning and not stopping, since if it stops she’s not going to get hold of insulin at all of and that’s much more dangerous compared to anything you can easily ever believe of in pregnancy, that she has actually to job even harder if she wears an artificial pancreas compared to if she merely takes multiple injections.
Steve Freed: So Exactly what is your feeling regarding pregnancy for any kind of type 1s and using insulin pumps?
Dr. Jovanovic: I believe they can easily go on to usage their insulin pump, they have actually to understand they have actually to go to a physician that knows Exactly how to improve the basal and bolus throughout pregnancy for the algorithms, not merely continue to be on the very same basal all of the time. You have actually to understand that you have actually to take a kiss of a long-acting insulin every night. And the requirement is if the pump stops on the artificial pancreas, you only have actually 4 hours to go in to ketoacidosis. So she has actually to understand she’s obtaining her insulin through a pump and it could malfunction, she has actually to have actually available syringes, pens, insulin in a refrigerator to take over while she’s waiting for her pump or her device to be returned to her. So she truly… it’s actually harder to be on a continuous glucose sensor and a continuous glucose pump and to believe that you can easily put the right algorithms in there for pregnancy and nobody’s written them. So you can’t usage the non-pregnant algorithm by Bruce Bode and believe it applies to pregnant women. So you’d have actually to make it specific, which would certainly mean an additional go through the FDA. The FDA actually has to enhance every little thing on pregnancy including devices.
This is a 5-section transcript. Part 1 | Part 2 | Part 3 | Part 4 | Part 5
