Ask The Doctor: October 2008

Question: I had gestational diabetes during both of my pregnancies. What are the chances that I will develop diabetes later in life?

Answer: Gestational diabetes occurs in about 4% of pregnancies. It is due to the hormones produced by the placenta that direct the mother’s nutrients toward the baby. To make up for this redirection, the placenta also makes a hormone that prevents the mother from developing low blood sugar. This can inhibit the function of insulin which can lead to insulin resistance or diabetes in the mother. This can be treated with dietary changes and/or insulin injections.

Gestational diabetes usually resolves after the baby is delivered; your blood sugar should return to normal in about 6 weeks. Your baby’s blood sugar will also need to be tested at birth. Your risk of developing gestational diabetes in following pregnancies is about 40-60%. Your risk of developing diabetes later in life is also elevated, at about 60% according to one source. You should make sure to let your primary care doctor know about your history of gestational diabetes and have your blood sugar monitored on a yearly basis.

To avoid developing type 2 diabetes, you should be sure to follow a healthy lifestyle: maintain a healthy weight, get regular exercise and follow a diet that focuses on whole grains, lean proteins, and vegetables.

Question: I have had symptoms of a bladder infection for about six months, and every time I go to my doctor she says my urine is normal and there is no infection. She thinks I may have interstitial cystitis and has sent me to a urologist. I have never heard of interstitial cystitis. Can you tell me more about it?

Answer: Interstitial cystitis (IC) is a condition that affects about 700,000 people in the US; 90% of these are women. Interstitial cystitis is what we call a diagnosis of exclusion. Since there is no official diagnostic test for IC, the diagnosis is based on symptoms and ruling out other causes that could explain those symptoms.

Most patients with IC have symptoms, as you do, that resemble a bladder infection such as frequency of urination, urgency to urinate and pain with urination. However, with a bladder infection the urine will have signs of bacteria and white blood cells. In IC, the urine is normal.

Your urologist will also want to look inside your bladder with a small camera, called a cystoscope. The urologist would be looking for signs of bladder cancer, but also inflammation or stiffness of the bladder wall. The bladder has a protective layer on the inside wall. Recent research suggests that this lining is defective in patients with IC. Since the bladder wall is not well protected, the bladder is exposed to irritants and toxins, which can cause some of the symptoms that you are having. Also, in some IC patients, the bladder wall is stiff and scarred from the exposure to the toxins.

There is one medication that has been FDA approved for IC, and urologists are also using other drugs known to help with pain syndromes to treat IC. You should talk to your urologist about these options and hopefully you will be able to find something to help with your symptoms.

Dr. Karen D. Lockwood is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, please email your question to: askthedoc@healthandleisureonline.com

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.