Questions. Diabetic foot syndrome. Diabetes and pregnancy

Hi all! Girls who have been in similar situations, please respond! On May 27th I had my first screening. The ultrasound showed everything was normal. We wrote down the phone number just in case, but I didn’t expect that they might call back, and then a week later I got a call - come and get a referral to the CPSI, you have high risk. I don’t remember myself, I arrived in tears, on weak legs, and took all the papers. Risk 1:53. The next day I went for further examination. The ultrasound specialist looked at both the abdomen and vagina for a very long time, turned on the Doppler several times, and everything seemed to be fine, but he didn’t like DOPPLER METRY OF THE TRISCUPID VALVE: REGURGITATION. I entered the new ultrasound data into the program and the screening results from a week ago, the computer showed a diabetes risk of 1:6. I sent him to a geneticist. After looking at the conclusion, she explained to me that this regurgitation could simply be a feature of the fetus, but coupled with an underestimated PAPP-A indicator - 0.232 MoM, this is a marker of chromosomal abnormalities. Everything else is within normal limits. They suggested undergoing a chorionic villus biopsy. I refused for now, the nurse almost fell out of her chair, like the risk is so high and CA cannot be treated, and if she were me, she wouldn’t even think for a minute. I asked a geneticist about the Panorama analysis (a terribly expensive genetic analysis of maternal blood), she told me that of course you can do it, but it excludes only 5 main CAs and several very rare ones, it cannot completely exclude anomalies, and in my case it is recommended invasion. I’ve already read a ton of articles, questions and the like on this topic, and I just don’t understand what they found so terrible in my analyzes? Regurgitation, as it turned out, is physiological at this stage and goes away by 18-20 weeks (if it doesn’t go away, this indicates a risk of heart defects, for many it goes away after childbirth, and some live with it and doesn’t affect anything. Moreover, the husband has prolapse mintral valve, which was inherited from my mother, maybe this is somehow connected). Hormones may not be indicative at all, because... I’ve been taking it since the beginning of pregnancy, I ate 2 hours before the test (it turns out you can’t eat 4 hours before, they didn’t tell me about it), drank coffee, was nervous and worried about the ultrasound and I’m afraid to donate blood, and Lately chronic fatigue, I’m tired with my older child. And all this affects the results. The geneticist didn’t ask anything of the kind, wasn’t interested, they actually have some kind of conveyor belt there, and it was as if they shoved me there for statistics. But they planted a bit of doubt in me, I cried and was not worried about the year ahead. My husband is trying to persuade me to have a biopsy. I am terribly afraid of the consequences, afraid of losing or harming the child, especially if he is healthy. On the one hand, if everything is fine, I will breathe a sigh of relief and send all the doctors away. On the other hand, if everything is bad, what should you do? Will I be able to terminate the pregnancy, allow my child to be dismembered inside me, especially now that it seems to me that I am beginning to feel him. But another option is whether I can raise a child who needs special approach and a lot of attention, when sometimes you want to run away from your completely healthy daughter... Damn, all these thoughts are eating me up. I don’t know what to do... Just in case, I’ll give you the screening data:

Delivery period: 13 weeks

Heart rate 161 beats/min

Ductus venosus PI 1.160

Chorion/placenta low on the anterior wall

Umbilical cord 3 vessels

Fetal anatomy: everything is determined, everything is normal

b-hCG 1.091 MoM

PAPP-A 0.232 MoM

Uterine artery PI 1,240 MoM

Trisomy 21 1:6

Trisomy 18 1:311

Trisomy 13 1:205

Preeclampsia up to 34 weeks 1:529

Preeclampsia up to 37 weeks 1:524

In the prevention of multifactorial diseases with a hereditary predisposition, which include IDDM, a necessary link ismedical and genetic counseling. The main task of medical and genetic consultation is to determine the genetic risk of a disease and explain its meaning in an accessible form. In cases of diabetes, spouses most often turn to medical genetic consultation to assess the risk of the disease in future children due to the presence of this disease in previous children, or in the spouses themselves and/or their relatives. Population genetic studies have made it possible to calculate that contribution of genetic factors to the development of diabetes withputs 60-80%. In this regard, medical genetic counseling of relatives of patients with diabetes is of exceptional relevance and perspective.

The main questions that a doctor usually has to deal with relate to the risk of developing diabetes existing children or siblingssick, the ability to classify it, as well as forecast in relation tofuture (planned) family members.

Counseling families of patients with type 1 diabetes consists of several generally accepted stages, which have their own characteristics for this population.

11.1. Stages of counseling

First stage of consultation – clarification of the diagnosis of the disease.

Typically, the diagnosis of type 1 diabetes in childhood and adolescence is not difficult. However, if other family members have diabetes, it is necessary to verify their type of diabetes, which in some cases can be a difficult task and will require the doctor to carefully collect the medical history of the sick relative. Differential diagnosis between the two main types of diabetes (1 and 2) is carried out according to generally accepted criteria.

The genetic heterogeneity of the two main types of diabetes, proven in population genetic studies, indicates their nosological independence and independence of inheritance. This means that cases of type 2 diabetes in the pedigree of individual patients are random and should not be taken into account when assessing family risk.

When conducting medical genetic counseling, it is also necessary to exclude genetic syndromes that include diabetes mellitus, since they are characterized by monogenic inheritance.

Second stage of consultation – determination of the risk of developing the disease in relation to existing family members and planned offspring.

Empirically, average estimates of the risk of developing diabetes were obtained for family members with relatives with type 1 diabetes. Relatives of the first degree of kinship (children, parents, brothers and sisters) have the maximum risk - on average from 2.5-3% to 5-6%. It has been established that the incidence of diabetes in children from fathers with type 1 diabetes are 1-2% higher than from mothers with type 1 diabetes.

In each specific family, the risk of developing the disease depends on many factors: the number of sick and healthy relatives, the age of manifestation of diabetes in family members, the age of the person being consulted, etc.

Table 8

Empirical risk for relatives of patients with type 1 diabetes

Using a special method, they are calculated development risk tablesDM 1 type depending on the number of sick and healthy relatives and the age of the person being consulted For families of various types. Family types, parental status and number of affected siblings are presented in Table 9.

Nuria asks:

Hello. I am 25 years old. At 16 weeks of pregnancy, I was tested for AFP 30.70/0.99 mΩ,/ and hCG 64.50/3.00 mΩ/. Please tell me what the numbers mean. What is my probability on SD? My pregnancy is 27-28 weeks. I just found out about the screening results. At this time I was taking Duphaston. Tell me how high the risk is. Thank you.

Based on the data you provided, the risk of your child having genetic pathology Down syndrome is low.

Nuria asks:

Thanks for clarifying. But the center gave me a threshold risk, so I’m very worried. What other data is taken into account to identify the risk of diabetes? TVP - 1.5, DNA - 3.2. Ultrasound at 20 weeks is good. Thanks again.

Most likely, the degree of risk was calculated taking into account increased value HCG, since the rest of the examination indicators you presented are normal.

Natalya asks:

Hello. Help, please. I received the screening result and was upset. They put:
Age-related risk of diabetes 1:371
DM risk value 1:306
AFP 26.04 Mohm 0.86, HCGb 29.74 Mohm 1.87
Fully 35 years old, second pregnancy, screened at 15 weeks 6 days, with a difference - they did an ultrasound, and 2 days later they took blood.
Conclusion - threshold risk.
Tell me everything is bad? Thank you

The risk of genetic pathology can be assessed as slightly above average. There is no reason to panic. The screening only assesses the likelihood of having a child with a genetic pathology.

Natalya asks:

in addition to the previous one.
An ultrasound was done at 16 weeks. TVP 4 mm (I read that they usually measure up to 14 weeks).
at 17.5 weeks, nasal bones 6.3 mm
Apparently, on the basis of TVP, the threshold for SD was set. Should we be afraid? Thank you.

The size of the nasal bone is indeed normal, the thickness of the TVP is measured before the 14th week of pregnancy, with the CTE of the fetus (coccygeal-parietal size) not higher than 84 mm, later than this period or at more high rates KTE results of the conducted research cease to be informative. Therefore, in your case, there is no need to worry. Your threshold risk was not determined based on an analysis of screening and ultrasound results, but based on your age.

Elena asks:

Hello! Please tell me. Results of prenatal screening: 1st trimester risk of trisomy 21 1: 2472; 2nd trimester 1:29 How can this be? Complex risk 1:208 Study results 13 weeks: St. beta hCG 74.53 ng/ml (1.74 MoM) PaPP-A5684.00 Mu|L (1.67 MoM) TVP 1.80 mm (1.05 MoM ) 17 weeks: AFP 32.39 IU/ml (1.16 MoM) hCG 207.00 IU/l (6.44 MoM) 2nd ultrasound will be on September 12 (21 weeks), the first at 12 weeks. 4 days no deviations were found. What actions to take? I am 34 years old and have one fetus.

The results of the second screening showed a sharply increased level of hCG, please clarify whether you took any medications before taking blood for analysis?

Oksana asks:

screening 18 weeks 4 days.
age risk 1:135, risk value 1:322
AFP 51.99 MoM 1.16
HCGb 15.60 MoM 1.61
They set a threshold risk, what to do?
I am 39 years old, second child, ultrasound at 21.3 weeks. without deviations

Dear Oksana, the biochemical screening parameters are completely normal. If according to the results ultrasound diagnostics, there are no deviations - there are also no indications for invasive diagnostics. Usually, in similar situation, at 22 weeks of pregnancy, an expert ultrasound is performed; for this examination, the maximum number of qualified specialist with experience in prenatal diagnostics birth defects development. However, if you trust the qualifications of the specialist who performed the last ultrasound at 21.3 weeks, there is no need to repeat the examination. You can read more about deciphering the results of biochemical screening in the second trimester of pregnancy in our medical information section dedicated to this method diagnostics, with the same name: Screening. .

Natalya asks:

Hello! Please help me understand the results of 1 screening within 10 weeks. I am 41 years old, weight 48 kg. The first birth is coming.
KTR 31mm
TVP up to 2mm
hCGb marker: conc. 100.1 ng/mL, corr. PTO 1.28
marker PAPP-A: conc. 623.9 mU/L, corr. PTO 0.58
They diagnosed a high risk of Down syndrome, age risk 1:70, calculated risk 1:65
As far as I know, the norm limits for PTO are 0.5-2.0. Are my PTO readings not up to standard? Do I have cause for concern? Neither my family nor my husband's congenital pathologies No. I would be very grateful for your answer.

Unfortunately, when determining the risk of chromosomal abnormalities, they are guided not only by IOM indicators, but evaluate the results of all studies in combination. If the risk turns out to be high, it is recommended to consult a geneticist, who, together with the attending gynecologist, can decide on a diagnostic intervention such as amniocentesis. More details on this issue You can get information in the thematic section of our website: Down Syndrome

Find out more on this topic:

• Blood test for antibodies - detection of infectious diseases (measles, hepatitis, Helicobacter, tuberculosis, lamblia, treponema, etc.). Blood test for the presence of Rh antibodies during pregnancy.
• Blood test for antibodies - types (ELISA, RIA, immunoblotting, serological methods), norm, interpretation of results. Where can I get a blood test for antibodies? Research price.
• Biochemical blood test - norms, meaning and interpretation of indicators in men, women and children (by age). Concentration of ions (electrolytes) in the blood: potassium, sodium, chlorine, calcium, magnesium, phosphorus
• Biochemical blood test - norms, meaning and interpretation of indicators in men, women and children (by age). Iron metabolism indicators: total iron, transferrin, ferritin, haptoglobin, ceruloplasmin

Type 1 diabetes clinic.

During type 1 diabetes, the following phases are distinguished:

· Preclinical diabetes

Manifestation or debut of diabetes mellitus

Partial remission or honeymoon phase

· Chronic phase lifelong insulin dependence

Unstable stage of the prepubertal period

Stable period observed after puberty

Preclinical diabetes can last for months or years and is diagnosed by the presence of the following:

· Markers of autoimmunity against B cells (autoantibodies to cells of the islets of Langerhans, to glutamate decarboxylase, tyrosine phosphatase, insulin). An increase in the titer of two or more types of antibodies means the risk of developing diabetes in the next 5 years is 25-50%.

· Genetic markers of type 1 diabetes (HLA).

· A decrease in the 1st phase of insulin secretion (less than the 10th percentile for the corresponding age and gender) during an intravenous glucose tolerance test - in this case, the risk of developing diabetes in the next 5 years is 60%.

Clinical picture manifest type 1 diabetes differs among age groups. The most common onset of the disease occurs in age group early puberty.

Main clinical symptoms diabetes are:

- polyuria

Polydipsia

Polyphagia

Weight loss

Nocturnal polydipsia and urinary incontinence should be alarming. These symptoms are a reflection of compensatory processes and help reduce hyperglycemia and hyperosmolarity. Increased appetite occurs due to impaired utilization of glucose by cells and energy starvation. The disease may manifest as pseudoabdominal syndrome. All of the above causes the manifestation of diabetes to occur under various masks, making diagnosis difficult and requiring careful differentiation. Diabetic flushing is a consequence of paretic dilatation of capillaries against the background of severe hyperglycemia and is observed, as a rule, in children with severe ketosis. Jaundice staining of the skin of the palms, soles, and nasolabial triangle (xanthosis), observed in some patients, is associated with a violation of the conversion of carotene into vitamin A in the liver and its deposition in subcutaneous tissue. In some patients, the disease may debut with a rare skin lesion - necrobiosis lipoidica, which is often localized on the outer surface shins, but can be located anywhere.

In children early age Type 1 diabetes has its own characteristics. According to a number of authors, two variants of the onset of diabetes in infants can be distinguished. In some, the disease develops suddenly as a toxic-septic condition. Severe dehydration, vomiting, intoxication quickly lead to diabetic coma. In another group of children, symptoms increase more slowly. Dystrophy gradually progresses, despite a good appetite, children are restless and calm down after drinking, have long-lasting symptoms, despite good care, diaper rash. Sticky stains remain on the diapers, and the diapers themselves resemble starched ones after the urine dries.

In children of the first 5 years of life, diabetes is also characterized by a more acute and severe manifestation compared to older patients. Such patients are more likely to develop ketoacidosis, more low level C-peptide, and generally more rapid depletion of endogenous insulin secretion and a lower likelihood of partial and complete remission on early stages diseases.

Patients with diabetes may have a history of furunculosis, itching of the external genitalia and skin. Spontaneous hypoglycemia may occur several years before the onset of diabetes. They are usually not accompanied by convulsions and loss of consciousness; they arise against the background physical activity; the child develops a desire to eat sweet foods.

I decided to describe my story with screens, in case it comes in handy for someone, as a positive example

The first time B didn’t do any screenings, she just didn’t know what it was. The gynecologist performed an ultrasound at 12 weeks, everything was fine and she decided not to do anything else. Wise woman!

The second B is very desirable and long-awaited (for me, but not by planning standards) (exactly a year has passed). And now the ultrasound is 11 weeks and 3 days and the first bell rings. OK, but the thickness of the collar space (TN) is 2.9 mm. The uzist woman saw the swelling and focused her attention on it. The next day I donated blood for biochemical screening. The results are borderline, genetic consultation is recommended.

The meeting with the first geneticist did not please me, although further tactics She described it correctly, but didn’t say anything specific about the situation or analysis. I left her in a state of uncertainty and anxiety. If you give the numbers, then everything looked like this: bHCG = 3.11 Mom, PAPP-A = 1.32 Mom, combined risk of diabetes taking into account TVP 1:262 (oh my god, I cried because of these numbers!). The geneticist recommended a chorionic villus/placenta puncture. Or wait for the second screening and expert ultrasound at 22 weeks. And she also advised me to undergo a second ultrasound before 14 weeks; if TVP increases, then it is no longer worth waiting for the second screening, but it is worth undergoing invasive diagnostics.

I was very afraid of the invasion back then, having heard a lot of scary stories from those who had little idea what it was. About how “one friend of a friend’s sister had their sister done to her” and how it ended... I went for an ultrasound at 13 weeks and 3 days, everything was fine, TVP was 1.5 mm (that is, the swelling was gone), no CA markers. We decided to wait for the 2nd screening, seemingly calming down. But on the periphery the thought was still itching.. “What if?” I didn’t buy a single “pregnant” item, I forbade myself to look in the direction of the children’s departments, rejoice at the kicks, come up with a name...

17 weeks, biochemical screening in Invitro taking into account TVP at 12 weeks. And the result: risk of diabetes 1:10. I cried for several days, it seemed to me that this was a death sentence, that the child definitely had diabetes. It was very scary. On the advice of a friend who went through all these ordeals, I made an appointment with a geneticist in Sechenovka. Immediately for an ultrasound, blood donation and consultation. At the ultrasound we were pleased that there were no markers of chromosomal abnormalities, and we will have a boy, biochemistry results (excluding TVP) 1:59. Recommendations from a geneticist: amnio- or cordocentesis. Because in such a situation, on the one hand, it is important for us to know whether the child has diabetes or not (for what, this is the tenth thing, but I definitely wouldn’t bear such news in the maternity hospital, it would be better in advance), and on the other hand, she, how genetics, it’s scary to miss diabetes in such tests. The doctor’s comments: she doesn’t see anything “like that” with us, such swelling occurs in 3% of cases with diabetes, in the remaining 97 - only the Lord God and Mother Nature know the cause; Fetal hormones are normal; a very elevated hCG (4.12 MΩ) may be due to low placentation (seen on ultrasound). So her prognosis was that the risk of diabetes was 5%, the chances of having a healthy birth are much higher. But I went for the amnio (I read a lot and thought a lot).

They scheduled it for Monday, and on Sunday my temp rose to 38, my voice disappeared - sore throat. Postponed to Friday. I was treated intensively all week, on Thursday new cold(an acute respiratory viral infection struck somewhere), nasty herpes blisters appeared on my face. Again it was postponed until Monday, and the amnio deadline was already approaching... I came to the hospital on day X, not at all sure that they wouldn’t send me home now. And then it’s a cordo, we don’t meet the deadline (the equator has already passed). In all these worries, I somehow forgot to be afraid of the procedure itself.

They assigned me to a room and left me to wait for a call. People were slowly arriving. An hour later, unable to bear it, I sat up on the bed with the question “when is it already?!”, and then the nurse invited me into the treatment room. It was very cold in the treatment room, the robe and slippers were left in the “waiting room”. I was the very first one that day. She lay down on the couch, rolled up her nightie to her chest, and treated her stomach. The doctor noticed herpes and turmoil began. And now I’m lying there, all ready, and I understand that now, instead of the procedure, I’ll go home... But in the end, the uzist carefully examined the bubbles and “decided” that this was already a non-acute phase of healing. As soon as I exhaled that they would do it, the sensor was immediately placed on my stomach and off we went. We chose a place, installed a clothespin for the needle on the sensor, and the needle itself. The nurse asked me to relax as much as possible and pressed my shoulders to the couch. Puncture. It seemed to me not painful at all, I once had a navel piercing, I was much more impressed. A couple of minutes and that's it. I tried not to strain my stomach, but because of the coolness I involuntarily wanted to shrink. She somehow crawled off the couch, holding the gauze pad at the puncture site, and helped me put on a robe. I crawled into the ward, where they injected me with noshpa and HyperRow (I am Rh negative). The injection from the noshpa hurt the most. The girls attacked, demanding details. The nurse came in every half hour and inquired about how I was feeling. Those who had complaints (though the symptoms were more likely of overexertion) were left until the evening. I was home 3 hours later.

For the first week after the procedure, I felt like I was leaking water. I was terribly afraid of infection - complications from an untreated cold. Then it somehow let go and was forgotten. A week later we went for an expert ultrasound, which showed the absence of any visible pathologies. The wait became easier. A week later I called to find out the results. The doctor asked to call back in 10 minutes, checking from the magazine. During these 10 minutes, I looked at the clock continuously, and my head was beating: “What if... What if?.. What if?!.” And here is the doctor’s voice: everything is all right, boy. I’m babbling prepared words of gratitude, but I still don’t understand, I don’t realize... and after the doctor’s words: “Congratulations, sun, you will have healthy child! " I was overcome. Tears poured in hail, AWARENESS, all the stress of the past weeks.. I roared, I called my husband: “SLAVKA IS HEALTHY!”

In the evening, my husband brought a bouquet of white roses and champagne!

We still have a lot of worries and worries ahead, but the most important ones are already behind us, they remain in the old year.

I would like to wish that no one encounters this, but if you have to, don’t worry, girls, everything will be fine! I checked