Contraception

Barrier methods, preferably sheath and spermicide, are the best option, but only if properly used. Condoms protect both partners from infection, protect the cervix from sperm and have no effect on blood glucose. They are also easily bought in a wide variety of shops, supermarkets, and garages. A diaphragm requires gynaecological assessment for fitting and there may be an increased risk of vaginal and urinary infection. However, barrier methods are useless if not used properly; planned conception and the avoidance of unwanted pregnancy are particularly important in women with diabetes.

Intra-uterine contraceptive devices (IUCDs) are rarely used in nulliparous women. In any woman there is a risk of pelvic infection rarely leading to infertility. This risk is greater in women with diabetes because of their propensity to infection generally. Older forms of IUCD underwent unusual chemical change in some women with diabetes and failed to prevent conception. This does not appear to be a problem with currently used IUCDs.

Oral contraceptive pills are the most effective form of contraception but they impair glucose tolerance and cause lipid abnormalities, both of which are already a problem in women with diabetes. The risk of cardiovascular and thromboembolic complications is undesirable as diabetes already predisposes to the former, if not the latter. Hypertension also occurs in both Pill use and diabetes. A woman with diabetes and her partner are therefore encouraged to use barrier contraception if possible. However, many couples do not wish to use barrier methods or cannot use them effectively. Many diabetologists would advise progestogen-only preparations (initially, changing to a combined oestrogen/progestogen preparation) if the progestogen-only preparation is not acceptable. The patient's glucose balance, lipids, and blood pressure must be monitored regularly.

The rhythm method and withdrawal are not effective and cannot be recommended for diabetic women.

Post-coital contraception using levonorgestrol and ethinyloestradiol can be initiated within 72 hours of unprotected intercourse.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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