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Query: UMLS:C0011849 (diabetes)
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Physicians at the University College Hospital in Ibadan, Nigeria recruited 24 26-39 year old women who had use Norplant for 18-30 months between January 1986-July 1988 into a study to determine changes in carbohydrate metabolism before and after removal of Norplant. None of the women had diabetes mellitus. The women underwent a glucose tolerance test (GTT) before insertion, just before removal, and 30 days after removal. The mean area under the GTT curve increased from 24.7 min mmol/L before insertion to 35.1 min mmol/L before removal and decreased to 26.1 min mmol/L 30 days after removal (p.0001). Yet there was no statistical difference between the mean areas under the GTT curve before insertion and those after removal. Thus glucose levels returned to preinsertion levels shortly after removal. There were significant differences in the mean areas under the insulin curves between before insertion and after removal, however (5314 min uU/L vs. 59.46 min uU/L; p.0001). Thus insulin levels 30 days after removal did not return to preinsertion levels as rapidly as did glucose levels. These results suggest that carbohydrate metabolic changes may be significant in women with diabetes mellitus. Therefore physicians should monitor blood glucose levels in diabetics. The changes in carbohydrate metabolism caused by Norplant return to almost normal when it is removed.
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PMID:Carbohydrate metabolism before and after Norplant removal. 142 24

Of the contraceptive choices open to a post-partum woman with gestational diabetes, this discussion concentrates on low-dose oral contraceptives. Although gestational diabetes usually clears at delivery, 75% of these women will go on to developed impaired glucose tolerance or overt diabetes, especially if they are obese or if their glucose level had been high. Many elect permanent sterilization, but those requiring reversible contraception usually choose the IUD or the pill. IUDs carry a high risk of infection and are less effective in diabetics. The author compared a low-dose combined pill with 400 mcg norethindrone and 35 mcg ethinyl estradiol (Ovcon 35), and a pill containing levonorgestrel (Triphasil), to barrier contraception in 230 women with recent gestational diabetes. After 6-13 months of use 11-17% of each group had impaired glucose tolerance, and 15-20% of each group had diabetes (n.s.). Insulin levels rose from 28.5 mIU/mL to 59.7 in controls, 32.0 to 71.8 in Ovcon 35 users, and from 40.2 to 85.1 in Triphasil users (p0.05). HDL values rose significantly in the group taking Ovcon, and LDL values fell significantly in all 3 groups. These low-dose pills can be used safely in postpartum gestational diabetic women, as long as they do not smoke, are encouraged to lose weight, and have no sign of cardiovascular disease as evidenced by albuminuria and an ophthalmoscopic exam.
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PMID:Contraceptive options for the gestational diabetic woman. 167 21

Blood glucose and plasma insulin levels during an oral glucose tolerance test were measured in 20 women using continuous subdermal levonorgestrel (Norplant) for contraception over a 12-month period. Changes in carbohydrate metabolism occurred as early as 1 month but were most marked after 6 months. After 1 month the area under the glucose and insulin curves increased by 12.3% and 37.7%, respectively. This increase was more marked by 6 months, but by 12 months it was significantly less marked. Although changes in the blood glucose and plasma insulin levels at different times during the oral glucose tolerance test occurred, they were all within normal limits for normal women. The peak blood glucose and insulin levels after insertion of the implant occurred 60 minutes after the glucose load, as opposed to 30 minutes before insertion. Apart from this, there was a significant delay in the return of these levels to fasting values. We conclude that this product, like any other progesterone-containing contraceptive, alters carbohydrate metabolism, but these alterations are not clinically significant in normal women. It is, however, possible that in potential cases of diabetes it may predispose to frank diabetes.
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PMID:The effect of continuous subdermal levonorgestrel (Norplant) on carbohydrate metabolism. 173 89

Effective contraceptives contribute to the regulation of births, protect the health of women, reduce maternal and perinatal mortality and gynecological diseases, and prevent abortion-related complications. Complications after abortion average 30%, and among primigravidas the rate reaches 45%. Abortion can result in sterility and in the inability to carry out the pregnancy. Oral contraceptives (OCs) are used by 150 million globally. In new preparations ethinyl estradiol (EE) and levonorgestrel (LNG) are the most common components. In the 2-phase and 3-phase preparations Sequilar, Anteovin, and lipid profile safe Triquilar the gestagen component was reduced 40%. Continuin and Famulen are minipills, and Postinor is a postcoital contraceptive. Absolute contraindications of OCs include thromboembolytic diseases, severe cardiovascular system diseases, liver disorders, cirrhosis, cerebral vascular diseases, grave diabetes, jaundice, and malignant tumors of the mammae and sexual organs. Rigevidon, Triquilar, and Trisiston have high steroid content with minimal side effects. The protective effect of OCs are: 2-3 times lower risk of inflammation of the small pelvis, lower risk of malignant and benign ovarian tumors that lasts even after discontinuation, uterine cancer prevention (antiproliferation effect on the endometrium and inhibition of mitotic activity of the myometrium), and reduced risk of benign breast neoplasms. The finding that estrogen-induced risk of breast cancer increases with longterm contraceptive use in young nulliparas has not been persuasively proven. The optimal duration of uninterrupted OC use is 1-1.5 years. Monophasic estrogen-gestagen preparations include Bisecurin, Non-Ovlon, Ovidon, Rigevidon, Minisiston, and Demulen with low dosages of EE, LNG, norethisterone acetate, and diacetate ethonodiol. Norplant is a subdermal silastic capsule with effectiveness for up to 5 years.
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PMID:[Hormonal contraception]. 178 55

Researchers followed 68 women who attended the Family Welfare Clinic at the Kenyatta National Hospital in Nairobi, Kenya to determine if the low estrogen combined oral contraceptive (OC) Microgynon, a progestogen only OC, and Depo-Provera induce changes in the oral glucose test. These women did not take any steroidal contraceptives before entry into the study. Blood glucose levels were significantly higher after 60, 90 and 120 minutes than the control levels for women taking Microgynon. In addition, the mean areas under the glucose curves were substantially elevated after 1, 3, and 6 months above the control (p.002, .005, and .01 respectively). The only significant change in blood glucose levels in women taking the progestogen only OC occurred at 30 minutes after 6 months. Yet the mean areas under the curve were significantly higher than the control after ,1 2, and 3 months (p.005, .05 and .002 respectively). As for Depo-Provera, significantly lowered blood glucose levels only occurred after 1 month at 30, 50, and 90 minutes although no significant changes occurred after 1, 3, and 6 months in the mean areas under the glucose curves. Metabolic change occurred earlier and more often in Microgynon users than progestogen only OC users. This could be due to the progestogen levonorgestrel which has been shown to interrupt glucose metabolism. These changes could possible adversely effect women who are predisposed to developing diabetes, since 1 woman did develop a diabetic curve after 1 month of using Microgynon. Nevertheless no pattern towards abnormal glucose tolerance existed. Standard deviations of areas under the curves indicated that the number of women who develop glucose intolerance may increase with duration of use.
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PMID:The effect of low-oestrogen combined pill, progestogen-only pill and medroxyprogesterone acetate on oral glucose tolerance test. 214 46

With oral contraceptives (OCs), estrogen and progestogen doses, as well as the type of progestogen used, seem to directly affect glucose tolerance and insulin resistance. Other factors that influence these parameters are a patient's weight and age, family history of diabetes, and previous gestational diabetes. In normal-weight women with previous gestational diabetes, low-dose OCs do not appear to directly affect glucose tolerance, plasma insulin levels, or insulin binding to monocytes. This paper reports the initial data from a study employing low-dose OC formulations in obese patients with a history of either Class A1 or A2 gestational diabetes. Although results are preliminary, they do suggest that Ovcon 35, a low-dose norethindrone-containing OC, may be safe in Class A1 diabetics; in Class A2 diabetics, Ovcon 35 is associated with significantly less change in oral glucose tolerance at 3 months than is the triphasic Triphasil.
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PMID:Effects of oral contraceptives on the borderline NIDD patient. 290 38

For some time it has been recognized that postovulatory exacerbation of hyperglycemia contributes to the instability of diabetes in many women of reproductive age. It has been suggested that increasing plasma levels of progesterone and estrogen may induce insulin resistance and consequently lead to increased hyperglycemia during the luteal phase of the menstrual cycle. Due to the fact that menstrual cycles in a given woman may vary in length and that it takes patients several days on intermediate or long-acting insulin to achieve a steady state with regard to any dosage adjustment, it is difficult to design an insulin regimen that maintains euglycemia throughout the menstrual cycle in these labile patients. Recognition of this problem led to trying a nonsequential low estrogen contraceptive as adjunctive therapy in a 20-year old woman with insulin dependent diabetes mellitus. The patient consistently suffered an exacerbation of hyperglycemia after ovulation in each cycle, lasting until the onset of menses. On 1 occasion the patient developed frank diabetic ketoacidosis. For the first 2 cycles on Lo Ovral, the hyperglycemia was postponed from the 1st postovulatory day until day 18-19 of the cycle. It was reasoned that the serum estrogen and/or progestin level might be building cumulatively, and the oral contraceptives (OCs) were subsequently withdrawn at day 19 of the cycle rather than day 21. A maximum blood glucose level of 400 mg/dl was attained at day 19 and was treated with additional regular insulin. Levels in excess of 240 mg/dl did not recur during that cycle. The following cycle OC therapy was interrupted at day 18; no blood glucose level in excess of 240 mg/dl occurred that month. Hemoglobin A1c fell from a pre-OC treatment value of 12.4% to the current A1c of 9.7%. A modest increase in blood pressure has occurred, but this is easily managed with a 2 g sodium diet and 25 mg of hydrochlorothiazide daily. On the basis of this experience, a controlled trial is warranted of low dose estrogen nonsequential OCs in lean, nonsmoking, 18-30 year old women with insulin dependent diabetes mellitus with postovulatory hyperglycemia.
Diabetes Care
PMID:Oral contraceptives abolish luteal phase exacerbation of hyperglycemia in type I diabetes. 676 14

A set of new guidelines were formulated by an expert group meeting in Sweden organized by the pharmaceutical office during March 31-April 1, 1993. It contains various methods to avoid an undesired pregnancy and also advice about postcoital contraception. Among barrier methods, the condom is the only reversible method for men with a method failure of 2 and user failure of 10. It protects against gonorrhea, chlamydia, condyloma, herpes simplex, HIV, and hepatitis B. The diaphragm can be used with a spermicide and protects to a lesser degree against chlamydia, gonorrhea, and cervical cancer. The female condom is as effective as the condom. Among spermicides, nonoxynol-9 is not only effective against sperms but also against bacteria, viruses, and certain vaginal and cervical cells. The vaginal sponge is impregnated with nonoxynol-9 and is effective up to 24 hours. The copper IUD, with a method failure of less than 1, can cause profuse menstrual bleeding, dysmenorrhea, and endometritis-salpingitis. Hormonal methods include combination pills (2-phase and 3-phase pills) and gestagen methods (high dose with 150 mg of medroxyprogesterone acetate injection every 3 months and low-dose minipills with levonorgestrel, norethisterone, or lynestrol). Mechanisms of action concern combination pills, gestagen methods, minipills, Norplant, and Levonova. Drug cross reaction can reduce effectiveness. Side effects include bleeding and amenorrhea. Risk-benefit determination is based on health effects. Possible risks are associated with breast cancer, cervical cancer, blood pressure increase, venous thromboembolism, and heart infarction. Various phases of the reproductive age include young women, lactating women, and women in the later part of the reproductive age. Special groups include those who have experienced ectopic pregnancy, infections (candida, sexually transmitted diseases: chlamydia trachomatis, HIV infections), obesity, cardiovascular diseases, diabetes mellitus, tumors of the reproductive organs, liver diseases, migraine, epilepsy, surgery, and handicapped women. Postcoital contraception is used only in need, and methods for postcoital contraception include hormonal method and the copper IUD.
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PMID:[Contraception. Recommendations from a group of experts]. 790 65

We performed oral glucose tolerance tests and frequently sampled iv glucose tolerance tests in a cross-sectional sample of women taking monophasic norgestrel containing oral contraceptives (OC). The goal of the study was to quantify the individual factors that determine glucose tolerance to assess responsibility for the reduced glucose tolerance associated with the use of OCs. Subjects were selected using stringent criteria to exclude confounding effects of ethnicity, adiposity, or conditions that may predispose subjects to metabolic disorders. Users of the low dose OC (Lo/Ovral and Nordette) and high dose OC (Ovral) were compared to controls, who were required to never have used OCs or to have discontinued OC use for at least 24 months. Oral glucose tolerance tests results confirmed the development of impaired glucose tolerance in both pill groups. Frequently sampled iv glucose tolerance test data were analyzed using the minimal model method to estimate parameters of insulin sensitivity, glucose effectiveness (SG), and beta-cell function. Lo/Ovral users had lower insulin sensitivity and SG compared to controls and inappropriately low beta-cell function in relation to the insulin resistance. Ovral users had metabolic parameters that were not different from controls. Based upon comparisons between normal and impaired glucose tolerant subjects combined with stepwise regression analysis, we conclude that Lo/Ovral use results in insulin and glucose resistance, which is not compensated by increased beta-cell function. The reduced glucose tolerance is due primarily to the defect in SG, and these OC users may place themselves at higher risk for the development of diabetes or cardiovascular disease. The reduced tolerance in Ovral users cannot be explained by the parameters measured in this study. We speculate that these latter subjects represent a special self-selected population in which tolerance is regulated by other factors. Ovral appears to be well tolerated by these women.
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PMID:Defects in carbohydrate metabolism in oral contraceptive users without apparent metabolic risk factors. 796 20

Prescribing contraceptives to diabetic women requires cognizance of metabolic effects and the risks of type I or type II and gestational diabetes mellitus (GDM) in prediabetic women. Studies have show that poor maternal glycemic control in the 1st trimester in diabetic women has resulted in a twofold to threefold increased risk for congenital malformations. A reduction from 6.6% to 1.1% in malformations could be realized by euglycemic control before conception and during the first 8 weeks of gestation. A low-estrogen preparation should be selected and blood pressure should be monitored regularly. Progestins adversely affect carbohydrate and lipid metabolism, as they decrease glucose tolerance by increased insulin resistance, thus the selection of proper progestin dose/potency is important in prescribing OCs. The lowest-dose OCs may be prescribed under close medical supervision to women with insulin-dependent diabetes mellitus (IDDM) without serious vascular complications. Patients should be evaluated after the 1st cycle of OC use and every 3-4 months thereafter with monitoring of weight, blood pressure, postprandial glucose, and glycosylated hemoglobin levels. Women with prior GDM should be evaluated annually utilizing a 2-hour, 75-g glucose tolerance test (OGTT) at the postpartum visit. For OCs, a low-dose estrogen ( 0.05 mg ethinyl estradiol) and a low-dose/potency progestin (or = 0.50 mg of norethindrone or or= 0.100 mg of levonorgestrel) should be selected. The safety of prescription of OCs to women with type II diabetes is unclear, but a supervised program similar to that of IDDM patients is recommended. Currently neither of the long-term contraceptives, depo-medroxy-progesterone acetate (Depo-Provera) injection or the levonorgestrel-containing implant, Norplant, are recommended as first-time methods for women with diabetes. On the other hand, the IUD is an effective, reversible method, particularly for older women with hypertension, provided antibiotic prophylaxis is undertaken at the time of insertion.
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PMID:Contraception in the diabetic woman. 822 75


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