Gestational diabetes mellitus (GDM) is classically seen in about 5–8% of the pregnant women. The condition appears to be caused by the same broad spectrum of physiological and genetic peculiarities that characterize diabetes outside of pregnancy. These women with GDM are also otherwise at high risk of having or developing diabetes even when not pregnant. The controversies regarding the diagnosis, management, and prevention of diabetes in pregnancy pose specific problems in clinical practice such as how to clinch the diagnosis, when to introduce therapy, what therapy to introduce, and how to predict the future course of the condition. This book is designed to address such questions with supportive typical clinical scenarios, with which all readers will be able to identify. Thus it provides an excellent opportunity to widen one’s perspective in this area.

The management of medical disorders in pregnancy has undergone significant changes in the recent years. The pattern of disease has changed with improvements in socio-economic conditions. For example, the incidence of antenatal anemia has decreased progressively in the past few decades, and pulmonary tuberculosis (which used to be prevalent) is now seen only rarely. Chronic rheumatic heart disease has also become less common. On the other hand, gestational diabetes has become more common. This may be due partly to the setting up of screening services for gestational diabetes in many hospitals. The four most common medical disorders complicating pregnancy are anemia, diabetes mellitus, cardiac disease, and thyroid disorders. In addition, because of the improvements in the medical, obstetric, and anesthetic management of pregnancy, many women with medical disorders can go through a pregnancy without major problems. There has also been a progressive decrease in the perinatal mortality associated with some medical disorders, such as diabetes. It is important for all healthcare professionals involved in the management of pregnant women with medical disorders to be conversant with the latest developments in order to provide the best care to these women. The chapters in this issue are certainly helpful in this respect. The eminent authors for the various chapters have discussed the various options available describing in detail their experiences regarding the various aspects of the condition.

Diabetes management, outcomes and prognosis are majorly affected by the lifestyle exercised by the diabetics. Diabetes has significant impact on the different facets of life. These facets tend to get overlooked in the management. The inter-relation of diabetes and marriage, sleep, travel, commute and uneven working hours seem to be trivial part of managing diabetes but are extremely important for a perfect recovery and management of the patient. Patients travelling with diabetes need to consider how to adapt their treatment programs to unfamiliar foods, irregular schedules, and varying amounts of exercise. Diabetes will be involved at every step of married life including vacations, outings, going to the movies, as well as intimate moments. Sleep and diabetes are interconnected. Sleep disorders have a slight but significant impact on diabetes management and it should be focused while attending a diabetic with sleep disorders. Shift workers make a special segment of diabetics, whose glucose monitoring and control need to be tailored in a special manner. With change in circadian rhythm and sleep pattern, diabetes management needs to be adjudged and adjusted. The main risks that arise in driving from having diabetes are hypoglycemia and the long term complications. All these aspects are being thoroughly covered in this book so as to facilitate better management of diabetes.

Decision making in instituting insulin therapy is an important aspect of diabetes management. The appropriate insulin regimen for an individual patient should take into account the patient’s lifestyle, age, motivation, general health, self-management skills, and treatment goals. In addition, a discussion of the newer insulins versus older insulin is a much desired topic in the Indian context. Another area of interest is the insulin delivery mechanism in the intensive care units in hospital settings. This CME module is designed to address such questions with supportive typical clinical scenarios, with which all readers will be able to identify. Thus it provides an excellent opportunity to widen one’s perspective in this area.

There are certain structural and functional changes that develop in the urinary tract during normal regnancy, which are significantly different than non-pregnant normal females. During pregnancy in women with underlying chronic kidney disease (CKD), the adaptation to these changes may not be optimal. Under these circumstances, the pregnancy outcome as well as maternal CKD may be affected. The issue focuses on the physiological changes in the kidney and assessment of proteinuria and GFR during pregnancy. The current update also details the cases of pregnancy in the setting of CKD describing the effect of CKD on pregnancy as well as effect of pregnancy on CKD. The chapter on pregnancy-induced hypertension―Pre-eclampsia focuses on the prevention and management of complications in the patient. The authors also give an insight into the pregnancy in cases after kidney transplantation.

Patients with diabetes are predisposed to infections. The risk ratio for infectious disease-related hospitalization for diabetic versus nondiabetic persons is more than 2, and almost 2 for death attributable to infection. Infections in diabetes may precipitate metabolic derangements and, conversely, the metabolic derangements of diabetes may facilitate infection. Abnormalities in the microvascular circulation of individuals with diabetes may result in decreased tissue perfusion, which facilitates the acquisition of infection and impairs response to therapy. The incidence of TB among diabetic patients is 2–5 times higher when compared to the general population, which recently has raised the concern that a combination of DM and HIV infection might lead to a further increased incidence of TB in India and in other developing nations. However, it is unclear whether diabetes is an independent risk for common upper and lower respiratory tract infections. Urinary tract is also reported to be the most prevalent site of infection in patients with diabetes. These infections are known to account for a relatively smaller percentage of reported patients probably due to the fact that most patients, including diabetics, with urinary tract infection are treated as outpatients. A number of long-term effects of diabetes mellitus on the genitourinary system predispose diabetic patients to bacterial urinary tract infections. In addition, complications of urinary tract infection (e.g., bacteremia, renal abscesses, and renal papillary necrosis) are more common in patients with than without diabetes. Rhinocerebral mucormycosis and emphysematous pyelonephritis are some of the less commonly reported conditions seen in diabetics though being important pathologies. The primary goal of this book is to provide a high-quality, evidence-based text on the various aspects of the associations of various infections in diabetics with prime focus on TB and diabetes, rare conditions such as rhinocerebral mucormycosis and emphysematous pyelonephritis and also the various acute infections commonly reported in the condition. The book includes in-depth analysis of the diagnostic and management issues considering the same.

Cell health depends on a steady supply of fuel from glucose and free fatty acids. Both these major fuels are regulated by insulin. Cells in the muscle, liver, and fat need insulin to receive glucose, and hence do not become exposed to high blood glucose levels when the blood sugars are high and insulin levels are low. The lack of insulin slows the movement of glucose into these cells, and probably spares them from damage when blood sugars are high. However, other cells such as those in the brain, nervous system, heart, blood vessels and kidneys pick up glucose directly from the blood without using insulin. These cells, except the brain, are more prone to damage from high blood sugars because they become exposed to high internal levels of glucose. This to quite an extent explains why damage tends to occur in specific organs such as in nerve and kidney cells, and in small blood vessels like those in the eyes. This project on the organ damage in diabetes is an attempt to elaborate on the various factors to be considered in managing these patients, the pointers for early diagnosis and prevention of the same.