There's one more cause of diabetes: pregnancy. It's called gestational dia­betes, and the rate is increasing fast­up eight-fold in the last two decades.

The increase might be because women are having babies when they're older, or because obesity, a risk factor for diabetes, is increasing. The extra stress of pregnancy on the body can cause high glucose levels, but often pregnancy highlights a woman's predisposition for diabetes: up to 50% of women develop l)pe 2 within five years of having the baby, not because of the gestational diabetes, but be­cause they were on course to get the disease anyway.

Women with a predisposition to diabetes are at particular risk while they're pregnant because their energy needs increase, plus hormones pro­duced by the placenta can block the action of the mother's insulin, causing insulin resistance. These factors mean insulin needs in pregnancy are two or three times greater than normal from about 24 weeks. Up to 16% of women develop gestational diabetes and it's usually picked up with a rou­tine glucose tolerance test between 24 and 28 weeks of pregnancy.

Alafiya Firoz, 29, a Chennai house­wife, is 11 weeks pregnant and has been diagnosed with gestational diabetes. She isn't surprised-she was diabetic during her previous pregnancy four years ago too. "The di­abetes was then diagnosed in the 36th

Adds Dr Greg Fulcher, an Australian expert, "As we learn more, we can identify the conditions more accu­rately; for example if they're caused by different genetic abnormalities. We even talk about a Type l'e, which has elements ofType 1 and Type 2. One day they may become catego­rized by the underlying abnormalities rather than just being bundled under one issue."

The Warning Signs

Here's what should ring alarm bells:

TYPE1

TYPE2

GASTATIONAL

Pregnant and over 30 years of age Family history of Type 2 diabetes.

Overweight

Certain ethnic groups including Indian, Vietnamese, Chinese, Middle Eastern, Polynesian/Melanesian, indigenous Australians Gestational diabetes in previous pregnancy Previous problems carrying a pregnancy to term .