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[Choice of a contraceptive method in the diabetic patient].


 The various contraceptive methods available and their suitability and contraindications in the case of diabetic patients are reviewed. After briefly discussing tubal sterilization, condoms, diaphragms and spermicides, and IUDs, and their respective safety and effectiveness, the risks and advantages of contraceptive steroids are analyzed in detail. It is concluded that the metabolic effects of estrogen-progestin combinations are more serious in many diabetics, and their use often increases the need for exogenous insulin, as well as the tendency to hyperlipemia, excessive weight gain, and hypertension, which are all factors that aggravate diabetes. The contraindications apply to cases of subclinical diabetes, because the administration of these drugs to genetically predisposed subjects may precipitate the appearance of clinical diabetes. Oral contraceptives should then be used only if IUDs are contraindicated in a specific case and the desire for future pregnancies precludes sterilization. Patients should then be carefully monitored, and the oral contraceptive used contain the smallest possible effective dose of estrogen (preferably ethinyl estradiol) and progestin (preferably other than the nortestosterone type of a 19-nortestosterone derivative in a very low dose).
