Diabetes

Diabetes

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications.

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    AAngela Ginn, Nutrition & Dietetics, answered on behalf of Academy of Nutrition and Dietetics

    Having a healthy baby is every woman’s dream. And when you are living or newly diagnosed with diabetes during your pregnancy, a dream team must be in place for a healthy baby. The ultimate dream team includes: OB-GYN, Certified Diabetes Educator, Registered Dietitian and an Endocrinologist. This dream team will provide education, treatment and management of the diabetes throughout your pregnancy and post partum care.

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    You’ll need a thorough physical exam before you become pregnant to assess any problems that could jeopardize your health or that of your baby.

    Pre-Pregnancy Checkup

    • An assessment of any complications, such as high blood pressure, heart disease, and kidney, nerve, and eye damage. If you have any of these complications, they need to be treated before you try to conceive. Even kidney transplant recipients who are otherwise healthy have had babies.
    • Your A1C level will be measured.
    • If you have type 1 diabetes, your thyroid function will be measured.
    • In addition, your exam will include a review of all the medications, herbs, and supplements you are taking to make sure they are compatible with a safe pregnancy.
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    Ask your provider to refer you to a medical geneticist or genetic counselor if you have concerns about your baby’s risk for diabetes. They are trained to assess the contributions of genetic and environmental factors in causing many diseases, including diabetes. They will know the results of the latest diabetes and genetics studies and studies to prevent diabetes in high-risk individuals.

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    Although women with diabetes and their unborn children face additional risks because of diabetes, these can be kept to a minimum through careful blood glucose management, before and during pregnancy, and intensive obstetrical care. For this reason, all women with diabetes need to plan ahead before becoming pregnant. 

    The first step is to meet with your health care team to consider the specific challenges you may face during your pregnancy. You need a complete evaluation of your overall health and any diabetes complications. It’s important to get a good idea of how much extra work and expense may be involved before you become pregnant.

    You may have specific questions for your health care provider. You may be concerned that your baby could develop diabetes. You may be worried for your own health. Your glucose levels may also be an issue.

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    In general, hormonal methods of birth control are safe for women with diabetes. If you are over 35 and smoke, or you have a history of heart disease, stroke, high blood pressure, peripheral blood vessel disease, or blood clots, these methods may be risky for you. 

    If you’ve found that your insulin sensitivity varies at certain times of the month, being on the pill, patch, ring, or injections may help smooth out your blood glucose levels. By providing a steady dose of hormones, blood glucose swings can be kept to a minimum. 

    Some women find that oral contraceptives increase insulin resistance. If your blood glucose levels are affected, your insulin or your dose of oral diabetes medication can be adjusted. Taking the lowest possible dose or the mini pill can also help.

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    Important Tests for Women Taking Hormone Replacement Therapy

    • Have your A1C tested two to four times a year. This test tells you about your blood glucose levels over the long term.
    • Have your cholesterol and triglyceride levels checked as recommended by your provider.
    • Have yearly eye exams and kidney function tests.
    • Have a yearly mammogram to detect breast cancer.
    • Have a yearly Pap smear and gynecologic examination to detect cancer of the cervix, uterus, endometrium, and ovaries.
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    If your periods are irregular and your blood glucose swings are unpredictable, try to chart your ovulation to see whether you can tell when your period will occur so you can adjust your treatment plan. If you are taking insulin, you may want to try intensive diabetes management, perhaps with an insulin pump. This may give you the flexibility you need to deal with changes in blood glucose levels on a daily basis.

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    Strategies for Highs before Your Period

    • If you use insulin, gradually increase your dose. Work with your health care team to add small increments, so that insulin levels are higher the last few days of your cycle, when blood glucose levels normally rise. One to two addi­tional units of insulin may be all it takes. It will take a little trial and error to figure out the right dose for you. As soon as menstruation begins, estrogen and ­progesterone levels drop. When this happens, return to your usual dose of insulin to lower your risk of ­hypoglycemia.
    • Eat at regular intervals, when possible. This will keep your blood glucose levels from swinging too much. Large blood glucose swings could contribute to some of the emotional and physical symptoms of PMS, which may in turn make variations in blood glucose levels worse.
    • Try to avoid eating extra carbohydrates. Keep a handy ­supply of crunchy veggies—for example, celery, radishes, or cucumbers—and dip them in fat-free salsa.
    • Cut back on alcohol, chocolate, and caffeine. They can affect both your blood glucose levels and your mood.
    • Be especially careful about your sodium intake, which causes ­bloating. Use pepper, fresh or powdered garlic, lemon, cayenne pepper, or scallions to add some zing to food.
    • Try to be more physically active. Many women find that regular exercise diminishes mood swings, prevents excessive weight gain, and makes it easier to manage blood glucose levels.
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    You can find out for sure if you suspect that your blood glucose levels are affected by your menstrual cycle. Look at your daily blood glucose records over the past few months. Mark the date that your period started for each month. Do you see any pattern? Are your blood glucose levels higher or lower than normal during the week before your period? If you are not recording your blood glucose levels, now may be a good time to start.
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    At first, you think you’re just imagining it. You’re going along and everything seems fine. You’re in good spirits, eating well, getting regular workouts, and your blood glucose levels are on target most of the time. Then, for some unexplained reason, everything seems out of whack. Maybe your blood glucose levels are too high; maybe they’re too low. Then you check the calendar. Oh, yeah—it’s that time of the month.

    If you have trouble keeping your blood glucose levels on target just before your period starts, you are not alone. A survey of 200 women with type 1 diabetes showed that in the week before their periods, 27% had problems with higher-than-normal blood glucose levels and 12% had lower-than-normal blood glucose levels. Another study revealed that among women under the age of 45 who were hospitalized for diabetic ketoacidosis, half were within several days of starting their periods. A survey of more than 400 women revealed that nearly 70% experienced problems with blood glucose levels during their premenstrual period. The problem was more common among women who considered themselves to suffer from the moodiness associated with premenstrual ­syndrome (PMS).

    It’s difficult to pinpoint just how many women have problems with their blood glucose levels before menstruation. Many studies are based on surveys con­ducted after the fact and do not take physical activity and eating patterns into account.