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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    In general, it's not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming, or water aerobics. Activities to avoid during pregnancy are:
    • Activities that put you in danger of falling or receiving abdominal injury, such as contact sports
    • Activities that put pressure on your abdomen (exercises done while lying on your stomach)
    • Scuba diving
    • Vigorous, intense exercise, such as running too fast to carry on a conversation
    • Activities with bouncing or jolting movements (horseback riding or high-impact aerobics)
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    Be aware that your blood sugar can change very quickly, becoming too high or too low. What you eat, how physically active you are, and your growing baby will change your blood sugar many times during the day. Check your blood sugar often—as directed by your doctor and any time you have symptoms. Know what blood sugar levels mean. Learn how to adjust what and when you eat, how physically active you are, and, if prescribed, how much insulin to take depending on your blood sugar tests. Check your blood sugar right away if you have symptoms. Treat low blood sugar quickly. Always carry with you a quick source of sugar, like hard candy or glucose tablets. Wear a medical alert diabetes bracelet.

    The presence of the CDC logo and CDC content on this page should not be construed to imply endorsement by the US Government of any commercial products or services, or to replace the advice of a medical professional. The mark “CDC” is licensed under authority of the PHS.
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    A , Pharmacy, answered
    If you have diabetes, your doctor may treat your pregnancy a little differently. For example, if a woman has diabetes, some doctors would prefer to deliver her baby a week or two before the due date to lower the risk of certain problems at birth. After you deliver, you should breastfeed your baby. But because breastfeeding can lower the amount of insulin your body needs, you'll need to check your blood sugar and adjust any medications accordingly. You'll also want to plan your meals and snacks carefully around breastfeeding so you don't experience very low blood sugar.
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    Blood sugar that remains high in a woman with gestational diabetes can cause her baby to grow very large (about 9 pounds or more). Being very large makes it hard for the baby to be born through the birth canal and can cause nerve damage to the baby's shoulder during birth. A very large baby has an increased chance of being overweight or obese later in life. Being overweight or obese increases the chance of also having diabetes later in life.

    Blood sugar that remains high in a pregnant woman with type 1 or type 2 diabetes can cause her baby to have the following health problems:
    • Birth defects, especially of the brain, spine, and heart
    • Increased birth weight
    • Nerve damage to the shoulder during delivery
    • Low blood sugar after birth
    • Increased chance of overweight, obesity, and/or diabetes later in life
    The presence of the CDC logo and CDC content on this page should not be construed to imply endorsement by the US Government of any commercial products or services, or to replace the advice of a medical professional. The mark “CDC” is licensed under authority of the PHS.
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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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    Having a baby is a major financial investment for any parent. Your pregnancy will include the added expenses involved in tight blood glucose management. It used to be worse. Before self-monitoring of blood glucose, a woman could easily spend half of her pregnancy in the hospital. Now the major expenses are fetal monitoring and blood glucose monitoring instead of hospitalizations.

    Before you conceive, check with your insurance company to find out what is covered. Your insurance plan may cover more during your pregnancy if you have the appropriate documentation.

    Extra Expenses and Doctor Visits

    • You will need to see both your obstetrician and your diabetes health care provider frequently—perhaps every week or every 2 weeks for most of your pregnancy. You will learn to make adjustments to insulin doses based on blood glucose values. This requires time, practice, and lots of support from your health care team.
    • Your health care should include nutrition counseling with a registered dietitian and diabetes educator. You will likely learn how to count carbohydrates and adjust insulin doses.
    • You’ll need to check blood glucose values often to make sure you are within your target ranges. Many pregnant women do seven or more checks each day. Test strips are the big expense in monitoring.
    • You may need to do ketone monitoring each day. This will protect you against surprise ketoacidosis as well as starvation ketosis, which can occur after a low blood glucose value, when carbohydrate intake is very limited, or when calorie intake is lower than needed. This means buying ketone strips.
    • If you treat your type 2 diabetes with oral diabetes medications, you may need to switch to insulin before you become pregnant. This means paying for insulin pens or syringes and insulin, plus training from an educator on how to give insulin and to adjust your dose.
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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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    Don’t be alarmed if your total insulin dosage increases as your pregnancy continues. This does not mean your diabetes is getting worse, only that your insulin resistance is increasing, which is to be expected. You may need to make changes in your insulin dosage as often as every 10 to 14 days.
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    As your due date nears, your doctors will study your health and that of your growing baby if you have diabetes. Then, you and the team will discuss the best time and method for delivery. To determine the safest time and method to deliver your baby, your health care team will examine a variety of factors: blood glucose control, blood pressure, kidney function, and any diabetes complications you may have. The team will also study your baby's size and movements, his or her heart-rate pattern and the amount of amniotic fluid in the uterus.

    Your labor may start on its own, or you may decide to have labor induced or have a planned cesarean section (C-section). During a cesarean birth, an incision is made through the abdomen and uterus, through which the baby is removed. Because of the surgery, your recovery time may be longer than if you delivered your baby vaginally.

    No matter how you deliver your baby, your doctors will be working during labor and delivery to keep your blood glucose level under control. At the start of active labor, your insulin needs will drop. You will most likely not need any insulin during labor and for 24 to 72 hours after delivery. Your blood glucose will be checked frequently (probably every few hours) and your insulin and glucose regimen will be tailored to your needs during that time.

    To help you prepare for labor, many hospitals and other organizations offer classes (such as Lamaze) to help you have a smooth delivery. They teach you what to expect during delivery, techniques to improve delivery and to relieve pain during labor, and how to care for your baby after birth. Because of the care needed for both mom and baby during and after delivery, home births are not advised for women with diabetes.

    It's important to have a partner or coach helping you throughout the labor and delivery process. This can be a spouse, parents, relative, or friend. Having a support system with you before and during the birth can help you be more relaxed during your time at the hospital.
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    During the first trimester (first three months) of your pregnancy, blood glucose targets are designed to help you minimize the risk of birth defects and miscarriage if you have diabetes. In the second and third trimesters, your glucose targets will help prevent your baby from getting too large. If you have trouble staying in your target range or have frequent low blood glucose levels, talk to your health care team about revising your treatment plan. Target blood glucose values for type 1, type 2, and gestational diabetes may differ slightly in different care systems and with different diabetic teams. Work with your health care team on determining your specific goals before and during pregnancy.