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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    Figuring out why drastic changes in blood glucose levels occur takes some doing. Here are some places to start looking for answers:

    •  Timing of insulin injections: The action times (onset, peak, duration)
       are important to know when timing your insulin injections.

    •  Insulin dose: Are you sure you are measuring your dose accurately?
       Would using an insulin pen or pump help?

    •  Injection sites: Are you on a regular rotation schedule? Most insulins
       are absorbed at the most consistent rate from the abdomen.

    •  Injection depth: Do you inject your insulin at the same depth each

    •  Blood flow: Do you inject into areas where muscles are at work? Do
       you smoke? Working muscles and warm temperatures speed up
       absorption. Cool temperatures and tobacco slow down absorption.

    •  Food intake: Are you able to accurately count the carbohydrates in
       your food? Does your carbohydrate-to-insulin ratio need to be

    •  Hypoglycemia: Do you have frequent bouts of very low blood
       glucose? Your body’s natural defenses to this (glucose release from
       the liver) can be spoiling your insulin’s work.

    •  Neuropathy: Do you have nerve damage that affects your absorption
       of food? Nerve damage can slow digestion or can produce unexpected
       bouts of diarrhea.

    •  Dehydration: Do you have sustained periods of high blood glucose
       that drain your body of fluids? The less water in your body, the harder
       it is for your insulin to flow into tissues.

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    Having a new baby can affect your diabetes care habits, especially if you have other children to care for. You may find that your baby’s unpredictable schedule and your own erratic sleep patterns make it difficult for you to eat or snack when you need to. Using multiple insulin injections may make your life easier and give you more flexibility. Although it is tempting to put your infant’s needs before your own, taking care of yourself is important for both you and your baby.
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    If you are planning to get pregnant, have a complete eye exam. Talk with your eye doctor about what can happen to your eyes during pregnancy. Pregnant women with diabetes need an eye exam in the first 3 months. They also need to be checked again for one year after the baby is born.
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    There is about a 30% chance that your kidney function will worsen during pregnancy, but these changes often improve after delivery of the infant. Many women with diabetes will first show signs of abnormal kidney function (spilling protein into the urine) during pregnancy. If you have kidney disease before getting pregnant, then there is a chance that it will get worse during pregnancy.
    Moreover, babies born to mothers with diabetic kidney disease have a higher risk of stillbirth, respiratory distress, jaundice, and abnormally small body size compared to babies of mothers with diabetes without kidney problems. Also, about 30% of these babies are born prematurely. You will need to have tight blood glucose control and careful control of blood pressure before and during the pregnancy. Thus, it can be done, but you should know the risk before you get pregnant.
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    Typical blood glucose levels for pregnant women with diabetes are: Fasting 60-99 mg/dl, after meals 100-129 mg/dl.
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    If you have type 2 diabetes, your doctor will decide which medication you should take after delivery. You will usually be able to go back to the same medications you were taking before pregnancy, as long as they were controlling your diabetes well. This may be modified if you are breastfeeding.
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    You’ll need more frequent visits to your obstetrician, perhaps every two weeks for the first part of your pregnancy and weekly during the last month. The reason for these visits is to make sure that your baby is developing as expected and that you stay in good health.

    Common Tests During Pregnancy

    • You will be screened for neural tube defects early in pregnancy (around weeks 15–18) by measuring the concentration of alpha-­fetoprotein in your blood.
    • You’ll need an ultrasound test early in your pregnancy (to show when your baby was conceived) and several more throughout your pregnancy to follow the baby’s growth.
    • A fetal echocardiogram may be done around the middle of your pregnancy.
    • Other monitoring includes counting your baby’s movements for an hour each day and fetal movement and heart rate monitoring during the last 6–12 weeks of pregnancy. These tests help ensure your baby’s well-being and will assist your health care team in deciding when to deliver your baby.
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    The following suggestions can help prevent diabetes-related health problems during pregnancy:
    • Plan your pregnancy. If you have diabetes, it is very important for you to get your body ready before you get pregnant. If you are already pregnant, see your doctor right away.
    • See your doctor. Your doctor needs to look at the effects that diabetes has had on your body already, talk with you about getting and keeping control of your blood sugar, change medications if needed, and plan for frequent follow up.
    • Monitor your blood sugar often. Pregnancy affects your blood sugar control. You will probably need to check your blood sugar more often than when you are not pregnant. Talk with your doctor about how often to check your blood sugar.
    • Take your medications on time. If medications are ordered by a doctor, take them as directed.
    • Control and treat low blood sugar quickly. Having tight blood sugar control can lead to a chance of low blood sugar at times. Keep a ready source of sugar, such as glucose tablets or gel or hard candy, on hand at all times. Talk with your doctor about how to treat low blood sugar.
    • Follow up with the doctor regularly. You will need to see your doctor more often than a pregnant woman without diabetes. Together, you can work with your doctor to prevent or catch problems early.
    • If you had gestational diabetes, talk with your doctor about getting your blood sugar checked after delivery and every 1-3 years. About half of all women who had gestational diabetes develop type 2 diabetes later.
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    Because you want your blood glucose levels to be as favorable to your developing baby as possible. All of the baby’s major organs are formed during the first 6–8 weeks of pregnancy, which may be before you know you’re pregnant.

    Research Behind Tight Control and Pregnancy

    In several studies, women who had an A1C that was 1% above normal levels before conception lowered their baby’s risk of birth defects to 1–2%, the same as women without diabetes. Normal A1C is less than 7%. Babies of mothers who began intensive diabetes management after conceiving were more likely to have birth defects.

    Planning ahead of time will ensure that you find a diabetes management plan that will work for you. This takes some trial and error as well as patience. It may take too long if you wait until you are pregnant.

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    The first step is to choose blood glucose targets for your pregnancy. Talk to your health care team about how to personalize blood glucose target ranges to your health and your lifestyle.

    Sample Target Blood Glucose Ranges During Pregnancy

    • Before meals: 60–99 mg/dl                
    • One hour after meals: 100–129 mg/dl
    • A1C less than 6%

    In the first trimester, targets are designed to help you minimize the risk of birth defects or miscarriage. In the second and third trimesters, the targets will help prevent your baby from growing too large. If you have trouble staying in the target range, or if you have frequent or severe hypoglycemia, talk to your health care team about revising your treatment plan or your targets.