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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    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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    If you have type 1 diabetes, you may require less insulin for the first few days after delivery. Your health care provider may check for postpartum thyroiditis. If you have type 2 diabetes, you may not need insulin at all during this time. Your insulin needs will gradually go back to your pre-pregnancy level in about 2–6 weeks. If you had gestational diabetes, your blood glucose levels will most likely return to normal after delivery.

    The postpartum period may be one of unpredictable swings in blood glucose. Your hormones and body chemistry are in flux. You are recovering from a major physical challenge. You are probably exhausted from caring for your baby, too. If you find that keeping your blood glucose on target poses a greater challenge, try not to get too discouraged.

    Hormonal changes, emotional shifts, irregular sleep patterns, and fatigue may hide or change your symptoms of high or low blood glucose. You may find it hard to tell the difference between “after-baby” blues, such as unexplained crying or moodiness, and low or high blood glucose. Fatigue, feeling spacey, weakness, or forgetfulness can be caused by both high and low blood glucose and by lack of sleep. If you’re not sure, play it safe and check your blood ­glucose.

    Although virtually every aspect of your life may seem turned on its head after the birth of a new baby, the four basic management tools remain the same: insulin or other diabetes medication (oral diabetes medications cannot be used while you are breast-feeding), blood glucose monitoring, meal planning, and physical activity.

    Working out may be the last thing you are thinking about after the baby is born. But as soon as you feel well enough and you have your doctor’s okay, taking your baby for a daily walk can help you feel better and more relaxed.

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    Your baby will be closely watched after birth. He or she is at risk for hypoglycemia and will have frequent blood glucose monitoring during the first 24 hours after birth. Hypoglycemia occurs because the baby has been producing enough insulin to cover the high glucose levels in the uterus. This does not mean your baby has diabetes.

    Jaundice is also common and may require therapy with lights. If your baby was delivered early or is very large for his or her age, your baby will also be evaluated for respiratory problems. It is not unusual for these babies to be in an intensive care nursery for a short time so that they can be watched very closely.

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    Labor is work, and usually you will not be able to eat. You will probably get an intravenous catheter (IV) so that fluids or calories can be given as needed. Your blood glucose levels will be monitored frequently during labor. You can be given insulin either as injections or through the IV. Many women don’t need insulin during active labor.
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    High blood pressure can be a sign of pre­eclampsia, a serious condition that occurs more often in women with diabetes. Preeclampsia may also lead to early delivery, often by C-section.

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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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    You will probably need to check your blood glucose levels several times each day. If you take insulin, you may monitor before and after meals and at bedtime. If you have type 2 or gestational diabetes and are managing it through meal planning and regular exercise, you will need to check more frequently than usual.

    When to Monitor

    • Once before each meal
    • 1–2 hours after each meal
    • At bedtime
    • During the middle of the night, around 2 a.m.
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    It is important to maintain physical activity during pregnancy, as long as your overall health permits it. Being fit prepares you for the physical stress of labor and delivery and the busy days that follow. It is usually safe to continue with any exercise you were doing regularly before pregnancy. But pregnancy is not the time to take up any new, strenuous activities.

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    You may need to change your eating habits during pregnancy to help stay on target. You will also want to make sure that you are eating foods that provide adequate nutrition for you and your baby. You will probably want to visit your dietitian even before you become pregnant. In general, choose nutritious foods that are part of any healthy eating plan.

    Common Weight Goals for Pregnancy

    If your pre-pregnancy weight is…                       Then gain…

    Underweight (BMI less than 18.5 kg/m2)                   28–40 lbs

    Normal (BMI 18.5–24.9 kg/m2)                                 25–35 lbs

    Overweight (BMI 25–29.9 kg/m2)                              15–25 lbs

    Obese (BMI 30 kg/m2 or higher)                               11–20 lbs

    Eating five or six small meals a day may help your efforts to stabilize your blood glucose. Women with gestational diabetes may be able to manage their blood glucose levels more effectively by limiting their carbohydrate intake to 35–40% of calories.

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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.