Best Way to Manage Diabetes during Pregnancy

Some women have diabetes before they get pregnant and some acquire it after becoming pregnant. Your body when pregnant has a higher demand for insulin.

Diabetes is caused when your body’s production of insulin, a hormone that converts sugar in the blood to energy, malfunctions. Sometimes there is not enough insulin produced or it can’t be used effectively to convert the sugar in your blood to energy. As a result, this sugar builds up in your blood. There is no mechanism to off-load or use the sugar, and the symptoms and effects of dia­betes occur.

Some women develop diabetes prior to pregnancy. This is called pregestational diabetes. This type of diabetes in pregnancy is a chal­lenge to the mother and her physician because of the increased demands that the pregnancy makes on the body. Many of these women are already on supplemental insulin, oral hypoglycemic agents, or con­trolled diet. These women will probably need to take insulin supple­ments to control their diabetes while they are pregnant.

The hormones of the placenta can affect your body’s production of insulin and lead to what is termed gestational diabetes, which first shows up during pregnancy, between the twenty-fourth and twenty-eighth week. Testing for gestational diabetes at weeks 24-28 is a stan­dard in the medical profession because many women do not notice any symptoms.

The symptoms of gestational diabetes include:

•  Frequent urination, sometimes as often as every hour
•  Excessive thirst
•  Fatigue and weakness
•  Loss of weight or rapid weight gain
•  Tingling in the hands and feet
•  Reduced resistance to infections, including urinary tract infections
•  Occasional blurred vision
•  Glucose or sugar in the urine

Testing for Diabetes

Most pregnant women are checked for abnormal glucose levels at every prenatal visit. However, the standard glucose screening for gestational diabetes is a i-hour glucose screening test performed on most women at 24-26 weeks into their pregnancy. You will be asked to drink a sweet soda-like beverage and have your blood drawn one hour later. If your results are elevated, you will be asked to take a three-hour glucose tol­erance test (GTT) another day. This is a diagnostic test that confirms gestational diabetes.

In preparation for the three-hour GTT, you’ll be asked to consume a carbohydrate-rich diet for the three days before the test and then fast the night before. The next day you’ll have blood drawn and then be given another sweet sodalike drink. Your blood will be drawn at regular intervals three more times and tested to find out how much sugar remains in your blood. If your blood is abnormal at the end of the testing period, you have gestational diabetes.

Treating Gestational Diabetes

The glucose tolerance test tells your doctor whether you have diabetes and the severity of the problem. Depending upon these results, you’ll either be given a diabetic diet to control your blood sugar and carbo­hydrate intake or you’ll be put on medication immediately along with the diet. Controlling your glucose level is very important to having a healthy pregnancy, delivery, and baby.

Your OB provider may prescribe a self-glucose testing kit that meas­ures your blood glucose levels and will tell you how often to self-test. His or her nurse or staff member will teach you how to use the kit and how to follow a diabetic diet that includes fresh fruit, vegetables, pasta, rice, potatoes, and lean meats. Eating more frequent, smaller meals throughout the day and before bedtime is another important practice.

Exercise is another critical component for controlling diabetes. With regular exercise, your body doesn’t need as much insulin to keep blood sugars in check. YourOBprovider and staff will help you estab­lish your diet and level of exercise; walking, swimming, and yoga are all good choices to help you control your diabetes in pregnancy.

But if diet and exercise are not effective, if your initial blood sugars are too high, or you’re unable to adhere to the regimen, insulin injec­tions or (nowadays) oral hypoglycemic agents may be prescribed. You may need to be hospitalized for a short time to allow your doctor to con­trol your diabetes more precisely and monitor the condition of your baby.

YourOBprovider will probably follow your pregnancy more closely and monitor the baby more often as you get closer to full term. You may be referred to a perinatologist, a specialist in high-risk pregnancies, for more specialized care and to a nutritionist for help with your diet. Con­trolling your diabetes will improve your own health and your baby’s health tremendously, and you will be working actively to delay the onset of adult diabetes. It is believed that women with gestational diabetes have a 50 percent chance of developing diabetes again later in life.

The Importance of Well-Controlled Diabetes

Diabetes is usually manageable, but it puts you at greater risk for other complications of pregnancy. These risks include preeclampsia; polyhydramnios (an excess fluid in the amniotic sac); and frequent urinary tract infections (UTIs), which are often without symptoms. Untreated UTIs may infect your kidneys, prohibiting them from effectively clean­ing toxins from your system.

Having diabetes can also affect your baby’s health. Babies born to mothers with uncontrolled pregestational diabetes are more at risk for birth defects. For both pregestational and gestational diabetes, the more common complication is that the excess and unused sugar from your system may go to your baby, making it grow larger than normal. Not only is this large baby more difficult to deliver, but he or she can have hypoglycemia (low blood sugar), excess red blood cells, jaundice, and a physiologically immature respiratory system at birth. Some of these babies require intensive care just after birth, but most babies recover quickly.

You have a good chance of having a vaginal birth even with diabetes. According to the CDC in 2000, 38.4 percent, or more than one-third of women with diabetes, were delivered by cesarean deliveries, but that means two-thirds had vaginal deliveries. You can breast-feed your baby even if you have already been treated for gestational diabetes.

Postpartum Care of Diabetes

Once home with your baby, you should continue your diet and exer­cise routine, and you may be asked to monitor your glucose levels, since they will be affected by the delivery, nursing, and daily life with your baby. Your gestational diabetes should resolve itself gradually after the baby is born. Make sure your internist or the family practice physician you see for routine care knows you had gestational diabetes and checks your blood sugar periodically, especially if you are planning to have another pregnancy. Preconceptual counseling is critical before becom­ing pregnant again.