Pregnancy With Type 1 Diabetes
Forty five years ago when I was diagnosed with type 1 diabetes I was clearly told I couldn’t have children. I didn’t. Today, thankfully that advice is no longer given. And while a woman with Type 1 diabetes needs to take precautions, she can absolutely, and safely, have a healthy baby. I sat down for an interview with Ginger Vieira, co-author,with Jennifer Smith, of the recent book, Pregnancy with Type 1 Diabetes: Your Month-to-Month Guide to Blood Sugar Management. What will people find in the book? As much information as you possibly need to understand why your blood sugars fluctuate during pregnancy and how to adjust your insulin management to keep your blood sugars as close to non-diabetic levels as possible. Also the book covers preparing for pregnancy, months one through nine of your pregnancy, delivery, and postpartum, including the challenges of breastfeeding for a woman with type 1 diabetes. My co-author Jenny is also my diabetes pregnancy coach. As a certified diabetes educator, woman with type 1 diabetes and mother, she knows this journey inside and out. What makes pregnancy for a woman with type 1 diabetes challenging? Let’s face it, a normal day with type 1 diabetes is challenging, balancing an autonomic system your body ought to balance on its own. And we’re only given insulin to do the job, while a non-diabetic body uses several different hormones to balance blood sugar. Add pregnancy to that mix and you add the insane pressure of, “Every decision you make impacts the human life growing inside of you!!!” And now you have to balance your blood sugars with constantly shifting pregnancy hormones. Plus those hormones impact your insulin needs in ways that are constantly changing and evolving. Also, there is never a break. Even when you’re sleepi Continue reading >>
Diabetes And Pregnancy
Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. When you are pregnant, high blood sugar levels are not good for your baby. About seven out of every 100 pregnant women in the United States get gestational diabetes. Gestational diabetes is diabetes that happens for the first time when a woman is pregnant. Most of the time, it goes away after you have your baby. But it does increase your risk for developing type 2 diabetes later on. Your child is also at risk for obesity and type 2 diabetes. Most women get a test to check for diabetes during their second trimester of pregnancy. Women at higher risk may get a test earlier. If you already have diabetes, the best time to control your blood sugar is before you get pregnant. High blood sugar levels can be harmful to your baby during the first weeks of pregnancy - even before you know you are pregnant. To keep you and your baby healthy, it is important to keep your blood sugar as close to normal as possible before and during pregnancy. Either type of diabetes during pregnancy increases the chances of problems for you and your baby. To help lower the chances talk to your health care team about A meal plan for your pregnancy A safe exercise plan How often to test your blood sugar Taking your medicine as prescribed. Your medicine plan may need to change during pregnancy. NIH: National Institute of Diabetes and Digestive and Kidney Diseases Continue reading >>
Diabetes And Gestational Diabetes
In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether may increase the risk for birth defects over that background risk. This information should not take the place of medical care and advice from your health care provider. What is diabetes? Diabetes is a medical condition in which the body either does not make enough insulin or cannot use insulin correctly. Insulin is a hormone in the blood that is necessary for providing our cells with energy to function. Insulin helps sugar (glucose) move from the bloodstream into the cells. When glucose cannot enter our cells, it builds up in the blood (hyperglycemia). These high sugar levels can lead to damage of organs like the eyes and kidneys, and damage blood vessels and nerves. There are different classes of diabetes. Some people have Type 2 diabetes (once called adult onset diabetes). This means that the body does not produce enough insulin or the insulin is not able to work well. In contrast, people with Type 1 diabetes (once called juvenile-onset diabetes or insulin-dependent diabetes) have a condition where the body does not produce any insulin at all. People with Type 1 diabetes need insulin injections and close monitoring to control their blood sugar levels. I have diabetes and I am planning on getting pregnant. Is there anything I need to know? It is recommended that you speak with your health care providers before becoming pregnant. This will help determine the best plan of care to keep your blood glucose levels under control before and during pregnancy. A blood test called hemoglobin A1c (glycosated hemoglobin) can be done to estimate glucose control over the past 2-3 months. Ideally, this level should be within Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Conjoint Associations of Gestational Diabetes and Hypertension With Diabetes, Hypertension, and Cardiovascular Disease in Parents: A Retrospective Cohort Study
- Does Gestational Diabetes always mean a Big Baby and Induction?
Screening Women For Gestational Diabetes In Pregnancy Based On Whether They Are Considered At Risk, And In Different Settings
What is the issue? What are the effects of screening all women for gestational diabetes mellitus (GDM), compared with only screening those who are 'at risk'? What are the effects of screening women for GDM in different settings (such as in the community versus the hospital)? This review updates a Cochrane Review, first published in 2010, and subsequently updated in 2014. Why is this important? GDM is a form of diabetes that can develop during pregnancy, and can increase the risk of complications for mothers and their babies. Women with GDM are more likely to develop pre-eclampsia (high blood pressure and protein in the urine) and require a caesarean section. For babies, potential problems include being large for gestational age (growing larger than they normally would), or having hypoglycaemia (low blood sugar) after birth. Although GDM usually resolves following birth, mothers and their babies are at risk of developing type 2 diabetes in the future. Treating GDM can improve health outcomes. Women often do not know they have GDM. Screening to identify and treat GDM in pregnant women may therefore improve outcomes. The two main approaches are 'universal' where all women undergo screening; and 'selective' or 'risk factor'-based where only those women 'at risk' are screened. The risk factors for GDM include certain ethnicities, being older, overweight or obese, having had a previous large baby, or a family history of GDM or type 2 diabetes. It possible to screen for GDM in different settings, such as in the community (e.g. a general practice clinic) or in hospital. The ideal screening method for GDM that leads to the best health outcomes for mothers and their babies remains unclear. What evidence did we find? We searched for evidence (January 2017) and included two trials Continue reading >>
Pre-existing Diabetes And Pregnancy
When Joy contacted TheDiabetesCouncil, she wanted to know if she would ever be able to get pregnant and have a healthy baby with her Type 1 diabetes. She had previously heard that there were risks that came with being pregnant and she needed some guidance. We decided to put together a comprehensive guide which would shed light on pregnancy with pre-existing diabetes. We hope Joy and others who have similar questions concerns will benefit from the information provided here, as they work to get the strict diabetes control that is needed. Let’s take a look at what it takes to have a healthy pregnancy and baby despite having diabetes. What this article is about In this article, we will look at how you can manage your diabetes during pregnancy for your health and the health of your baby. We will learn about the guidelines for managing diabetes during pregnancy, and provide you with a detailed instruction. We will explore what women with pre-existing diabetes need to know before they get pregnant, and what they need to know in order to experience a healthy pregnancy with diabetes. What this article is not about Gestational diabetes, or diabetes acquired after pregnancy. I want to stress that this article is not about gestational diabetes. We have already covered the topic of Gestational Diabetes for which the in-depth article can be found here: How opinions on pre-existing diabetes and pregnancy have changed over time Back in the 1980’s, I strongly urged all my teenage patients with diabetes to stay on birth control and prevent pregnancy with diabetes. The outcome was never too good when they got pregnant, had out of control diabetes, and the complications that would arise from the pregnancy. Outcomes are still grave if tight control is not achieved before and during the Continue reading >>
The Risks Associated With Pregnancy In Women Aged 35 Years Or Older
The number of babies born to women in their late 30s has progressively increased over the past decade (General Register Office for Scotland, 1996). The published data on the risks associated with childbirth at >35 years are inconsistent. It is known that older women are more likely to have pre-existing medical disorders such as diabetes mellitus or hypertension (Hansen, 1986). Some studies have demonstrated an increased incidence of antepartum haemorrhage, malpresentation(Roberts et al., 1994), operative vaginal delivery, Caesarean delivery (Peipert and Bracken, 1993; Cnattingius et al., 1998; Rosenthal and Paterson Brown, 1998), and fetal death (Lehmann and Chism, 1987; Fretts et al., 1995). Advanced maternal age is also postulated as an independent risk factor for low birthweight, preterm delivery (Aldous and Edmonson, 1993), placenta praevia (Williams and Mittendorf, 1993), and infants being admitted to the special care baby unit (Berkowitz et al., 1990). There is no evidence that women aged >35 years with a post-term pregnancy have an increased risk of antepartum fetal compromise but their babies do not tolerate labour as well as those of younger women, with more decelerative traces and more Caesarean sections (Shapiro and Lyons, 1989). In contrast, other papers report little or no adverse outcomes associated with pregnancy in older women (Barkan and Bracken, 1987; Kirz et al., 1985; Ales et al., 1990). Pregnancy in older women is associated with many confounding factors e.g. parity, pre-existing diabetes mellitus and/or hypertension, which should be taken into account if the risks associated with advanced maternal age are to be quantified (Chan and Lao, 1999; Gilbert et al., 1999). To clarify these issues we have reviewed a large number of consecutive singleton pre Continue reading >>
What Is Gestational Diabetes And Its Link To Pre-diabetes?
Insulin Resistance and obesity-associated Gestational Diabetes are conditions that develop in the third trimester of pregnancy and affect 4-5% of all pregnant women in the U.S. - around 135,000 cases each year. With Gestational Diabetes, the pancreas produces insulin but it doesn't lower the mother's blood sugar levels. The symptoms are only detectable by laboratory testing. Pregnant women get a urine dip stick test with each pre-natal visit. This test may show glucose in the urine, which will prompt a health care provider to carry out further examinations for the presence of Gestational Diabetes, also known as Gestational Diabetes Mellitus (GDM). To determine if a woman has this condition, she should be tested between 24 and 28 weeks if she is at average risk i.e. has no history of prior Gestational Diabetes and is of regular weight. Women at higher risk should be tested earlier. A patient is considered high risk if she is obese, has glycosuria (glucose in the urine) or has a personal or family history of Gestational Diabetes. Laboratory diagnosis of the condition includes a fasting blood glucose measurement of greater than 126 milligrams per deciliter (mg/dl) or a random blood glucose of 200 mg/dl. An Oral Glucose Tolerance Test should also be carried out. If the glucose level exceeds what is considered normal, this could result in a diagnosis of Gestational Diabetes. Pregnancy and Obesity Women who are overweight before they become pregnant are most at risk from this disorder. The best way to avoid it is to lose weight before becoming pregnant via a low insulin, low Glycemic Index (GI) diet and regular exercise. Gestational Diabetes usually disappears after pregnancy, but it can lead to the development of Pre- and Type 2 Diabetes years later. As a baby grows, it is s Continue reading >>
Diabetes Management Guidelines
Source: American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016;39(suppl 1):S1-S106. Available here. Refer to source document for full recommendations, including class of recommendation and level of evidence. Jump to a topic or click back/next at the bottom of each page Diabetes in Pregnancy (Gestational Diabetes) Glycemic Targets in Pregnancy Pregestational diabetes Gestational diabetes mellitus (GDM) Fasting ≤90 mg/dL (5.0 mmol/L) ≤95 mg/dL (5.3 mmol/L) 1-hr postprandial ≤130-140 mg/dL (7.2-7.8 mmol/L) ≤140 mg/dL (7.8 mmol/L) 2-hr postprandial ≤120 mg/dL (6.7 mmol/L) ≤120 mg/dL (6.7 mmol/L) A1C 6.0-6.5% (42-48 mmol/L) recommended <6.0% may be optimal as pregnancy progresses Achieve without hypoglycemia Recommendations for Pregestational Diabetes Pregestational type 1 and type 2 diabetes confer greater maternal and fetal risk than GDM Spontaneous abortion Fetal anomalies Preeclampsia Intrauterine fetal demise Macrosomia Neonatal hypoglycemia Neonatal hyperbilirubinemia Diabetes in pregnancy may increase the risk of obesity and type 2 diabetes in offspring later in life Maintain A1C levels as close to normal as is safely possible Ideally, A1C <6.5% (48 mmol/L) without hypoglycemia Discuss family planning Prescribe effective contraception until woman is prepared to become pregnant Women with preexisting type 1 or type 2 diabetes Counsel on the risk of development and/or progression of diabetic retinopathy Perform eye exams before pregnancy or in first trimester; monitor every trimester and for 1 year postpartum Management of Pregestational Diabetes Insulin is the preferred medication for pregestational type 1 and type 2 diabetes not adequately controlled with diet, exercise, and metformin Insulin* management during pre Continue reading >>
Gestational Diabetes (gd)
What is gestational diabetes? Gestational diabetes (GD) happens when you have too much sugar (glucose) in your blood during pregnancy. Your blood sugar levels can go up when your body isn’t producing enough of a hormone called insulin. Insulin helps: the cells in your body to get energy from blood sugar your body to store any blood sugar that isn’t needed During pregnancy, hormones make it harder for your body to use insulin efficiently. So your body has to make extra insulin, especially from mid-pregnancy onwards. If your body can't make enough extra insulin, your blood sugar levels will rise and you may develop GD. Having too much sugar in your blood can cause problems for you and your baby, so you’ll have extra care during your pregnancy. On average, GD affects one mum-to-be in 20. GD goes away after your baby is born, because it's a condition that's only caused by pregnancy. The other types of diabetes, which are not caused by pregnancy, are type 1 diabetes and type 2 diabetes. Some women have diabetes, without realising it, before they become pregnant. If this happens to you, it will be diagnosed as GD during your pregnancy. What are the symptoms of gestational diabetes? You probably won't notice any symptoms if you have GD. That's why you'll be monitored by your midwife, and offered a test if she thinks you're at risk. GD symptoms are like normal pregnancy symptoms, and easy to miss. By the time you have clear symptoms, your blood sugar levels may be worryingly high (hyperglycaemia) . Symptoms of hyperglycaemia include: feeling more thirsty needing to wee more often than usual having a dry mouth feeling more tired getting recurring infections, such as thrush, and UTIs having blurred vision If you have any of these symptoms, tell your midwife or doctor straig Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
- Gestational Diabetes: The Overlooked Form of Diabetes
Management Of Type 1 Diabetes In Pregnancy
Abstract Women with type 1 diabetes (T1DM) have unique needs during the preconception, pregnancy, and postpartum periods. Preconception counseling is essential for women with T1DM to minimize pregnancy risks. The goals of preconception care should be tight glycemic control with a hemoglobin A1c (A1C) < 7 % and as close to 6 % as possible, without significant hypoglycemia. This will lower risks of congenital malformations, preeclampsia, and perinatal mortality. The safety of medications should be assessed prior to conception. Optimal control of retinopathy, hypertension, and nephropathy should be achieved. During pregnancy, the goal A1C is near-normal at <6 %, without excessive hypoglycemia. There is no clear evidence that continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) is superior in achieving the desired tight glycemic control of T1DM during pregnancy. Data regarding continuous glucose monitoring (CGM) in pregnant women with T1DM is conflicting regarding improved glycemic control. However, a recent CGM study does provide some distinct patterns of glucose levels associated with large for gestational age infants. Frequent eye exams during pregnancy are essential due to risk of progression of retinopathy during pregnancy. Chronic hypertension treatment goals are systolic blood pressure 110–129 mmHg and diastolic blood pressure 65–79 mmHg. Labor and delivery target plasma glucose levels are 80–110 mg/dl, and an insulin drip is recommended to achieve these targets during active labor. Postpartum, insulin doses must be reduced and glucoses closely monitored in women with T1DM because of the enhanced insulin sensitivity after delivery. Breastfeeding is recommended and should be highly encouraged due to maternal benefits including i Continue reading >>
Summer Pregnancy May Raise Gestational Diabetes Risk
Researchers have identified a new possible risk factor for gestational diabetes: Being exposed to hot outdoor temperatures in the month before giving birth. According to a new study published in the Canadian Medical Association Journal (CMAJ), in one geographic region in Canada, the rate of gestational diabetes varied more than 3 percentage points between the coldest times of year and the hottest. Gestational diabetes, a condition that develops during pregnancy, is usually a temporary condition. But women who develop it are at higher risk for type 2 diabetes and other health conditions later on. (One recent study linked gestational diabetes to postpartum depression, for example.) Gestational diabetes can also raise babies' risks of excessive birth weight, preterm birth, and type 2 diabetes later in life. Previous studies have suggested that exposure to cold temperatures can improve insulin sensitivity and activate the body's brown fat tissue, which -- unlike other types of fat -- burns calories and seem to protect against metabolic conditions like obesity and diabetes. For this reason, it's been suggested that cold temperatures might protect against these conditions. To study this potential connection in pregnant women, researchers looked at medical records of nearly 400,000 women living in the same urban area in Canada, in a region with wide temperature fluctuations throughout the year. Over a 12-year period, those women gave birth to more than 555,000 children. When the researchers looked at average temperatures in the 30 days before these women gave birth, they found that the prevalence of gestational diabetes was 4.6% among those exposed to very cold temperatures (14 degrees Fahrenheit or lower), compared to 7.7% among those exposed to very hot temperatures (75 degr Continue reading >>
Preeclampsia: A Risk Factor For Gestational Diabetes Mellitus In Subsequent Pregnancy
Abstract Preeclampsia and gestational diabetes (GDM) have several mechanisms in common. The aim of this study was to determine whether women with preeclampsia have an increased risk of GDM in a subsequent pregnancy. Study data were collected from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service for 2007–2012. Patients who had their first delivery in 2007 and a subsequent delivery between 2008 and 2012 in Korea were enrolled. A model of multivariate logistic regression analysis was performed with GDM as the final outcome to evaluate the risk of GDM in the second pregnancy. Among the 252,276 women who had their first delivery in 2007, 150,794 women had their second delivery between 2008 and 2012. On the multivariate regression analysis, women with preeclampsia alone in the first pregnancy had an increased risk of GDM in the second pregnancy when compared with women who had neither of these conditions in their first pregnancy (OR 1.2, 95% CI, 1.1–1.3). Women with GDM alone in the first pregnancy were at an increased risk for GDM in the second pregnancy (OR 3.3, 95% CI 3.1–3.4). The co-presence of preeclampsia and GDM in the first pregnancy further increased the risk of GDM in the second pregnancy (OR 5.9, 95% CI, 4.0–8.6). Our study showed that a history of preeclampsia may serve as an additional risk factor for GDM in a subsequent pregnancy. Citation: Lee J, Ouh Y-t, Ahn KH, Hong SC, Oh M-J, Kim H-J, et al. (2017) Preeclampsia: A risk factor for gestational diabetes mellitus in subsequent pregnancy. PLoS ONE 12(5): e0178150. Editor: Zhong-Cheng Luo, Shanghai Jiaotong University School of Medicine Xinhua Hospital, CHINA Received: June 22, 2016; Accepted: May 8, 2017; Published: May 22, 2017 Copyright: © 2017 Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Summer pregnancy may raise gestational diabetes risk
- Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study
Gestational Diabetes
Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy.[2] Gestational diabetes generally results in few symptoms;[2] however, it does increase the risk of pre-eclampsia, depression, and requiring a Caesarean section.[2] Babies born to mothers with poorly treated gestational diabetes are at increased risk of being too large, having low blood sugar after birth, and jaundice.[2] If untreated, it can also result in a stillbirth.[2] Long term, children are at higher risk of being overweight and developing type 2 diabetes.[2] Gestational diabetes is caused by not enough insulin in the setting of insulin resistance.[2] Risk factors include being overweight, previously having gestational diabetes, a family history of type 2 diabetes, and having polycystic ovarian syndrome.[2] Diagnosis is by blood tests.[2] For those at normal risk screening is recommended between 24 and 28 weeks gestation.[2][3] For those at high risk testing may occur at the first prenatal visit.[2] Prevention is by maintaining a healthy weight and exercising before pregnancy.[2] Gestational diabetes is a treated with a diabetic diet, exercise, and possibly insulin injections.[2] Most women are able to manage their blood sugar with a diet and exercise.[3] Blood sugar testing among those who are affected is often recommended four times a day.[3] Breastfeeding is recommended as soon as possible after birth.[2] Gestational diabetes affects 3–9% of pregnancies, depending on the population studied.[3] It is especially common during the last three months of pregnancy.[2] It affects 1% of those under the age of 20 and 13% of those over the age of 44.[3] A number of ethnic groups including Asians, American Indians, Indigenous Australians, and Pacific Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Leeds diabetes clinical champion raises awareness of gestational diabetes for World Diabetes Day
- Gestational Diabetes: The Overlooked Form of Diabetes
What Are The Early Symptoms Of Diabetes?
If you have any of the following diabetes symptoms, see your doctor about getting your blood sugar tested: Urinate (pee) a lot, often at night Are very thirsty Lose weight without trying Are very hungry Have blurry vision Have numb or tingling hands or feet Feel very tired Have very dry skin Have sores that heal slowly Have more infections than usual People who have type 1 diabetes may also have nausea, vomiting, or stomach pains. Type 1 diabetes symptoms can develop in just a few weeks or months and can be severe. Type 1 diabetes usually starts when you’re a child, teen, or young adult but can happen at any age. Type 2 diabetes symptoms often develop over several years and can go on for a long time without being noticed (sometimes there aren’t any noticeable symptoms at all). Type 2 diabetes usually starts when you’re an adult, though more and more children, teens, and young adults are developing it. Because symptoms are hard to spot, it’s important to know the risk factors for type 2 diabetes and visit your doctor if you have any of them. Gestational diabetes (diabetes during pregnancy) usually shows up in the middle of the pregnancy and typically doesn’t have any symptoms. If you’re pregnant, you should be tested for gestational diabetes between 24 and 28 weeks of pregnancy so you can make changes if needed to protect your health and your baby’s health. Disclaimer: I am the co-founder of DeeveHealth. DeeveHealth is a mobile platform to prevent Type 2 diabetes. Based on the scientific behavior of human and science of prevention using data points. For more information check out our web-site Continue reading >>
What Are The Risks Of Gestational Diabetes?
A risk means there is a chance that something might happen. With every pregnancy there are some risks, but if you have gestational diabetes your risks of some things will be increased. Managing your blood sugar level brings these risks right down again though and most women with gestational diabetes have healthy pregnancies and healthy babies. These things are very unlikely to happen to you, but understanding the risks may help you see why it is important that you follow your healthcare team’s advice. The risks linked to gestational diabetes are caused by blood glucose levels being too high. If you can keep your blood glucose as close as possible to the ideal level, your risks will be reduced. Risk of having a large baby (macrosomia) If your blood glucose level is high, it can cause high blood glucose levels in your baby. Your baby will produce more insulin in response, just like you do. This can make your baby grow larger than normal. This is called macrosomia. Babies weighing more than 4kg (8lb 8oz) at birth are called macrosomic. Macrosomia increases the risk of: Birth trauma - either the mother or baby can be affected when it is difficult for the baby to be born. Trauma may include physical symptoms, such as bone fractures or nerve damage for the baby, or tearing and severe bleeding for the mother as well as psychological distress. Shoulder dystocia - where the baby’s shoulder is stuck in your pelvis once the head has been born. This can squash the umbilical cord, so the team need to use additional interventions to deliver the baby quickly and safely. It means you may have labour induced early or to have a caesarean section so that your baby is born safely. Your baby's weight will be monitored carefully in pregnancy to see whether these interventions are needed. Continue reading >>
