How does type 2 diabetes affect pregnancy. What are the risks for mother and baby. How can complications be minimized. What changes in diabetes management are necessary during pregnancy. How can women with type 2 diabetes prepare for a healthy pregnancy.

Understanding Type 2 Diabetes in Pregnancy

Type 2 diabetes during pregnancy presents unique challenges for expectant mothers. While it’s entirely possible to have a healthy pregnancy and baby with diabetes, it’s crucial to understand the potential complications and take proactive steps to manage the condition effectively.

Type 2 diabetes is a chronic condition characterized by the body’s inability to properly use insulin, leading to high blood sugar levels. When combined with pregnancy, it requires careful monitoring and management to ensure the health of both mother and baby.

How does type 2 diabetes differ from gestational diabetes?

Type 2 diabetes is a pre-existing condition diagnosed before pregnancy, while gestational diabetes develops during pregnancy and typically resolves after delivery. Both require careful management, but type 2 diabetes may necessitate more intensive care throughout the pregnancy and beyond.

Risks and Complications for Mothers with Type 2 Diabetes

Pregnant women with type 2 diabetes face several potential risks and complications. Being aware of these can help in taking preventive measures and seeking timely medical intervention.

• Preeclampsia: A condition characterized by high blood pressure and organ damage
• Cesarean section: Increased likelihood of requiring a C-section delivery
• Diabetic retinopathy: Potential worsening of existing eye problems
• Diabetic nephropathy: Increased risk of kidney problems
• Severe hypoglycemia: More frequent episodes of dangerously low blood sugar

Can diabetic ketoacidosis occur during pregnancy?

Yes, diabetic ketoacidosis (DKA) can occur during pregnancy, particularly in women with type 1 diabetes. However, women with type 2 diabetes are also at risk. DKA is a serious condition where the body produces high levels of blood acids called ketones. It requires immediate medical attention as it can be life-threatening for both mother and baby.

Potential Impact on the Baby’s Health

Uncontrolled diabetes during pregnancy can have significant consequences for the developing fetus and newborn. Understanding these risks can motivate expectant mothers to maintain tight glucose control.

1. Macrosomia: Excessive fetal growth, potentially leading to delivery complications
2. Congenital disabilities: Increased risk of heart and nervous system abnormalities
3. Premature birth: Higher likelihood of early delivery
4. Respiratory distress syndrome: Breathing difficulties after birth
5. Hypoglycemia: Low blood sugar in the newborn
6. Jaundice: Yellowing of the skin and eyes
7. Stillbirth or neonatal death: While rare, the risk is slightly higher in diabetic pregnancies

Does diabetes increase the risk of birth defects?

Yes, poorly controlled diabetes during pregnancy, especially in the first trimester, can increase the risk of birth defects. However, maintaining good blood sugar control before and during pregnancy significantly reduces this risk, making it comparable to that of non-diabetic pregnancies.

Pre-Pregnancy Planning for Women with Type 2 Diabetes

Planning for pregnancy when you have type 2 diabetes is crucial for optimizing maternal and fetal health outcomes. A proactive approach can significantly reduce risks and complications.

What steps should be taken before conception?

Before trying to conceive, women with type 2 diabetes should:

• Consult with a healthcare team, including an endocrinologist and obstetrician
• Optimize blood sugar control, aiming for an HbA1c level of 6.5% or lower
• Review and adjust medications as some may not be safe during pregnancy
• Begin taking high-dose folic acid supplements (5mg daily)
• Achieve a healthy body weight through diet and exercise
• Address any existing diabetes-related complications
• Ensure vaccinations are up to date

Why is folic acid important for diabetic pregnancies?

Folic acid is crucial for all pregnancies as it helps prevent neural tube defects. Women with diabetes are at a higher risk of having a baby with these defects, making folic acid supplementation even more critical. The recommended dose for women with diabetes is higher (5mg daily) compared to non-diabetic women (400mcg daily).

Managing Type 2 Diabetes During Pregnancy

Effective diabetes management during pregnancy is essential for minimizing risks and ensuring the best possible outcomes for both mother and baby. This often involves more intensive monitoring and potential changes in treatment approaches.

How often should blood glucose be monitored during pregnancy?

Pregnant women with type 2 diabetes typically need to monitor their blood glucose levels more frequently than before pregnancy. This may include:

• Fasting blood glucose checks upon waking
• Pre-meal and 1-hour post-meal checks
• Bedtime blood glucose checks
• Occasional middle-of-the-night checks

Your healthcare team will provide specific guidelines based on your individual needs and circumstances.

What are the target blood glucose levels during pregnancy?

While target ranges may vary slightly depending on individual factors, general guidelines for blood glucose levels during pregnancy are:

• Fasting: 95 mg/dL or less
• 1 hour after meals: 140 mg/dL or less
• 2 hours after meals: 120 mg/dL or less

Your healthcare provider may adjust these targets based on your specific situation and the overall management of your pregnancy.

Medication Adjustments for Pregnant Women with Type 2 Diabetes

Pregnancy often necessitates changes in diabetes medication regimens to ensure the safety of the developing fetus while maintaining optimal blood glucose control.

Are oral diabetes medications safe during pregnancy?

Many oral diabetes medications are not recommended during pregnancy due to limited safety data or potential risks to the fetus. Metformin is generally considered safe and may be continued or initiated during pregnancy. However, other oral medications are typically discontinued, and insulin therapy is often introduced or intensified.

How is insulin therapy managed during pregnancy?

For women with type 2 diabetes who require insulin during pregnancy:

• Insulin needs often increase as pregnancy progresses
• More frequent dose adjustments may be necessary
• A combination of long-acting and rapid-acting insulins is typically used
• Insulin pumps may be considered for some women

Close collaboration with your healthcare team is essential to fine-tune insulin dosing throughout pregnancy.

Lifestyle Considerations for Pregnant Women with Type 2 Diabetes

Maintaining a healthy lifestyle is crucial for managing type 2 diabetes during pregnancy. This includes attention to diet, exercise, and stress management.

What dietary guidelines should be followed?

A balanced diet is essential for managing blood sugar levels and supporting fetal growth. Key considerations include:

• Consistent carbohydrate intake, focusing on complex carbohydrates
• Adequate protein intake to support fetal development
• Healthy fats from sources like avocados, nuts, and olive oil
• Regular meals and snacks to maintain stable blood sugar levels
• Proper hydration
• Limiting caffeine intake

Working with a registered dietitian can help create a personalized meal plan that meets both maternal and fetal nutritional needs while supporting blood glucose control.

Is exercise safe during pregnancy with type 2 diabetes?

Regular physical activity is generally safe and beneficial for pregnant women with type 2 diabetes. Exercise can help:

• Improve insulin sensitivity
• Manage blood glucose levels
• Control weight gain
• Reduce the risk of pregnancy complications

However, it’s important to consult with your healthcare provider before starting or continuing an exercise regimen during pregnancy. They can provide guidance on safe activities and any necessary precautions.

Monitoring and Managing Diabetes-Related Complications During Pregnancy

Pregnancy can exacerbate existing diabetes-related complications or lead to the development of new ones. Regular monitoring and proactive management are crucial for maintaining maternal health.

How often should eye examinations be performed?

Women with type 2 diabetes should have a comprehensive eye examination before pregnancy or in the first trimester. Follow-up exams may be recommended throughout pregnancy, especially if there’s pre-existing retinopathy. The frequency of these exams will depend on the severity of any eye problems and the overall stability of blood glucose control.

What kidney function tests are necessary during pregnancy?

Kidney function should be assessed early in pregnancy and monitored regularly. This typically involves:

• Urine tests to check for protein (a sign of kidney damage)
• Blood tests to measure creatinine levels and estimate glomerular filtration rate (GFR)
• Blood pressure monitoring, as kidney problems can contribute to hypertension

Women with pre-existing kidney disease may require more frequent monitoring and specialized care during pregnancy.

Labor, Delivery, and Postpartum Considerations

As the pregnancy progresses, attention turns to preparing for labor, delivery, and the postpartum period. Women with type 2 diabetes may require special considerations during this time.

How is blood glucose managed during labor and delivery?

During labor and delivery, blood glucose management is crucial. This typically involves:

• More frequent blood glucose monitoring
• Intravenous insulin administration in some cases
• Adjusting insulin doses to account for the physical stress of labor
• Ensuring glucose levels remain in a safe range to prevent neonatal hypoglycemia

Your healthcare team will develop a specific plan for managing your diabetes during this time.

What changes occur in insulin requirements after delivery?

After delivery, insulin requirements typically decrease dramatically. Women who were using insulin during pregnancy may need to reduce their doses significantly or, in some cases, return to their pre-pregnancy diabetes management regimen. Close monitoring and frequent adjustments are often necessary in the immediate postpartum period.

Can women with type 2 diabetes breastfeed?

Yes, women with type 2 diabetes can and should be encouraged to breastfeed if they choose to do so. Breastfeeding offers numerous benefits for both mother and baby, including:

• Improved blood glucose control for the mother
• Reduced risk of type 2 diabetes for the baby later in life
• Enhanced bonding between mother and infant
• Nutritional benefits for the baby

However, breastfeeding can affect blood glucose levels, so continued monitoring and potential medication adjustments may be necessary.

Long-Term Health Considerations for Mother and Child

The impact of type 2 diabetes during pregnancy extends beyond the immediate postpartum period, influencing long-term health outcomes for both mother and child.

How does gestational diabetes affect future diabetes risk?

While this article focuses on pre-existing type 2 diabetes, it’s worth noting that women who develop gestational diabetes have an increased risk of developing type 2 diabetes later in life. Regular screening and maintaining a healthy lifestyle can help mitigate this risk.

What is the long-term diabetes risk for children born to mothers with type 2 diabetes?

Children born to mothers with type 2 diabetes have an increased risk of developing obesity and type 2 diabetes later in life. This risk is influenced by both genetic factors and the intrauterine environment. Promoting healthy eating habits and regular physical activity from an early age can help reduce this risk.

In conclusion, while type 2 diabetes adds complexity to pregnancy, with proper planning, management, and medical care, women can significantly reduce risks and increase the likelihood of a healthy pregnancy and baby. Regular communication with your healthcare team, strict adherence to treatment plans, and a commitment to a healthy lifestyle are key factors in achieving the best possible outcomes for both mother and child.

Diabetes and pregnancy – NHS

If you become pregnant and you have diabetes, you should go on to have a healthy baby. But there are some possible complications you should be aware of.

The information on this page is relevant for you if you were diagnosed with type 1 or type 2 diabetes before you got pregnant.

It does not cover gestational diabetes, which is high blood sugar that develops during pregnancy and usually goes away after the baby is born.

Important:
Coronavirus (COVID-19) update

If you’re well, it’s really important you go to all your appointments and scans for the health of you and your baby.

If you’re pregnant, hospitals and clinics are making sure it’s safe for you to go to appointments.

If you get symptoms of COVID-19, or you’re unwell with something other than COVID-19, speak to your midwife or maternity team. They will advise you what to do.

Find out more about pregnancy and COVID-19

What it means for you

If you have type 1 or type 2 diabetes, you may be at higher risk of having:

People with diabetes (whether they are pregnant or not) are at risk of developing problems with their eyes (diabetic retinopathy) and kidneys (diabetic nephropathy).

Some people with type 1 diabetes can develop diabetic ketoacidosis, where harmful chemicals called ketones build up in the blood.

Pregnancy can increase your risk of developing these problems or make existing ones worse.

What it means for your baby

If you have type 1 or type 2 diabetes, your baby may be at higher risk of:

• having health problems shortly after birth, such as heart and breathing problems, and needing hospital care
• developing obesity or diabetes later in life

There’s also a slightly higher chance of your baby being born with birth defects, particularly heart and nervous system abnormalities, or being stillborn or dying soon after birth.

But managing your diabetes well, before and during your pregnancy, will help to reduce these risks.

Reducing the risks

The best way to reduce the risks to you and your baby is to ensure your diabetes is well controlled before you become pregnant. So, ideally, a pregnancy should be planned.

Before you start trying for a baby, ask your GP or diabetes specialist (diabetologist) for advice. You should be referred to a diabetic pre-conception clinic for support.

Find diabetes support services near you.

You should be offered a blood test, called an HbA1c test, every month. This measures the level of glucose in your blood.

It’s best if the level is no more than 6.5% before you get pregnant. If you cannot get your level below 6.5%, try to get it as close as possible to reduce the risk of complications for you and your baby.

If your blood glucose level is above 10%, your care team should strongly advise you not to try for a baby until it has fallen.

You should continue using contraceptives until you get your blood glucose under control. A GP or diabetes specialist can advise you about how best to do this.

If you have type 1 diabetes, you should be given testing strips and a monitor to test your blood ketone levels, to check for diabetic ketoacidosis. You should use these if your blood glucose levels are high, or if you are being sick or have diarrhoea.

Folic acid

If you have diabetes and are trying to get pregnant, you should take 5 milligrams (mg) of folic acid each day (and until you are 12 weeks pregnant). A doctor will have to prescribe this, because you cannot buy 5mg tablets from a pharmacy or shop without a prescription.

Taking folic acid helps prevent your baby developing birth defects, such as spina bifida.

Your diabetes treatment in pregnancy

Your doctors may recommend changing your treatment regime during pregnancy.

If you usually take tablets to control your diabetes, you’ll normally be advised to switch to insulin injections, either with or without a medicine called metformin.

If you already use insulin injections to control your diabetes, you may need to switch to a different type of insulin.

If you take medicines for conditions related to your diabetes, such as high blood pressure, these may have to be changed.

It’s very important to attend any appointments made for you so that your care team can monitor your condition and react to any changes that could affect your or your baby’s health.

You will need to monitor your blood glucose levels more frequently during pregnancy, especially since nausea and vomiting in pregnancy (known as “morning sickness”, although it can happen at any time of the day) can affect them. Your GP or midwife will be able to advise you on this.

Keeping your blood glucose levels low may mean you have more low-blood-sugar (hypoglycaemic) attacks (“hypos”). These are harmless for your baby, but you and your partner need to know how to cope with them. Talk to your doctor or diabetes specialist.

Diabetic eye screening in pregnancy

You will be offered regular diabetic eye screening during your pregnancy. This is to check for signs of diabetic eye disease (diabetic retinopathy).

Screening is very important when you are pregnant because the risk of serious eye problems is greater in pregnancy.

Diabetic retinopathy is treatable, especially if it is caught early.

If you decide not to have regular screening tests, you should tell the clinician looking after your diabetes care during pregnancy.

Read Diabetic eye screening.

Labour and birth

If you have diabetes, it’s strongly recommended that you give birth in a hospital with the support of a consultant-led maternity team.

Your doctors may recommend having your labour started early (induced). This is because there may be an increased risk of complications for you or your baby if your pregnancy carries on for too long.

If your baby is larger than expected, your doctors might discuss your options for the delivery and may suggest an elective caesarean section.

Your blood glucose should be measured every hour during labour and birth. You may be given a drip in your arm with insulin and glucose if there are problems.

After the birth

Feed your baby as soon as possible after the birth (within 30 minutes) to help keep their blood glucose at a safe level.

Your baby will have a heel prick blood test (or newborn blood spot test) a few hours after they’re born to check if their blood glucose level is too low.

If your baby’s blood glucose cannot be kept at a safe level, or they’re having problems feeding, they may need extra care. Your baby may need to be fed through a tube or given a drip to increase their blood glucose.

Read more about special care for babies.

After your pregnancy, you should not need as much insulin to control your blood glucose. You should be able to decrease your insulin to your pre-pregnancy dose or return to the tablets you were taking before you became pregnant. Talk to your doctor about this.

You should be offered a test to check your blood glucose levels before you go home and at your 6-week postnatal check. You should also be given advice about diet and exercise.

Video: gestational diabetes

This video gives advice about gestational diabetes and Kimberly talks about her pregnancy after being diagnosed.

Media last reviewed: 10 March 2019
Media review due: 10 March 2022

Community content from HealthUnlocked

Diabetes and Pregnancy

It is estimated that between 2% and 3% percent of pregnant women are affected by gestational diabetes during pregnancy.

If the mother’s body cannot produce sufficient insulin to overcome this, diabetes in pregnancy can develop.

Genetics and pregnancy

Genetics is a prominent factor as to whether your child will develop diabetes, with the risk heightened if the newborn’s parents or siblings have diabetes.

The risk percentages vary between type 1 and type 2 diabetes and are also dependent on which parent has diabetes. Read more about genetics and diabetes

Type 1 diabetes and pregnancy

People with type 1 diabetes should aim to achieve tight control of their diabetes prior to and throughout their pregnancy.

To help you to meet the target level of diabetes control, you may be put onto an insulin pump, if you are not on one already, and your health team should provide plenty of support.

Transcript

You may already have diabetes, such as type 1 or type 2 diabetes, before starting your pregnancy or you may develop gestational diabetes during your pregnancy.

Gestational diabetes is a form or diabetes that can develop specifically during pregnancy and usually disappears again after pregnancy has finished. See our video on gestational diabetes for more info about this type of diabetes.

Blood sugar control is especially important during pregnancy to ensure your baby is healthy. The target HbA1c for mothers in pregnancy is 6.1% (43 mmol/mol). This can be quite a challenging target, which may require dedication to reach.

If you have diabetes before your pregnancy then it’s best to prepare for pregnancy before you try to conceive. Preparation may include:

• Undergoing a health assessment
• Attending a preconception clinic
• Achieving the target HbA1c for pregnancy
• Being vaccinated against illnesses such as chickenpox and rubella
• Begin taking folic acid

Depending on your type of diabetes, you may or may not need medication.

If you have type 1 diabetes, you may be put onto an insulin pump to help you achieve tight diabetes control. If you have type 2 diabetes, you may or may not need medication. It is possible that you may be put onto insulin or have your medication changed during pregnancy.

If you develop gestational diabetes, you may or may not need medication depending on your blood sugar levels.

Having diabetes can increase the chances of problems developing for your baby such as:

• Having a larger baby
• Abnormal development of organs
• Higher likelihood of the baby developing diabetes later in life
• Stillbirth or miscarriage

These risks can be reduced with good control of blood sugar levels through your pregnancy.

People with diabetes are more at risk of the following difficulties during pregnancy:

• Pre-eclampsia – very high blood pressure
• Development of retinopathy – particularly if blood pressure rises significantly

Again, achieving good control of your diabetes can help to reduce the risks.

Some of the risks may come across as quite scary but expecting mothers with diabetes are well looked after by health teams. You can expect to receive regular checks throughout your pregnancy and access to specialists.

If you have questions or any concerns, they will be happy to help you.

Type 2 diabetes and pregnancy

Pregnancy typically places higher demands for insulin than normal and therefore it is quite common for people with type 2 diabetes to be put onto insulin during their pregnancy.

Whether you are put onto insulin or not, you should receive plenty of help from your health team to ensure your diabetes is well controlled through your pregnancy.

Gestational diabetes and pregnancy

Gestational diabetes is a form of diabetes that develops during pregnancy if the body cannot fully cope with the additional insulin demands of both the mother and baby.

The first line of treatment for gestational diabetes is through diet and exercise, however, diabetes tablets and insulin may be needed if blood glucose levels remain high.

Target blood glucose levels before and during pregnancy

The target HbA1c (a measure of long term diabetic control) for people with diabetes prior to and during pregnancy is 6.1% (or 43 mmol/mol). ^[91]

Risks for your baby from diabetes during pregnancy

The following risks are more common as a result of diabetes:

• Abnormal development, particularly with the baby’s heart
• Heart and breathing problems shortly after birth
• Stillbirth or death shortly after the birth
• Developing diabetes later in life

These risks can be reduced with good diabetes control.

Risks for a mother from diabetes in pregnancy

Raised blood sugar levels during pregnancy increases your chances of having a larger baby, which could mean the need to have an induced labour or a caesarean section delivery.

The chances of suffering a miscarriage are also higher with diabetes. Similarly to the risks for your baby, the risks for you can also be reduced with well controlled diabetes.

Diabetes and preconception care

If you have diabetes prior to being pregnant, it is highly recommended to prepare for your pregnancy by ensuring you receive preconception care. Make an appointment to discuss the best preparation for your pregnancy.

Blood glucose control during pregnancy

Hypoglycemia (low blood sugar levels) and hyperglycemia (high blood sugar levels) are both likely to happen during pregnancy.

Keeping your blood sugar levels well managed is essential to reduce the chances of complications developing for you or your baby.

Pregnancy and the artificial pancreas

In April 2015, a 41-year-old Norfolk woman with type 1 diabetes became the first in the world to give birth naturally using an artificial pancreas.

The device, developed at Cambridge University, produced insulin for Catriona Finlayson-Wilkins throughout her pregnancy. All previous births using the artificial pancreas were carried out through caesarean section.

The artificial pancreas helped control the mother’s blood glucose levels using a computer algorithm. It is worn externally on the body.

Gestational Diabetes Mellitus (GDM) | Johns Hopkins Medicine

What is gestational diabetes mellitus?

Gestational diabetes mellitus (GDM)  is a condition in which a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells.

Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin, but by other hormones produced during pregnancy that can make insulin less effective, a condition referred to as insulin resistance. Gestational diabetic symptoms disappear following delivery.

Approximately 3 to 8 percent of all pregnant women in the United States are diagnosed with gestational diabetes.

What causes gestational diabetes mellitus?

Although the cause of GDM is not known, there are some theories as to why the condition occurs.

The placenta supplies a growing fetus with nutrients and water, and also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

What are the risks factors associated with gestational diabetes mellitus?

Although any woman can develop GDM during pregnancy, some of the factors that may increase the risk include the following:

• Overweight or obesity

• Family history of diabetes

• Having given birth previously to an infant weighing greater than 9 pounds

• Age (women who are older than 25 are at a greater risk for developing gestational diabetes than younger women)

• Race (women who are African-American, American Indian, Asian American, Hispanic or Latino, or Pacific Islander have a higher risk)

• Prediabetes, also known as impaired glucose tolerance

Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for GDM.

How is gestational diabetes mellitus diagnosed?

The American Diabetes Association recommends screening for undiagnosed type 2 diabetes at the first prenatal visit in women with diabetes risk factors. In pregnant women not known to have diabetes, GDM testing should be performed at 24 to 28 weeks of gestation.

In addition, women with diagnosed GDM should be screened for persistent diabetes 6 to 12 weeks postpartum. It is also recommended that women with a history of GDM undergo lifelong screening for the development of diabetes or prediabetes at least every three years.

What is the treatment for gestational diabetes mellitus?

Specific treatment for gestational diabetes will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:

Possible complications for the baby

Unlike type 1 diabetes, gestational diabetes generally occurs too late to cause birth defects. Birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy. The insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes mellitus generally have normal blood sugar levels during the critical first trimester.

The complications of GDM are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of diabetes is made.

Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia:

• Macrosomia. Macrosomia refers to a baby who is considerably larger than normal. All of the nutrients the fetus receives come directly from the mother’s blood. If the maternal blood has too much glucose, the pancreas of the fetus senses the high glucose levels and produces more insulin in an attempt to use this glucose. The fetus converts the extra glucose to fat. Even when the mother has gestational diabetes, the fetus is able to produce all the insulin it needs. The combination of high blood glucose levels from the mother and high insulin levels in the fetus results in large deposits of fat which causes the fetus to grow excessively large.

• Hypoglycemia. Hypoglycemia refers to low blood sugar in the baby immediately after delivery. This problem occurs if the mother’s blood sugar levels have been consistently high, causing the fetus to have a high level of insulin in its circulation. After delivery, the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother, resulting in the newborn’s blood sugar level becoming very low. The baby’s blood sugar level is checked after birth, and if the level is too low, it may be necessary to give the baby glucose intravenously.

Blood glucose is monitored very closely during labor. Insulin may be given to keep the mother’s blood sugar in a normal range to prevent the baby’s blood sugar from dropping excessively after delivery.

Preexisting diabetes

What is preexisting diabetes?

Diabetes is a condition in which your body has too much sugar in the blood (called blood sugar or glucose). Preexisting diabetes (also called pregestational diabetes) means you have diabetes before you get pregnant. This is different from gestational diabetes, which is a kind of diabetes that some women get during pregnancy. Women with diabetes can and do have healthy pregnancies and healthy babies. But untreated diabetes can cause complications for both moms and babies.

In the United States, about 1 to 2 percent of pregnant women have preexisting diabetes. The number of women with diabetes during pregnancy has increased in recent years.

When you eat, your body breaks down sugar and starches from food into glucose to use for energy. Your pancreas (an organ behind your stomach) makes a hormone called insulin that helps your body keep the right amount of glucose in your blood.  When you have diabetes, your body doesn’t make enough insulin or can’t use insulin well, so you end up with too much sugar in your blood. This can cause serious health problems, like heart disease, kidney failure and blindness. High blood sugar can be harmful to your baby during the first few weeks of pregnancy when his brain, heart, kidneys and lungs begin to form. Treatment for diabetes can help prevent problems like these. 

There are two types of preexisting diabetes. Managing them before and during pregnancy can help reduce your risk of complications: 

• Type 1 diabetes. This is when your body doesn’t make insulin. This is because your immune system destroys the cells in your pancreas that make insulin. If you have type 1 diabetes, you need to take insulin every day. Type 1 diabetes is usually diagnosed in children and young adults, but you can get it at any age.
• Type 2 diabetes. This is the most common kind of diabetes. If you have type 2 diabetes, your body makes insulin but doesn’t make or use it well. It most often is diagnosed in adults, but you can develop it at any age. 

Can preexisting diabetes cause problems during pregnancy? 

Yes. If it’s not managed well, diabetes can increase your risk for complications during pregnancy, including:

• Birth defects, like heart defects and birth defects of the brain and spine called neural tube defects (also called NTDs). Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works.
• Cesarean birth. Cesarean birth (also called c-section) is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb). You may need to have a c-section if you have complications during pregnancy, like your baby being very large (called macrosomia).
• High blood pressure and preeclampsia. High blood pressure is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Preeclampsia is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having protein in the urine, changes in vision and severe headaches.
• Macrosomia or fetal growth restriction. These conditions have to do with your baby’s weight. Macrosomia is when a baby weighs more than 8 pounds, 13 ounces (4,000 grams) at birth. Weighing this much makes your baby more likely to get hurt during labor and birth. And you may need to have a c-section to keep you and your baby safe. Fetal growth restriction (also called small for gestational age) is when a baby doesn’t gain the weight he should before birth.
• Miscarriage and stillbirth. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb after 20 weeks of pregnancy.
• Perinatal depression. This is depression that happens during pregnancy or in the first year after having a baby (also called postpartum depression). Depression is a medical condition that causes feelings of sadness and a loss of interest in things you like to do. It can affect how you feel, think and act and can interfere with your daily life. It needs treatment to get better.
• Preterm labor and premature birth. Preterm labor is labor that starts too early, before 37 weeks of pregnancy. Premature birth is birth that happens before 37 weeks of pregnancy. Premature babies are more likely than full-term babies to have health problems at birth and later in life. Women with diabetes are at increased risk for a condition called polyhydramnios. This is when there’s too much amniotic fluid in the sac around your baby. This can lead to preterm labor and premature birth. If there are problems with your pregnancy, your provider may induce your labor, sometimes earlier than your due date. Inducing labor means your provider gives you medicine or breaks your water (amniotic sac) to make your labor begin.  
• Shoulder dystocia or other birth injuries (also called birth trauma). Shoulder dystocia happens when a baby’s shoulders get stuck inside the mother’s pelvis during labor and birth. It often happens when a baby is very large. It can cause serious injury to both mom and baby. Complications for moms caused by shoulder dystocia include postpartum hemorrhage (heavy bleeding). For babies, the most common injuries are fractures to the collarbone and arm and damage to the brachial plexus nerves. These nerves go from the spinal cord in the neck down the arm. They provide feeling and movement in the shoulder, arm and hand.

Most babies born to women with preexisting diabetes are healthy after birth. But preexisting diabetes can increase your baby’s risk for health problems, including:

• Autism spectrum disorder. A group of developmental disabilities that can cause social, communication and behavior challenges. Developmental disabilities are problems with how the brain works that can cause a person to have trouble or delays in physical development, learning, communicating, taking care of himself or getting along with others.
• Enlarged organs if your baby is very large
• Jaundice. This is when a baby’s eyes and skin look yellow because his liver isn’t fully developed or isn’t working.
• Obesity later in life. Obesity is being very overweight. It means you have an excess amount of body fat and a body mass index (also called BMI) of 30 or higher. To find out your BMI, go to cdc.gov/bmi.
• Hypoglycemia (also called low blood sugar) and polycythemia. Polycythemia is when the body makes too many red blood cells which causes the blood to be thick.
• Respiratory distress syndrome (also called RDS). This is a breathing problem caused when babies don’t have enough surfactant in their lungs. Surfactant is a protein that keeps the small air sacs in the lungs from collapsing.

Pregnancy can make health complications associated with diabetes worse. Some can be life-threatening. Getting regular treatment and managing your diabetes during pregnancy can help you prevent severe complications. 

What kinds of health care providers do you need to treat preexisting diabetes during pregnancy? 

To best manage your diabetes during pregnancy, you need a team of health care providers who work together to give you the best all-around care. Your team is led by:

• Your prenatal care provider
• Your endocrinologist. This is a doctor who treats people with diabetes and other diseases of the endocrine system. The endocrine system is all the glands in your body that produce hormones that control how your body works.

Your team also may include other providers, including:

• A perinatologist. This is a doctor who treats women with high-risk pregnancies.
• A diabetes educator. This person has training to help you control your blood sugar.
• A registered dietitian (also called RD). This health professional has training to help you use diet and nutrition to help you stay healthy.  
• Your baby’s health care provider, especially as you get closer to your baby’s birth.

Before you try to get pregnant, make sure each provider knows about your pregnancy plans and the other providers you see. All your providers work together with you to help you get ready for pregnancy and stay healthy during pregnancy. They make sure that any treatment you get is safe for your baby. Share their contact information so you and your providers can connect easily.

If you have diabetes, what can you do before you get pregnant to help you have a healthy pregnancy?

Plan ahead so you’re as healthy as you can be before you get pregnant. Here’s what you can do:

• Manage your diabetes. Get your diabetes under control 3 to 6 months before you start trying to get pregnant. Make sure all the providers on your health care team know you’re trying to get pregnant.
• Use birth control until your diabetes is under control and you’re ready to get pregnant. Birth control (also called contraception and family planning) is methods you can use to keep from getting pregnant. Also called contraception or family planning. Methods you can use to keep from getting pregnant. Birth control pills and intrauterine devices (also called IUDs) are examples of birth control.
• Take a multivitamin with 400 micrograms of folic acid in it every day. Folic acid is a vitamin that every cell in your body needs for healthy growth and development. If you take it before pregnancy and during early pregnancy as part of healthy eating, it can help protect your baby from neural tube defects. If you have diabetes, your provider may need more than 400 micrograms of folic acid each day. Talk to your provider about the right amount of folic acid for you.
• Tell your prenatal provider about any medicine you take. Your provider can make sure the medicine is safe for your baby when you do get pregnant. If not, you may need to change to another medicine.  Don’t start or stop taking any medicine during pregnancy without talking to your provider team first.
• Eat healthy foods and do something active every day. Work with your RD or diabetes educator to create a healthy meal plan to help control your blood sugar.  

How is preexisting diabetes treated during pregnancy? 

If you have diabetes, your prenatal care provider wants to see you often during pregnancy so she can monitor you and your baby closely to help prevent problems. At each prenatal care checkup, you get tests to make sure you and your baby are doing well. Tests can include:

• An ultrasound in the second trimester that includes a detailed look at your baby, to check his growth, weight and heart. Ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.
• Tests like the nonstress test and the biophysical profile. The nonstress test checks your baby’s heart rate. The biophysical profile is a nonstress test with an ultrasound.  

Your provider tells you how often to check your blood sugar, what your levels should be and how to manage them during pregnancy. Blood sugar is affected by pregnancy, what you eat and drink and how much physical activity you get. What worked for you before pregnancy to control your blood sugar may not work as well during pregnancy. You may need to change what you eat or your physical activity. If you were taking insulin before pregnancy, you may need to take more during pregnancy, or you may need to take insulin shots. 

Here’s what you can do to help manage your diabetes during pregnancy:

• Go to all your prenatal care checkups, even if you’re feeling fine. And keep seeing all the providers on your health care team who help you manage your diabetes.
• Follow your provider’s directions about how often to check your blood sugar. Call your provider if your blood sugar is too high or too low. Keep a log that includes your blood sugar level every time you check it. Share the log with your provider at each prenatal checkup.
• If you take insulin, take it exactly as your provider tells you to. You need more insulin during pregnancy, especially between 28 and 32 weeks of pregnancy. Insulin is safe for your baby during pregnancy and labor.
• Tell your providers about any medicine you take, even medicine that’s not related to your diabetes. Some medicines can be harmful during pregnancy, so your provider may need to change them to ones that are safer for you and your baby. Don’t start or stop taking any medicine during pregnancy without talking to your provider first.
• Talk to your provider about taking low-dose aspirin. Low-dose aspirin (also called baby aspirin or 81 mg aspirin) can help prevent preeclampsia. You can start taking low-dose aspirin after 12 weeks of pregnancy (before 16 weeks is best). Don’t start or stop taking low-dose aspirin or any other medicine during pregnancy without talking to your provider first.
• If you don’t have a dietician, get one. Your provider can recommend one for you. An RD can help you learn what, how much and how often to eat to best control your diabetes. She can help you make meal plans and help you know the right amount of weight to gain during pregnancy. Check to see if your health insurance covers treatment from an RD. Eating healthy foods and being active every day can help you manage your diabetes.
• Ask your provider if you need to have a c-section. Diabetes increases your chances for needing a c-section. If your provider thinks you need to have your baby by c-section, ask about timing. If your diabetes is well controlled, ask about waiting until at least 39 weeks to have your baby. This gives your baby time to grow and develop in the womb before birth. If you have complications during pregnancy, you may need to have your baby earlier.

During labor and birth, your provider watches your glucose level closely. You can take insulin during labor.

What is insulin resistance?

Some pregnant women with diabetes become insulin resistant. This means your body makes insulin but doesn’t use it well. During pregnancy, the placenta grows in your uterus (womb) and supplies food and oxygen to your baby through the umbilical cord. The placenta also makes hormones that help your baby develop. But these hormones can make you insulin resistant. You may need more and more insulin the longer you’re pregnant—up to 3 times as much as you needed before pregnancy. You’re most resistant to insulin in your third trimester.

If you have preexisting diabetes, is it OK to breastfeed? 

Yes. If you have diabetes, it’s safe to breastfeed your baby. Breast milk is the best food for a baby in the first year of life. It helps him grow healthy and strong. Talk to your providers before your baby is born about breastfeeding:  

• Talk to your dietician. She can help create a new meal plan to make sure you get all the calories you need for you and your baby. You need about 500 more calories each day for breastfeeding. She may recommend that you eat a healthy snack before or after breastfeeding.
• Talk to your providers about the amount of insulin you need. You may need less insulin than usual for a few days after giving birth, and breastfeeding can lower the amount even further. It’s safe to take insulin while breastfeeding.
• Talk to your providers about how often to monitor your blood sugar. If you’re breastfeeding, your providers may want you to check your blood sugar more often than usual. 

What are hypoglycemia and hyperglycemia? 

Hypoglycemia is low blood sugar and hyperglycemia is high blood sugar. Both of these conditions are common if you have preexisting diabetes. If you have signs or symptoms of either condition, tell your provider. Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

If you have preexisting diabetes, you’re more likely to have low blood sugar (hypoglycemia) during pregnancy. This can happen if you don’t eat enough or often enough, if you get too much physical activity or if you take too much insulin. It’s usually mild and easily treated by eating or drinking something. But if it’s not treated, it can cause you to pass out. Signs and symptoms of hypoglycemia include:

• Being hungry
• Having a headache
• Feeling weak, dizzy, shaky, confused, anxious (worried) or cranky
• Looking pale
• Sweating
• Having a fast heart beat

You also may have high blood sugar (hyperglycemia), even if you’re being treated for diabetes. You may have hyperglycemia if:

• You don’t take your medicine at the right times.
• You eat more than usual or at irregular times.
• You’re less active than normal.
• You’re sick.

If you have hyperglycemia, you may need to change the amount of insulin you take, your meal plan or the amount of physical activity you get. Signs and symptoms of hyperglycemia include:

• Being thirsty
• Having a headache
• Needing to urinate often
• Felling weak or tired
• Having trouble paying attention
• Having blurred vision
• Having a yeast infection

Your provider can check you for these conditions during pregnancy to make sure you and your baby stay healthy.

Last reviewed: April, 2019

Gestational Diabetes (Diabetes During Pregnancy)

Your health care team will help you make a healthy eating plan with food choices that are good for both you and your baby. These choices are good for you to follow throughout pregnancy and after, as you raise your family.

Using a healthy eating plan will help your blood glucose stay in your target range. The plan will help you know which foods to eat, how much to eat, and when to eat. Food choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.

More information is provided in the NIDDK health topic, What I need to know about Eating and Diabetes.

Physical Activity

Physical activity can help you reach your blood glucose targets. Talk with your doctor about the type of activity that is best for you. If you are already active, tell your doctor what you do. Being physically active will also help lower your chances of having type 2 diabetes—and its problems—in the future. Now is the time to develop good habits for you and your baby.

• Be as physically active as you can. Aim for at least 30 minutes most days of the week.
• Do aerobic activities, which use your large muscles to make your heart beat faster. Try brisk walking, swimming, dancing, or low-impact aerobics.
• Ask your doctor if you may continue some higher intensity sports to strengthen muscles and bone if you were already doing them before becoming pregnant, such as lifting weights or jogging.
• Avoid activities in which you can get hit in the stomach, such as basketball or soccer.
• Avoid activities that may cause you to fall, such as horseback riding or downhill skiing.
• Do not exercise on your back after the first trimester. This kind of physical activity can put too much pressure on an important vein and limit blood flow to your baby.

For more information about physical activity and pregnancy, visit www.womenshealth.gov/pregnancy .

Insulin Shots

If you have trouble meeting your blood glucose targets, you may need to take a medicine called insulin, along with following a healthy meal plan and being physically active. Your health care team will show you how to give yourself insulin shots. Insulin will not harm your baby.

How Will I Know Whether My Blood Glucose Levels Are on Target?

Your health care team may ask you to use a small device called a blood glucose meter to check your blood glucose levels on your own. You will learn:

• how to use the meter,
• how to prick your finger to obtain a drop of blood,
• what your blood glucose target range is, and
• when to check your blood glucose.

You may be asked to check your blood glucose:

• when you wake up,
• just before meals,
• 1 or 2 hours after breakfast,
• 1 or 2 hours after lunch, and
• 1 or 2 hours after dinner.

Each time you check your blood glucose, write down the results in a record book. Ask your health care team for a blood glucose record book or use an electronic blood glucose tracking system on the Internet or on your cell phone. Always bring your blood glucose meter and your record book to your checkups so you can talk with your health care team about reaching your target blood glucose levels.

Will I Need to Do Other Tests on My Own?

Your health care team may teach you how to test for chemicals called ketones in your morning urine or in your blood. High levels of ketones are a sign that your body is using your body fat for energy instead of the food you eat. Using fat for energy is not recommended during pregnancy. Ketones may be harmful for your baby.

If your ketone levels are high, your doctor may suggest that you change the type or amount of food you eat. Or you may need to change your meal or snack times.

Gestational Diabetes: Causes, Diagnosis & Treatments

Overview

What is gestational diabetes?

Gestational diabetes (GD) is a type of diabetes. The condition develops in pregnant women if their blood sugar levels get too high. GD usually appears during the middle of pregnancy, between 24 and 28 weeks.

Developing GD doesn’t mean you already had diabetes before you got pregnant. The condition appears because of the pregnancy. Women with Type 1 and Type 2 diabetes have their own, separate challenges when it comes to pregnancy.

How common is gestational diabetes in pregnancy?

Between 2% and 10% of pregnant women in the U.S. develop gestational diabetes.

Symptoms and Causes

What causes gestational diabetes?

Gestational diabetes comes from hormonal changes, and the way our bodies convert food into energy.

A hormone called insulin breaks down the glucose (sugar) from food and delivers it to our cells. Insulin keeps the level of glucose in our blood at a healthy level. But if insulin doesn’t work right or we don’t have enough of it, sugar builds up in the blood and leads to diabetes.

During pregnancy, hormones can interfere with the way insulin works. It may not regulate your blood sugar levels like it’s supposed to, which can lead to gestational diabetes.

Who is at risk for gestational diabetes?

Gestational diabetes can develop in any woman who is pregnant. But women over the age of 25 who are of African, Asian, Hispanic, Native American or Pacific Island descent are at a higher risk.

Other factors that may increase your chances of GD include:

What are the symptoms of gestational diabetes?

Gestational diabetes doesn’t usually cause any symptoms. But some women experience:

• Frequent urination.
• Nausea.
• Thirst.
• Tiredness.

Diagnosis and Tests

When does a healthcare provider test for gestational diabetes?

Your healthcare provider tests for gestational diabetes around weeks 24 to 28 of your pregnancy. At this stage, hormones start getting produced by the placenta. This organ forms in the uterus and supplies the baby with oxygen and nutrients. The hormones it makes can interfere with insulin.

How is gestational diabetes diagnosed?

Your healthcare provider will test your blood sugar during pregnancy. The test may have two parts:

• Glucose challenge test: You drink a sweet liquid. After about an hour, you’ll have a blood test to check your blood sugar level. If your blood sugar is high, your healthcare provider will do a glucose tolerance test.
• Glucose tolerance test: An oral glucose tolerance test is only done if your challenge test results are unusual. You fast (don’t eat for eight hours) before the tolerance test. Your healthcare provider draws your blood before and after you drink a sweet liquid. The tolerance test can confirm a diagnosis of gestational diabetes.

Management and Treatment

Why is it important to treat gestational diabetes?

If left untreated, gestational diabetes can pose health risks to both you and your baby.

Gestational diabetes increases your risk of:

Gestational diabetes increases your baby’s risk of:

• Breathing problems.
• Hypoglycemia.
• Obesity.
• Premature birth.
• Type 2 diabetes.

How is gestational diabetes managed?

If you’re diagnosed with gestational diabetes, you may need more frequent checkups during your pregnancy. Your healthcare provider will check your blood sugar levels regularly. You may need to monitor your blood sugar at home with a tool called a glucose meter.

Some women need medication to manage gestational diabetes. But most women can keep their blood sugar levels under control with diet and exercise.

How should I change my diet for gestational diabetes?

You may need to adjust your diet to keep gestational diabetes under control. Try to:

• Avoid junk food, processed foods and sugary drinks.
• Choose a healthy balance of proteins, carbohydrates, fiber and fat.
• Eat smaller meals more often.
• Schedule your meals at the same time each day.

How can I exercise safely during pregnancy?

Exercise helps your body use more glucose, which may lower your blood sugar. If you have gestational diabetes, talk to your healthcare provider about creating a safe exercise plan. Your exercise plan should get tailored to your unique needs, including your:

• Age.
• Fitness level before pregnancy.
• Overall health.
• Weight.

Prevention

How can gestational diabetes be prevented?

Reduce your risk of gestational diabetes by staying healthy before and during your pregnancy. Eat a balanced diet and get regular exercise.

Outlook / Prognosis

Will gestational diabetes go away after pregnancy?

Most women’s blood sugar levels come down after they give birth and hormone levels return to normal. But about 50% of women with gestational diabetes develop Type 2 diabetes later in life. Diet and exercise can help lower your risk. Your healthcare provider may recommend blood glucose tests every six to 12 weeks after pregnancy to watch for diabetes.

Living With

What can I do to make living with gestational diabetes easier?

Make diabetes management part of your daily routine. Create a schedule and stick to it. Try to:

• Check your blood glucose levels at the same time each day.
• Choose three days each week to get 30 minutes of light exercise.
• Plan small, balanced meals ahead of time.
• Talk with your healthcare provider or a diabetes educator about other tips for daily diabetes management.

A note from Cleveland Clinic

Gestational diabetes (GD) develops in pregnant women when there’s too much glucose in their blood. GD is usually diagnosed during the middle stage of pregnancy with a few simple blood tests. If left untreated, GD can cause health complications for the mother and the baby. Most women can manage gestational diabetes with diet and exercise. Some will need medication. Gestational diabetes increases your risk of developing Type 2 diabetes later in life. Talk to your healthcare provider about ways to reduce your risk of diabetes before, during and after pregnancy.

Diabetes – gestational – Better Health Channel

Gestational diabetes is diabetes that occurs during pregnancy. Diabetes is a common condition where there is too much glucose in the blood. Gestational diabetes usually goes away after the baby is born. It is important to have a follow-up glucose tolerance test 6 to 12 weeks after the birth to confirm that you no longer have diabetes.  

How does gestational diabetes develop?

Your body makes insulin to help keep your blood glucose at the right level. Your blood glucose levels become higher if your body doesn’t make enough insulin or if your insulin does not work as well as it should. 

During pregnancy, hormones are made by the placenta to help the baby develop and grow. These hormones, however, stop the mother’s insulin from working properly. This is called insulin resistance. As the pregnancy develops and the baby grows bigger, the mother’s body has to make more insulin to keep her blood glucose at the optimal level.

Later in pregnancy the amount of insulin needed to keep blood glucose levels optimal is two to three times higher than usual. If the mother is unable to produce enough insulin to meet this demand then her blood glucose levels rise and gestational diabetes develops.

The baby’s response to the higher glucose levels is to make more insulin. This can lead to the baby becoming larger than usual and cause problems during and after birth. 

Who is at risk of gestational diabetes?

Between three and eight per cent of pregnant women develop gestational diabetes. It is usually detected around weeks 24 to 28 of pregnancy, although it can develop earlier. Being diagnosed with gestational diabetes can be both unexpected and upsetting.

Certain women are at increased risk of developing gestational diabetes. This includes women who:

• are over 40 years of age
• have a family history of type 2 diabetes
• are overweight or obese
• are of Aboriginal and Torres Strait Islander descent
• are of particular cultural groups, such as Indian, Chinese, Vietnamese, Middle Eastern, Polynesian and Melanesian
• have previously had gestational diabetes
• take some antipsychotic or steroid medications
• have previously had a baby whose birth weight was greater than 4,500 grams (4. 5 kg)
• have had a previous complicated pregnancy
• have polycystic ovarian syndrome.

Some women who develop gestational diabetes have no known risk factors.

What are the symptoms of gestational diabetes?

Gestational diabetes usually has no obvious symptoms. If symptoms do occur, they can include:

• increased thirst
• excessive urination
• tiredness
• thrush (yeast infections). 

How is gestational diabetes diagnosed?

Most women are diagnosed using a pathology test, which requires blood samples to be taken before and after a glucose drink. This is known as a pregnancy oral glucose tolerance test (OGTT). These tests are usually performed between 24 and 28 weeks into the pregnancy, or earlier if you are at high risk.

A pregnancy oral glucose tolerance test involves:

• fasting overnight
• having a blood test in the morning
• having a drink containing 75 grams of glucose 
• having a blood test one hour after having the drink
• having a blood test two hours after having the drink.

Gestational diabetes is diagnosed if any of these blood tests show that your blood glucose is raised.

How do you manage gestational diabetes?

If you are diagnosed with gestational diabetes it is important that you are supported and know what to do to manage it. Health professionals such as your doctor, a dietitian, a diabetes nurse educator or sometimes a diabetes specialist will help you understand what to do and will support you. 

Family also can be a great support. It is important that your family understands about gestational diabetes and how it is managed.

Management of gestational diabetes aims to keep blood glucose levels in the recommended range during pregnancy. This can prevent problems during birth and also helps reduce the baby’s risk of being overweight in childhood and developing type 2 diabetes later in life. 

Management of gestational diabetes involves:

• monitoring blood glucose levels
• healthy eating
• regular physical activity
• education about insulin commencement.

Some women may need insulin injections to help manage their gestational diabetes.

Monitoring blood glucose levels 

Monitoring your blood glucose levels is essential. It gives you a guide as to whether the changes you have made to your lifestyle are effective or whether further treatment is required. 

A diabetes nurse educator can teach you how and when to measure your blood glucose levels. They will discuss the recommended blood glucose levels to aim for. 

Your doctor or diabetes educator can help you link in with the National Diabetes Services Scheme (NDSS) for cheaper blood glucose strips. Regular contact with your diabetes educator or doctor is recommended.

Healthy eating

Make sure you are eating a nutritious diet that helps you maintain a healthy weight. Tips include:

• Choose varied and enjoyable food, including foods rich in calcium (milk and cheese), iron (red meat, chicken and fish) and folic acid (dark green leafy vegetables).  
• Include some carbohydrates at each meal such as grains, cereals, fruits, pasta and rice. Reduce your saturated fat intake by limiting the amount of processed and takeaway foods that you eat. 
• Avoid foods and drinks containing a lot of added sugar. Discuss with a dietitian how much carbohydrate you should eat and the best way to spread it out throughout the day to help control your blood glucose levels. 

A dietitian can also help you with any other questions about how to make sure you are eating the best diet for you and your baby.

Regular physical activity

Regular physical activity, such as walking, helps to keep you fit, prepares you for the birth of your baby and will help to control your blood glucose levels. 

Check with your doctor before starting a new or particularly strenuous exercise regimen.

Education about insulin commencement

It is very important that you get information and support from your diabetes educator or doctor on how insulin works, how to give insulin and how to store it.  

Insulin sometimes causes blood glucose levels to go too low (hypoglycaemia), so it is very important that you learn the signs and symptoms of this and how to prevent and treat it (as well as safe blood glucose levels for driving).

Insulin injections

You may need insulin injections to help keep your blood glucose level in the normal range. Many diabetes tablets are not safe to take during pregnancy so insulin injections may be necessary. Insulin is safe to take during pregnancy and does not cross the placenta from the mother to the baby.

What happens after my baby is born?

If you have been having insulin injections to help manage gestational diabetes these are usually stopped once your baby is born. This is because women’s blood glucose levels usually return to the optimal range quite quickly after their baby’s birth.

Your blood glucose levels will be measured for a few days after your baby is born to make sure that they are within the recommended range. Glucose checking times are usually before breakfast and two hours after meals. An oral glucose tolerance test (OGTT) is done six to twelve weeks after the baby is born to check that your diabetes has gone away.
Following the birth of your baby, it is important that your baby’s blood glucose levels are measured to check that their blood glucose is not too low. If it is, this can be treated by feeding your baby breast milk or formula. Breastfeeding is encouraged as this is best for you and your baby.

A baby whose mother had gestational diabetes will not be born with diabetes, but they may be at risk of developing type 2 diabetes later in life.

How does gestational diabetes affect any future pregnancies?

If you have had gestational diabetes you are more likely to have it again in future pregnancies. For that reason, a test for gestational diabetes will be performed early in any future pregnancy. If this test gives a result within the recommended range, then another pregnancy OGTT will be done again later in the pregnancy (between 22 and 28 weeks) to make sure your blood glucose levels are still in the recommended range.

How can I reduce my risk of type 2 diabetes?

Women who have gestational diabetes have a high chance (almost one in two) of developing type 2 diabetes at some point later in their lives. However, type 2 diabetes can be prevented. The following steps can reduce your risk: 

• maintain a healthy eating plan
• maintain a healthy weight for your height
• do regular physical activity
• have regular follow-up blood tests (OGTT, fasting blood glucose or HbA1c) every one to three years to check your blood glucose levels, especially if you may have further pregnancies.

Talk to your doctor about follow-up blood tests to check for diabetes. The frequency of the tests will depend on your risk for developing diabetes.

Where to get help

90,000 Diabetes mellitus and pregnancy. What does the expectant mother need to know?

Gestational diabetes mellitus is a type of diabetes that occurs or is first diagnosed during pregnancy. At the heart of the disease is a violation of the metabolism of carbohydrates of varying degrees: a decrease in glucose tolerance in the body of a pregnant woman. His middle name is “pregnancy diabetes.”

In general, diabetes mellitus is a disease characterized by a gross violation of carbohydrate metabolism due to insufficiency of the pancreatic hormone – insulin – in the blood.As a rule, it is accompanied by an increased blood glucose level. According to the WHO, there are several types of diabetes mellitus:

– 1 type. It occurs in childhood and adolescence as a result of the autoimmune decay of specific cells of the pancreas that produce insulin, which leads to a decrease or complete cessation of its production.

– type 2. It develops in overweight people in the second half of life against the background of genetic defects, previous infectious diseases, acute and chronic pancreatitis, taking certain medications and chemicals.The disease is characterized by a hereditary predisposition.

Gestational diabetes mellitus during pregnancy develops as a result of a decrease in the sensitivity of cells and tissues of the body to its own insulin – insulin resistance develops. This is due to an increase in the level of hormones in the blood. In addition, in pregnant women, glucose levels decrease more rapidly due to the needs of the fetus and placenta. All this affects the increase in the production of insulin by the pancreas. That is why insulin levels in the blood of pregnant women are most often increased.If the pancreas cannot produce insulin in the amount required by the pregnant body, gestational diabetes mellitus develops.

Since January 2014, an appropriate test for pregnant women has been introduced in Russia. According to the results of data analysis, 425 patients with gestational diabetes mellitus were registered in the Alexandro-Mariinsky Regional Clinical Hospital alone this year. In 2017, the figure was lower – 420 expectant mothers.

We discussed this urgent problem with the head of the endocrinology department of the Alexandro-Mariinsky Regional Clinical Hospital, the chief freelance specialist of the Ministry of Health of the Astrakhan region, Alla Baghdasaryan.

-Who is more susceptible to this disease. Describe the risk group?

– First, I want to point out that pregnancy is a job that needs preparation. It is very important for us that women treat their health consciously even at the stage of pregnancy planning. Very often girls or women of fertile age “run” themselves. This is a non-observance of a balanced diet, the absence of any physical activity. The consequences of this irresponsible attitude towards the body are obvious – obesity, which is one of the main factors in the development of GDM.

It also develops in the case of a genetic predisposition and other risk factors, such as: disorders of carbohydrate metabolism, high sugar levels in urine, type 2 diabetes mellitus in direct relatives, a woman’s age (over 30 years old), arterial hypertension and other diseases of the cardiovascular systems.

As a freelance specialist of the regional Ministry of Health, I am not just worried about this problem, but very worried when a woman with such a diagnosis comes to our department. I often hear that this disease supposedly stops after childbirth. However, it is not. About 10% of women after childbirth remain with signs of the disease, which subsequently transforms into type 2 diabetes mellitus. According to statistics, it develops over the next 10-15 years in 50% of women who underwent this disease during pregnancy.

– So, the long-awaited pregnancy. What are the symptoms of GDM?

– There are no specific manifestations in gestational diabetes mellitus.Therefore, the only criterion for making a diagnosis is laboratory screening of pregnant women. Women at risk, at the first visit to the antenatal clinic, should be tested for fasting blood sugar levels against the background of a normal diet and physical activity. If your finger stick blood sugar is 4.8-6.0 mmol / L, a special glucose load test is recommended.

To detect gestational diabetes mellitus, an oral glucose tolerance test is performed for all pregnant women between the sixth and seventh months, which shows the quality of glucose uptake by the body. If the level of glucose in blood plasma taken on an empty stomach exceeds 5.1 mmol / L, an hour after a meal – more than 10.0 mmol / L, and after a couple of hours – more than 8.5 mmol / L, then the doctor has a reason to diagnose GDM.

With timely diagnosis of the disease and follow-up, following all the doctor’s recommendations, the risk of having a sick child is reduced to 1-2%.

– What threats does gestational diabetes pose to a baby? What complications of this pathology should expectant mothers know about?

– The fetus receives glucose from the mother, but does not receive insulin.These are the features of carbohydrate metabolism between mother and fetus. Thus, excess glucose is a feature of the first trimester. After 12 weeks, when the body of the unborn baby produces its own insulin, hyperinsulinemia develops, which threatens the development of asphyxia and injuries during childbirth, respiratory disorders and hypoglycemic conditions of newborns. Is there a way to prevent these complications? Of course, the main thing is timely diagnosis and well-chosen therapy.

As for the mother. A woman will have to constantly monitor blood glucose levels: at least 4 times a day. You also need to stick to your diet. It is very important that the diet is as balanced as possible in terms of the content of basic nutrients: proteins, fats and carbohydrates, vitamins and microelements, since the full growth and development of the fetus directly depends on this.

Taking medications that lower blood glucose levels during pregnancy is contraindicated.If the diet prescribed by the doctor, along with moderate physical activity, does not give the expected results, insulin therapy will have to be started.

– How to build a nutritional plan for yourself with this disease?

– Diabetes mellitus during pregnancy requires mandatory dietary therapy. Proper nutrition can be the key to successful treatment of this disease. The emphasis must be placed on reducing the calorie content of food, without lowering its nutritional value. Doctors recommend following a series of simple but effective guidelines:

– eat in small portions at the same hours;

– exclude from the diet fried, fatty foods saturated with easily digestible carbohydrates (cakes, pastries, bananas, figs), as well as fast food and fast food;

– enrich the diet with cereals from various cereals (rice, buckwheat, pearl barley), vegetable and fruit salads, bread and pasta made from whole grains, i.e.e. foods rich in fiber;

– eat lean meat, poultry, fish, exclude sausages, small sausages, smoked sausages containing a lot of fat

– cook food using a small amount of vegetable oil;

– drink enough liquid.

– What about physical activity? Will she harm the expectant mother?

– No, it won’t. Exercise is very beneficial for pregnant women because, in addition to maintaining muscle tone and staying vigorous, it improves the action of insulin and prevents the accumulation of excess weight.Naturally, physical activity for pregnant women should be moderate and consist of walking, gymnastics, water exercises. You should not abuse active physical activity, which is fraught with injury. It is important to regulate the number of loads, based on the current state of health at a given time.

– Postpartum follow-up. What does a woman need to know? How to control your health?

– After childbirth, insulin therapy is discontinued in all patients with GDM.During the first days after childbirth, it is necessary to measure the level of glycemia in order to identify a possible violation of carbohydrate metabolism. If a woman’s insulin secretion adequately increased in accordance with the increasing insulin resistance during pregnancy and diabetes did not develop, then the insulin secretory resources of the pancreas are preserved.

1.5-2 months after childbirth, women who have had gestational diabetes need to be tested to determine the level of glucose in the blood and to conduct a glucose tolerance test.Based on the results of these studies, the doctor will recommend a specific diet and exercise regimen, as well as determine the timing for control tests.

90,000 Gestational diabetes – causes, symptoms, diagnosis, treatment, diet, prevention of diabetes during pregnancy

Published: 12.04.2021 17:20:00 Updated: 12.04.2021 Views: 13372 90 003

Gestational diabetes is diabetes mellitus that occurs during pregnancy.From 1 to 20% (on average – 7%) of expectant mothers face such a problem. For most, this pathology after childbirth passes without a trace, but in 10-15% it turns into type II diabetes mellitus. Half of women who have gestational diabetes during pregnancy acquire type II diabetes within the next 10-15 years after giving birth.

Causes of gestational diabetes

The exact mechanism of the onset of the disease is still not completely clear. Doctors are inclined to believe that hormones responsible for the proper development of the fetus block the production of insulin, which leads to a violation of carbohydrate metabolism.During pregnancy, more glucose is required for both the woman and the baby. The body compensates for this need by suppressing insulin production.

There are other possible causes of gestational diabetes, such as autoimmune diseases that damage the pancreas. Basically, any pathology of the pancreas can increase the risk of diabetes during pregnancy.

Risk of diabetes during pregnancy

This pathological condition threatens the health of both the mother and the child.Even before birth, the fetus begins to actively produce insulin to compensate for the increased glucose in the mother’s blood. These babies are prone to low blood sugar from birth and have a higher risk of obesity and type II diabetes in adulthood.

Gestational diabetes increases the risk of high blood pressure and preeclampsia, a severe form of gestosis. It manifests itself as headaches, nausea, vomiting, visual impairment, lethargy, drowsiness, or insomnia. It is one of the most severe disorders during pregnancy that affects the central nervous system.

Another alarming factor – diabetes during pregnancy contributes to the rapid weight gain in the baby during the prenatal period (macrosomia). This causes difficulties in childbirth and is a threat to the mother. A large child is considered to be more than 4 kg. These babies have a higher risk of birth trauma and are more likely to need a caesarean section. Due to the large size of the fetus, early delivery may be required. At the same time, the risk of premature birth is high.

Also, high sugar in pregnant women increases the risk of cardiovascular and nervous pathologies of the fetus, increases the risk of respiratory distress syndrome in the baby (a condition that makes breathing difficult) and, in general, increases the frequency of complications during pregnancy and childbirth.

Risk factors for gestational diabetes

• Age under 18 and over 30.
• Unbalanced diet with a lot of fast carbohydrates.
• Bad habits (smoking, alcohol abuse).
• Overweight and obesity. Excess weight obviously implies a violation of metabolic processes.
• Lack of physical activity.
• Previous gestational diabetes or prediabetes.The tendency to diseases of this series does not disappear over time.
• Polycystic ovary syndrome.
• Diabetes in a close relative. The risk of gestational diabetes is doubled or more if close relatives have any form of diabetes.
• The birth of a child over 4 kg earlier or a large fetus during the current pregnancy.
• Race. The European race has the lowest risk of developing gestational diabetes, most often black women suffer from this problem.

Unfortunately, a perfectly healthy woman can develop GDM without risk factors, so you need to visit a doctor and do not miss the recommended screenings.

Gestational diabetes symptoms

In most cases, the disease is asymptomatic for a long time, and this is its danger. Usually, the problem is detected after the 20th week of pregnancy thanks to a blood sugar test.

Severe symptoms are rare, and they are all nonspecific: intense thirst, weight gain, increased daily urination.Sometimes patients complain of fatigue and lack of energy.

Diagnosis of gestational diabetes

There is good news, too. All pregnant women, when registering, are required to take a blood test for glucose levels, therefore, if you regularly undergo all the prescribed examinations, you will find a problem at the very initial stage.

The normal value is 3.3-5.1 mmol / l in the analysis of blood from a vein on an empty stomach. Patients whose glucose levels exceed 5.1 mmol / L are at risk.In this case, the doctor will order a glucose load test or glucose tolerance test to confirm or deny the diagnosis. It is performed at 24-28 weeks of pregnancy. Such a study includes two stages: first, a woman takes a regular fasting blood glucose test, after which she drinks a special solution containing 75 grams of glucose, and two hours later she takes the test again. If a disease is suspected, the same analysis is repeated again after a few hours.

Gestational diabetes is diagnosed if the fasting blood glucose level is less than 7 mmol / L but higher than 5.1 mmol / L, and the venous blood glucose level two hours after ingestion of 75 g of glucose is above 8.5 mmol / L …

Treatment of pregnancy diabetes

The first step in treating GDM is a balanced diet and moderate exercise. The main goal of the diet is to lower sugar to normal values, so the expectant mother will have to give up sweets and fast carbohydrates.

Pregnant women are recommended:

• Little by little, but often.
• Exclude foods with a high glycemic index (sugar, honey, potatoes, white bread, buns, bananas, grapes).
• Give up fast food and fatty sweet pastries.
• Drink plenty of fluids unless contraindicated by the kidneys.
• Diversify the diet with fresh vegetables, lean meat, cereals.

Like all pregnant women, it is important for patients with GDM to receive the full range of vitamins and minerals that are necessary to maintain their own health and the correct development of the fetus.

Walking, swimming, water gymnastics, physiotherapy exercises for pregnant women – any light activity will benefit.

If diet and exercise do not help lower blood sugar levels, insulin therapy is prescribed.

Important: with high sugar, a woman should check her glucose level daily. Measurements are taken on an empty stomach and one hour after each meal using a home blood glucose meter.

Prevention of gestational diabetes

Unfortunately, there are no 100% effective measures that would protect against this disease.

But the more good habits a woman develops before pregnancy, the easier the gestation and childbirth will be:

• Eat healthy food from the first days of pregnancy: choose foods high in fiber and low in fat.Focus on vegetables and whole grains. Strive for variety and watch your portion sizes.
• Keep active. Try to devote 30 minutes to sports every day. Take daily walks, bike rides, swim.
• Plan your pregnancy at a healthy weight and do not gain more than recommended. Gaining weight too quickly can increase your risk of gestational diabetes.

Although there is no universal protection against GDM, a healthy lifestyle can reduce the risk of its occurrence.The most important thing is to detect the problem in time and prevent it from developing.

90,000 Pregnancy and diabetes: major risks

When carrying a baby, serious problems can arise with three variants of the disease, therefore, when planning a child, it is important to seek the advice of a gynecologist in time. Frequent visits to the polyclinic, examinations, consultation are also required with an endocrinologist and other specialists of the company “Serdolik” in the city of Novosibirsk.

Diabetes options

Type 1 or 2 – the disease had already been diagnosed before pregnancy, and the woman was under the supervision of a specialist. It is important to continue monitoring the condition of the expectant mother, and for her to regularly visit the doctor and periodically go for examination (if necessary).

Manifest – also called prediabetes, (latent), which is difficult to detect even with a blood test. Pregnancy becomes the impetus for the transition of the disease to the manifest type, in which symptoms develop at the beginning of the 1st trimester.A blood test reveals an elevated sugar level. After childbirth, the manifest variant is converted to type 2 diabetes (non-insulin dependent).

Gestational – occurs during pregnancy due to increased stress on organs and systems, leading to pancreatic dysfunction. The metabolism of carbohydrates is impaired, that is, a gestational variant is formed, which is asymptomatic in the first weeks. Symptoms of the disease occur mainly at the end of the second trimester.

The gestational type disappears after the birth of the baby, the metabolism of carbohydrates returns to normal.

This type of diabetes occurs when there are factors such as:

• obesity;
• age 35 and older;
• the presence of gestational diabetes during the previous bearing of the child;
• large fruits;
• polyhydramnios;
• death of an infant during a previous pregnancy;
• birth of a child with pathologies.

Types of complications

It should be understood that with diabetes mellitus, the body undergoes significant restructuring, the risk of disruption of the functioning of the kidneys, blood vessels, heart, and visual impairment is likely.

The negative effect of any type of diabetes on the female body is manifested by such signs as:

• infectious processes in the urinary tract;
• development of toxicosis in late stages – eclampsia, preeclampsia;
• development of the risk of premature birth and miscarriage;
• Premature placental abruption;
• the formation of a large size of the fetus, because of which it is necessary to apply a cesarean section;
• postpartum hemorrhage.

Diabetes risks for a child

An increased blood sugar level of a pregnant woman directly affects the baby – there is a violation of the metabolic processes of the mother and the child, which has a bad effect on the formation of organs. There is a possibility of the formation of oxygen deficiency, abnormalities in the central nervous system, fetopathy. Signs of the listed pathologies are:

• big weight of the baby;
• internal organs exceed standard sizes;
• body imbalances – short limbs, large belly, elongated trunk;
• underdevelopment of life-support systems;
• low blood glucose.

With such indications, there is a high risk of critical situations leading to the death of the baby during childbirth.

Ways to prevent complications

Diabetes mellitus is not a sentence, the only thing to be afraid of is the surges in blood sugar levels. To monitor the condition of a pregnant woman, you must follow a simple recommendation:

• carefully monitor blood glucose levels;
• regularly take medications prescribed by your doctor;
• follow a specific diet;
• don’t be nervous;
• visit a doctor regularly.

It is important to give up unhealthy foods – fatty, sweet, fried, sour, starchy foods, etc. An interesting fact is that women who have been diagnosed with diabetes before pregnancy are in a better position with diabetes. They have a “bitter” experience of living with a difficult disease and are used to following certain rules that improve the quality of life.

90,000 Diabetes mellitus and pregnancy

Women with diabetes can give birth to a healthy baby, provided they take precautions

A woman with diabetes may have a normal pregnancy and a healthy baby, provided certain precautions are taken.

The more the mother’s metabolism deviates from normal, the higher the risk of developmental disorders in the unborn child. The baby’s blood sugar will be the same as that of his mother, because they share the same blood flow. If an adult can tolerate rises in sugar relatively painlessly, then for the future little man it is not indifferent.

Therefore, careful control of diabetes before conception is the key to the birth of a full-fledged child.

Pregnancy with diabetes must be planned.The first 7-8 weeks after conception, normal sugar in the mother is especially important, because it is during this period that the laying and development of all major organs and systems take place.

A woman receiving insulin should know that during pregnancy the need for insulin changes: it slightly decreases at the very beginning of pregnancy and slightly increases later. After childbirth, the daily dose of insulin returns to that which was before conception.

A woman with diabetes can breastfeed her baby, but only if she does not develop hypoglycemia.Therefore, during lactation, it is necessary to either reduce the dose of insulin, or eat more, especially “fast” carbohydrates.

During pregnancy, a woman should also increase her intake of calcium (with dairy products), iron and vitamins.

NUTRITION FOR DIABETES

The body lacks insulin, since the cells that were responsible for its production have died and no longer perform their functions. Is it possible to eat like everyone else? You can very well.But for this you need to follow a number of rules that are part of the lifestyle of a patient with diabetes.

In order to understand these rules, let’s remember how the pancreas works in a person without diabetes mellitus. Each time the blood sugar rises, the pancreas increases the amount of insulin entering the bloodstream. As soon as the blood sugar level drops, the release of insulin into the blood slows down. Therefore, in a person without diabetes, the blood sugar level does not exceed 7.8 mmol / l.We call this mechanism the “autopilot” of the pancreas. But in a man with diabetes, this pilot refused. That is, it does not enter the bloodstream.

If there is no insulin in the blood, then the blood sugar level does not decrease after eating, the blood sugar level not only goes beyond the normal level, but also exceeds the renal threshold, so sugar begins to enter the urine.

Food contains three main groups of nutrients: proteins, fats and carbohydrates. The food also contains vitamins, mineral salts and water.The most important component of all of these is carbohydrates.

Only carbohydrates immediately after a meal raise blood sugar levels.

All other food components do not affect post-meal blood sugar. If you eat a sandwich with butter, and after half an hour your blood sugar level rises, then it came from the bread, not from the butter.

There is such a thing as calorie content. Calorie is the amount of energy that is generated in a cell of the body when a substance is “burned” in it.It must be learned that there is no connection between the calorie content of food and an increase in blood sugar levels. Therefore, all over the world, doctors and patients with the first type of diabetes mellitus believe that calories should not be taken into account if there is no increased body weight.

Only foods containing carbohydrates raise blood sugar levels. This means that only these products need to be taken into account in the diet. But! In doing so, you must follow all the recommendations for self-control.

PHYSICAL EXERCISE IN DIABETES

Diabetes mellitus is not a disease, but a special way of life.It means that when a number of rules are followed, a person with diabetes is no different from other people. With normal blood sugar, a person feels absolutely healthy, all the symptoms of diabetes are absent, complications do not develop. Therefore, the basic rules of life for a patient with diabetes mellitus should be aimed at maintaining normal blood sugar levels.

Many factors affect the rise and fall of blood sugar levels. Inadequate doses of insulin, uncompensated physical activity, increased body weight – lead to an increase in blood sugar levels, which in turn leads to complications.

In life, situations often arise when the level of sugar in the blood can rise or fall sharply, and the patient does not always have time to correctly respond to this event. But with a good reserve, having a “margin of safety” the body can more easily cope with changes in blood sugar levels.

The most physiological way to maintain health and create a reserve “safety margin” for the body is physical activity. Physical activity is a necessary condition for the life of any person, one of the main components of the lifestyle of a person with diabetes mellitus.

The latest research by American diabetologists shows that patients with diabetes who regularly play sports have a more favorable prognosis for the development of complications: retinopathy, nephropathy, neuropathy. If there are already complications, then, with regular sports, they develop much more slowly.

At all stages of human existence, movement and physical activity have been an integral part of human life. In order not to die, man hunted, made long transitions, escaped from wild animals, traveled, plowed the land, in a word, spent his whole life in motion.

The modern way of life has borne negative results. The more comfort there is in the surrounding world, the less natural physical activity. This is contrary to human nature. A decrease in the intensity of natural physical activity has led to the appearance of the so-called. “diseases of civilization” – angina pectoris, peptic ulcer, atherosclerosis, obesity, etc.

Diabetes mellitus is on a par with these diseases. The number of patients with diabetes mellitus is most developed in industrialized countries, i.e.That is, there is a direct link between the occurrence of diabetes mellitus and a decrease in the level of physical activity. Japanese researchers concluded that among people with a car, the incidence of type 2 diabetes is higher than among those who walk.

Physical activity has a beneficial effect on all types of metabolism. Since human muscles are built mainly from proteins, then by loading muscles, we improve protein metabolism, and protein is the basis of life. With regular physical activity, the breakdown of fats increases, body weight decreases, and the fat composition of the blood improves.This eliminates the prerequisites for the development of atherosclerosis and other vascular diseases. The fat composition of the blood is more important in the development of insulin resistance.

Exercise has a significant effect on carbohydrate metabolism. With intense exercise, insulin receptors become more sensitive to insulin, leading to lower blood sugar levels and lower insulin dosages. This mechanism operates not only during physical activity as such, but is also consolidated during regular physical education and sports.Many famous athletes participating in the Olympic Games suffer from diabetes mellitus.

One can cite the example of the famous hockey player Bobby Hal, who suffered from type 1 diabetes since childhood. During active workouts, his daily insulin requirement is 6-8 units per day. The usual dosage is 50-60 IU per day.

Another example – Adrian Marples, world champion in triathlon, also has type 1 diabetes since he was 13 years old. During the competition, he always has glucose with him in case of hypoglycemia.

The list of famous people with diabetes can be continued: writer Herbert Wells, Mikhail Gorbachev, aircraft designer Tupolev, most of the US senators.

These examples are vivid proof that with diabetes mellitus it is possible to achieve high results in all areas of life, and even in professional sports. But the main condition is the achievement of normoglycemia. But it is possible only if a special lifestyle is observed.

For diabetes mellitus, including physical activity.

I would like to give one example: the United States is the only country in the world that has achieved a reduction in the number of cardiovascular diseases. This became possible thanks to mass sports. Morning jogging is very popular in America.

With regard to diabetes mellitus, all types of physical activity can be divided into short-term and long-term. Short-term, in turn, can be planned and unplanned. With different types of physical activity, the actions of a patient with diabetes mellitus will be different.

If you made one unplanned run, for example, caught up with a bus, carried heavy loads, then you need to eat one quickly digestible bread unit to prevent hypoglycemia.

In the event of a short-term planned physical activity, it is necessary to eat one additional slowly digestible bread unit (apple, slice of bread) every half hour.

During prolonged physical activity (hike, digging a garden), depending on its duration and intensity, as well as the characteristics of your body, you need to reduce the dose of short and long insulin by 20-50%.But if hypoglycemia nevertheless occurs, then they compensate with the intake of easily digestible carbohydrates (sweet juice). With too intense physical exertion and an excessive level of insulin in the blood, the liver does not have time to release a sufficient amount of carbohydrates into the bloodstream – hypoglycemia develops.

But physical activity does not always lead to a decrease in blood sugar levels. It happens that against the background of intense physical activity, blood sugar rises and even acetone appears.

At normal blood sugar levels, moderate-intensity physical activity leads to the fact that the amount of glucose released into the blood by the liver and the amount of glucose consumed by the muscles are balanced; the blood sugar level remains stable at the same time. But with a lack of insulin in the blood and intense physical activity, the cells starve. The liver, having received a signal about cell starvation, releases additional glucose. But even this glucose does not reach the goal, since it can get into the cells only with the help of insulin, which is just not enough.The more intense the load, the more the liver releases sugar into the blood, the higher the blood sugar level.

Therefore – the basic rule for patients with diabetes mellitus – never start physical activity with blood sugar above 15 mmol / l.

First you need to wait for the decrease in blood sugar levels under the influence of insulin.

One of the most important principles of physical activity is the even distribution of physical activity on all muscle groups. It is advisable to have approximately the same physical activity every day to better control diabetes.

What is the most optimal way to distribute physical activity during the day? It is best to do gymnastics in the morning, and we recommend leaving strength exercises for 16-18 hours of the day. There are basic principles for the selection of physical activity, which must be adhered to.

1. Individual selection of the intensity and methodology for performing exercises for each specific person, depending on age, capabilities and health.

2. Systematic impact and ensuring a certain selection of exercises and the sequence of their implementation: from simple to complex, from known to unknown.

3. The regularity of the exercise, because only with regular exercise, it is possible to achieve a strengthening of the body.

4. A gradual increase in the duration of physical activity, because restoration of disturbed body functions under the influence of physical exercises occurs gradually and only with prolonged training.

5. Gradual increase in the intensity of physical activity during a series of training sessions.

6. Variety and novelty in the selection of exercises and the choice of the type of physical activity.

7. Moderation of exposure; those. moderate but prolonged physical activity is more appropriate than super-intense, but short-term.

8. Compliance with the cyclicity when performing exercises in accordance with the indications: the alternation of physical exercise and rest.

9. Comprehensive impact on the body in order to improve the neurohumoral mechanisms of regulation (water procedures).

It is important to know

During any illness, especially with an increase in body temperature, the body releases into the blood a number of hormones that counteract insulin, and therefore increase blood sugar.That is why, every person with diabetes needs to remember that in such cases, the need for insulin increases by 25-50%, even if the food is eaten less than usual.

If the dose of insulin, for example, for a cold, is not increased, acetone begins to form in excess in the body (this can be easily recognized by the smell of acetone from the mouth or by using a special urine test). In the future, if you do not take any action, the amount of urine released per day increases, a feeling of thirst appears, and body weight decreases.In addition, high sugar alone can cause symptoms such as loss of appetite, nausea, and vomiting.

If such symptoms appear, an urgent need to consult a doctor. Before that, it is necessary to frequently measure blood sugar and test urine for acetone.

And more …

Check your feet regularly

Monitor your blood pressure carefully

Functional fundus examination

The best way to stay healthy is to control your blood sugar.However, with diabetes mellitus, problems with blood vessels often appear, especially on the legs and feet. Regular exercise, even simple walking, can help prevent them.

In diabetic patients, the smallest lesions on the feet take much longer to heal than in others. To avoid them, you must wear well-fitting shoes and take good care of your feet. If you find it difficult to carefully examine your feet yourself, use a mirror and remember that the wound on your legs can be painless, and if you are not careful enough, it may take some time before you feel pain.

Those who have had diabetes for a long time are prone to kidney problems. It has been proven that maintaining blood sugar in the normal range is very important in preventing kidney complications. It is also well known that high blood pressure can cause kidney complications. Therefore, it is necessary to measure your blood pressure regularly. If it turns out to be higher than normal, the attending physician may recommend you a special diet and special medications to help normalize your blood pressure.In addition, doctors usually examine the fundus and check blood cholesterol levels.

7.6. Peculiarities of treatment of type 2 diabetes mellitus during pregnancy

Pregnancy developed against the background of diabetes mellitus is accompanied by a risk to the health of the mother and fetus. Pregnancy planning and maintenance of physiological glucose levels in pregnant women with diabetes can reduce the incidence of complications and the course and outcomes of pregnancy [454, 455]. and for the fetus [454, 456, 457].

Strength of recommendation A (level of evidence 2)

Comments: An effective method of contraception should be used until proper assessment and preparation for pregnancy has been carried out. When planning pregnancy, it is necessary to determine the level of HbA1c, serum creatinine, urine albumin / creatinine ratio, TSH level, prescription of folic acid ** at a dose of at least 400 μg, potassium iodide preparations ** 150 μg.

– It is recommended to achieve compensation for carbohydrate metabolism 3–4 months before conception in patients with diabetes mellitus 2 planning pregnancy in order to reduce the risk of developing fetal malformations and prevent adverse pregnancy outcomes [458, 459].

Strength of recommendation B (Evidence level 3)

Comments: Treatment goals during this period correspond to: HbA1c <6.5%, fasting / pre-meal plasma glucose <6.1 mmol / L, plasma glucose 2 hours after meals < 7.8 mmol / l. It is necessary to inform patients with type 2 diabetes and her family members about the possible risks to the mother and the fetus in the absence of satisfactory compensation for carbohydrate metabolism at the time of conception and during pregnancy.

– It is recommended to transfer to insulin therapy in patients with diabetes mellitus 2 who are planning pregnancy in order to maintain a stable compensation of carbohydrate metabolism [460, 461].

Level of persuasiveness of recommendations B (level of evidence – 3)

Comments: When planning pregnancy, it is necessary to transfer a patient with type 2 diabetes to insulin therapy, due to the lack of placenta permeability for insulin preparations [462 – 465]. In case of pregnancy on the background of therapy with oral hypoglycemic drugs, it is necessary to discontinue the administration of drugs and initiate insulin therapy. – It is recommended to cancel ACE inhibitors in patients with diabetes mellitus planning pregnancy, in order to prevent the teratogenic effect of these drugs [466].

Level of persuasiveness of recommendations B (level of evidence – 3)

– It is recommended to stop taking HMG-CoA reductase inhibitors in patients with diabetes mellitus, planning pregnancy, to prevent the teratogenic effects of these drugs [467].

Level of persuasiveness of recommendations B (level of evidence – 3)

– It is recommended to consult an ophthalmologist with fundus biomicroscopy under mydriasis in patients with type 2 diabetes planning pregnancy to assess the presence and severity of retinopathy [468].

Level of persuasiveness of recommendations B (level of evidence – 3)

– It is recommended to assess the stage of CKD, consult a nephrologist for patients with diabetes mellitus planning pregnancy to assess the presence and severity of kidney pathology [469 – 472].

Level of persuasiveness of recommendations B (level of reliability of evidence – 3)

– Daily self-monitoring of blood glucose during pregnancy in patients with diabetes mellitus 2 is recommended – at least 7 times a day (before and 1 hour after meals, at night), if you feel unwell , if necessary (risk of hypoglycemia, dose titration of prolonged insulin) – at 3 and 6 hours to assess the degree of achievement of the target glycemic control parameters and timely correction of therapy in order to reduce the risk of preeclampsia, adverse pregnancy outcomes and delivery [3].

Level of persuasiveness of recommendations C (level of evidence – 5

– Intensified insulin therapy in a regimen of repeated insulin injections is recommended for patients with diabetes mellitus, planning pregnancy and during pregnancy to maintain stable compensation of carbohydrate metabolism [473, 474].

Level of persuasion of recommendations B ( level of evidence confidence – 2)

Comments: It is necessary to structured training of patients with diabetes mellitus 2 on the principles of intensified insulin therapy in a basal-bolus mode.It is possible to switch to insulin pump therapy at the planning stage of pregnancy [474]. – It is recommended to maintain the target values ​​of glycemic control in patients with diabetes mellitus during pregnancy: fasting plasma glucose / before meals / before bedtime / 3 h 1c475 – 479].

Strength level of recommendations A (level of evidence confidence – 2)

– A multidisciplinary approach to pregnancy management in patients with diabetes mellitus 2 is recommended: observation of an obstetrician-gynecologist, an endocrinologist and a general practitioner or general practitioner to ensure comprehensive management of pregnancy and prevention of adverse pregnancy outcomes [480, 481].

Strength of recommendation B (level of evidence – 2)

Comments: The timing and method of delivery is determined by obstetric indications. To ensure an integrated approach to delivery and postpartum management, delivery in a specialized maternity hospital is recommended.

Open the full text of the document

PREGNANCY AND DIABETES MELLITUS – Modern problems of science and education

1.Boroyan R.G. Clinical pharmacology for obstetricians and gynecologists. – 3rd ed. – M., 2008. – S. 39–43.

2. Burumkulova F.F., Petrukhin V.A. Gestational diabetes mellitus: endocrinological and obstetric aspects // Doctor. – 2012. – No. 9. – S. 2-5.

3. Burumkulova F.F., Petrukhin V.A. Gestational diabetes mellitus: yesterday, today, tomorrow // Therapeutic archive. – 2014. – T. 86, No. 10. – S. 109-115.

4. Dedov I.I., Melnichenko G.A., Romantsova T.I. Hyperprolactinemia syndrome.- Tver: Triada, 2004 .– 67p.

5. Dedov I.I., Krasnopolsky V.I., Sukhikh G.T. et al. Russian national consensus “Gestational diabetes mellitus: diagnosis, treatment, postpartum follow-up” // Diabetes mellitus. – 2012. – No. 4. – S. 4-10.

6. Jobava E.M., Amintaeva L.A., Alieva D.N. Endothelial Dysfunction: Homocysteine ​​and Nitric Oxide in High-Risk Pregnant Women. Modern approaches to therapy. The role of folic acid // Problems of reproduction. – 2010. – No. 6. – S.98-103.

7. Dzgoeva F.S., Gatagonova T.M., Dzugkoeva F.S., Kochisova Z.Kh., Kadzaeva Z.K., Khamitsaeva O.V. The role of free radical oxidation in the development of cardiovascular complications in chronic renal failure // Therapeutic archive. – 2010. – T. 82, No. 1. – S. 51-56.

8. Dzugkoev S.G., Metelskaya V.A., Mozhaeva I.V., Dzugkoev F.S. Influence of a complex homeopathic preparation containing coenzyme Q on indicators of oxidative stress and hemodynamics in experimental diabetes mellitus // Rational Pharmacotherapy in Cardiology.- 2010. – T. 6, No. 3. – S. 376-380.

9. Dzugkoev S.G., Mozhaeva I.V., Gigolaeva L.V., Tedtoeva A.I., Takoeva E.A., Dzugkoeva F.S., Margieva O.I. Systemic oxidative stress and biochemical markers of internal organ damage // Fundamental research. – 2014. – No. 7-3. – S. 478-481.

10. Dzugkoeva F.S., Dzugkoev S.G. The role of endothelial dysfunction in dysfunction of visceral organs and a pathogenetically substantiated method of correction // Fundamental research.- 2010. – No. 11-1. – S. 42-46.

11. Dzugkoev S.G., Dzugkoeva F.S. Some mechanisms of the corrective effect of endogenous antioxidants on metabolic and hemodynamic disorders in experimental diabetes mellitus // Fundamental research. – 2011. – No. 11-3. – S. 499-502.

12. Didenko V.A. Metabolic syndrome X: History and etiopathogenesis // Laboratory medicine. – 1999. – No. 2. – S. 49-57.

13. Zemlyanikina L.I. Diagnostic and prognostic value of the determination of protein and steroid hormones in malnutrition and a large fetus: author.dis. … Cand. honey. sciences. – Volgograd, 1986 .– 24 p.

14. Ignatieva G.A., Sidorovich I.G., Boltovskaya M.N. Hybridomas and monoclonal antibodies in biotechnology and medicine // Results of Science and Technology VINITI. Biotechnology. – 1989. – T. 20. – S. 3-126.

15. Karachentsev Yu.I. Gestagenic diabetes mellitus (review) // Therapeutic archive. – 2001. – T. 8, No. 10. – S. 201−208.

16. Kostenko I.V. et al. The structure of risk factors development, prevalence, diagnosis and treatment methods for gestational diabetes mellitus (review) // Saratov Journal of Medical Scientific Research.- 2011. – T. 7, No. 2. – S. 534-541.

17. Kosheleva N.G. Features of the course and management of pregnancy in diabetes mellitus // Diabetes mellitus and pregnancy: materials of the symposium. – SPb., 1991 .– S. 57-61.

18. Krasnopolsky V.I. Gestational diabetes mellitus – a new look at an old problem / ed. IN AND. Krasnopolsky, V.A. Petrukhin, F.F. Burumkulova // Obstetrics and Gynecology. – 2010. – No. 2. – P. 3−6.

19. Melnichenko G.A., Marova E.I., Dzeranova L.K. Hyperprolactinemia in women and men. – M., 2007 .– 33 p.

20. Nelson D.N. Diabetes and pregnancy. – M.: Medicine, 1989. – S. 215-263.

21. Severin E.S. Biochemistry. – M.: GEOTAR-MED, 2003 .– S. 428-432.

22. Strayer L. Biochemistry. – M.: Mir, 1985 .– T. 3. – S. 304-324.

23. Tadzhieva V.D., Teterina N.G., Izmailova F.A. and others. The role of latent forms of diabetes mellitus (DM) in miscarriage // Materials of the I Regional Scientific Forum “Mother and Child”.- Kazan, 2007 .– P. 152.

24. Shekhtman M.M. Maternal morbidity and mortality in extragenital pathology // Akush. and gyno. – 1996. – No. 7. – P. 54–56.

25. Ben-Jonathan N. Focus on prolactin as a metabolic hormone / N. Ben-Jonathan, E.R. Hugo, T.D. Brandebourg // Trends Endocrinol. Metab. – 2006. – No. 17 (3). – R. 110-116.

26. Domhorst A., Bailey P. C., Anyaoku V. et al. Abnormalities of glucose tolerance following gestational diabetes.// Q J Med. – 1990. – No. 284 (New Series 77). – R. 1219-28.

27. Dzugkoev S.G., Kaloeva M.B., Dzugkoeva F.S. Effect of Combination Therapy with Coenzyme Q10 on Functional and Metabolic Parameters in Patients with Type 1 Diabetes Mellitus // Bulletin of Experimental Biology and Medicine. – 2012. – T. 152, No. 3. – P. 364-366.

28. Garamvölgyi Z., Prohászka Z., Rigó Jr. J. [et al.] Increased circulating heat shock protein 70 (HSPA1A) levels in gestational diabetes mellitus: a pilot study // Cell Stress and Chaperones.- 2015. – Vol. 20, No. 4. – P. 257-281.

29. Haesler M. C. H., Hofman H. M. H., Kainer F. et al. Non-diabetic factor influencing the oral glucose tolerance test // Abstracts second international Graz-symposium on gestational diabetes. – Graz, 1992. – P. 30.

30. Hare J.W., Kahn C.R., Weir G.C. et al. Diabetes and pregnancy in Joslin Diabetes Mellitus. // Lea & Febiger, 1994. P. 889-899.

31. Huddle K., England M. & Nagar A. Outcome of pregnancy in diabetic women in Soweto, South Africa // Diabetic Med.- 1993. – No. 10. – P. 290-294.

32. Kiihl C. Insulin secretion and insulin resistance in pregnancy and GDM. Implications for diagnosis and management // Diabetes. – 1991. – No. 40 (Suppl 2). – R. 18-24.

33. Kirwan J. TNF-alpha is a predictor of insulin resistance in human pregnancy / J. Kirwan, S. Hauguel-De Mouzon, J. Lepercq et al. // Diabetes. – 2002. – No. 51 (7). – R. 2207−13.

34. Kjos A. Gestational diabetes mellitus / A. Kjos, T. Buchanan // N Engl J Med.- 1999. – Vol. 341. – P. 1749-1756.

35. Kurishita M., Nakashima K., Kozu H. A retrospective study of glucose metabolism in mother of large babies // Diabetes Care. – 1994. – Vol. 17. – No. 7. – P. 649-652.

36. Landon M. Obstetric management of pregnancies complicated by diabetes mellitus // Clin. Obstet. Cynecol. – 2000. – Vol. 43. – No. 1. – P. 65-74.

37. Matsuda M., Mori T., Sassa S. et al. Chronic effect of hyperprolactinemia on blood glucose and lipid levels in mice // Life Science.- 1996. – No. 58. – P. 1171-1177.

38. Mayer A., ​​Lunenfeld E., Wiznitzer A. et al Increased prevalence of gestational diabetes mellitus in vitro fertilization pregnancies inandvertently conceived during treatment with long-acting triptorelin acetate // Fertil. Steril. – 2005. – No. 84 (3). – R. 789−92.

39. Montelongo A., Lasuncion A., Pallardo L. F., Herrera E. Longitudinal study of plasma lipoproteins and hormones during pregnancy in normal and diabetic women // Diabetes.- 1992. – Vol. 41 .– P. 1651-1659.

40. Pettitt D., Aleck K., Baird H., Carraher M., Bennett B. & Knowler W. Congenital susceptibility to NIDDM: Role of intrauterine environment // Diabetes. – 1988. – No. 37. – P. 622-8.

90,000 what is dangerous and how to identify it

Gestational diabetes, or diabetes of pregnant women, is a dangerous disease that threatens the life and health of the mother and baby. The prevalence of gestational diabetes in the world, according to various sources, ranges from 4 to 13% *, and, apparently, this figure will only grow over time.Let’s figure out how gestational diabetes can be diagnosed, what a glucose tolerance test is, and whether it really needs to be taken for all pregnant women.

What is gestational diabetes and how does it appear?

Diabetes mellitus is a disease in which the level of sugar in the blood is increased due to impaired absorption of glucose from the bloodstream by the cells of the body. Gestational diabetes differs from bovine diabetes in that it resolves on its own after childbirth.

The mechanism of development of gestational diabetes is associated with changes in hormonal levels during pregnancy.An increase in the level of some hormones interferes with the action of insulin, the substance responsible for the delivery of glucose from the blood to the cells of the body. Thus, the pancreas of a pregnant woman needs to produce significantly more insulin than usual in order to keep blood glucose levels under control. If the pancreas can no longer cope with the increased stress, gestational diabetes occurs.

Risk factors for diabetes in pregnancy:

• overweight before pregnancy;
• heredity: diabetes in relatives;
• Too much and / or rapid weight gain during pregnancy;
• are over 25 years old;
• diagnosed with gestational diabetes during a previous pregnancy;

There are also studies linking the risk of gestational diabetes to smoking during pregnancy.

Consequences of gestational diabetes

Research results indicate that about half of women who have gestational diabetes will develop type 2 diabetes mellitus within the next 5-10 years **. Gestational diabetes can also cause unpleasant consequences for the baby, including:

• excess weight gain in the womb (from 4 kg and more), which can lead to complicated childbirth or the need for a caesarean section;
• premature birth;
• hypoglycemia (low blood sugar) immediately after birth;
• Increased risk of type 2 diabetes in adulthood;
• in severe cases, fetal hypoxia with intrauterine growth retardation may develop.

How gestational diabetes is diagnosed

Diabetes in pregnant women is often asymptomatic at all, and can only be determined by the results of some tests. But a simple test for sugar levels does not always show the real picture, and even if the blood sugar of a pregnant woman is kept within the normal range, this is not a reason to refuse additional research on gestational diabetes.

A glycated hemoglobin test and a glucose tolerance test are best suited for the diagnosis of pregnancy diabetes.Today, all pregnant women (except for women with previously diagnosed diabetes) are sent for a glucose tolerance test, or, as it is also called, a sugar load test, for a period of 24-28 weeks, regardless of whether they are at risk.

What is a glucose tolerance test?

Glucose tolerance test, of course, is not the most pleasant, but really necessary procedure for diagnosing latent gestational diabetes. It is done strictly in the period from 24 to 28 weeks, after which the risks from the test itself increase significantly.

The test takes about two hours, all this time you will not be able to eat or drink, you will need to limit physical activity, maintain a sitting position.

First, a fasting vein will be drawn to test your blood sugar. Then you will need to drink a glass of water in which glucose powder is dissolved, and donate blood twice more with an interval of 1 hour. The procedure may be accompanied by symptoms such as weakness, nausea, dizziness. If possible, ask someone close to accompany you.

What if you are diagnosed with pregnancy diabetes?

You should immediately contact your doctor. You will be prescribed a diet that limits or eliminates carbohydrates, and in some cases, medication may be required.

You will also need to carefully monitor your health, often take a blood sugar test (or check it with a home glucometer).

By following all the doctor’s instructions and following a diet, it is quite possible to keep blood sugar levels under control and avoid unpleasant consequences.