Diabetes in Pregnancy

Diabetes mellitus (DM) is a disease state that is complicated by the hormonal changes of pregnancy. Women with Type 1 DM, Type 2 DM, or Prediabetes should be seen by a specialist as soon as a pregnancy is confirmed.

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have existed before or began simultaneously with the pregnancy. All pregnant women should be screened for GDM by their obstetrician between 24-28 weeks. Women with a higher risk for GDM should be screened at their first prenatal visit and then again at the standard time if they passed the early screen.

A consultation with our specialist includes education on the diagnosis, how pregnancy affects diabetes and how diabetes can affect the pregnancy, reviewing potential risks to both mother and fetus. Our diabetes packet has meal planning tips and portion sizes to help you eat smarter. Diet and exercise are an important part of managing your blood sugars.

Diet

This is a great introduction from the American Diabetes Association:

What can I eat? from American Diabetes Association on Vimeo.

The American Diabetes Association offers a simple method for meal planning. Follow these steps when preparing your plate:

• Fill half of your plate with non-starchy vegetables, such as spinach, carrots, cauliflower, beets, cabbage, okra, beans or tomatoes.
• Fill a quarter of your plate with a protein, such as tuna, lean pork or chicken.
• Fill the last quarter with a whole-grain item, such as brown rice, or a starchy vegetable, such as green peas.
• Include “good” fats such as nuts or avocados in small amounts.
• Add a serving of fruit or dairy and a drink of water or unsweetened tea or coffee.

For dietary tips and meal plans:

• https://www.diabetes.org/nutrition
• https://www.diabetesfoodhub.org

Checking your blood sugars

You will be asked to check your blood sugars four times a day and send your sugar log to us weekly. We use a cut-off of <90 for fasting sugars. This is based on the findings from the Hyperglycemica and Adverse Pregnancy Outcomes study published in 2008 in the New England Journal of Medicine. One-hour values are preferred over two-hour values because of better overall glucose control. If you are on fast-acting insulin, it also to helps to better adjust your dose.

Your blood sugars should ideally be within this range:

• Fasting 60-90
• One hour after breakfast ≤140
• One hour after lunch ≤140
• One hour after dinner ≤140

We will review your blood sugars weekly via e-mail or phone. If diet and exercise are not enough to control blood glucose for the entire pregnancy, oral medication or insulin may be added and reassessed routinely to achieve optimal outcomes. Poorly controlled diabetes can lead to stillbirth. It is very important that you monitor your blood sugars.

If you are prescribed insulin, this is a great video on how to administer it to yourself.

Our team is here to educate and support our pregnant moms with diabetes, from preconception to delivery and everything in between.

To get a head start before your appointment, visit the American Diabetes Association website.

If you develop gestational diabetes, you have a 70% lifetime risk of developing Type 2 diabetes. After having your baby, don’t forget to continue focusing on your health! Follow up with your primary care provider or discuss this further with your OBGYN at your postpartum visit.