What are the types of Diabetes in Pregnancy?

Pregnancy Diabetes is a very important area, which needs special attention and very close supervision both by Obstetrician and Diabetes physician. Diabetic pregnancies are mainly of two types. First one is women with known diabetes either type 1 or 2 becoming pregnant called pre-gestational Diabetes. The other is diabetes for the first time detected in the current pregnancy what is called Gestational Diabetes. Your Obstetrician will check this as part of routine antenatal check up. Most of the cases you do not require insulin after delivery. Your blood sugar should be checked 6 weeks after delivery (GTT) to make sure that Diabetes has disappeared.

Who are at risk of developing Diabetes in Pregnancy?

Any of the following conditions can be a risk for developing diabetes in pregnancy: obesity, family history of diabetes, high blood pressure, birth of big baby in the last pregnancy, pregnancy after 35 years of age, history of unexplained loss of baby in uterus before. This high risk women should be carefully looked for diabetes by frequent monitoring rather than waiting for symptoms of diabetes to appear.

Why is it important to treat Diabetes in Pregnancy?

It is important to treat Diabetes in pregnancy for a safe confinement. Some potential risks to the foetus if sugars are uncontrolled include:

• The baby’s body is larger than normal—called macrosomia.  A large baby may need to be delivered by cesarean section, instead of naturally through the vagina.

• The baby’s blood sugar is too low—called hypoglycemia.  Starting to breastfeed right away can help get more glucose to the baby.  The baby may also need to get glucose through a tube into his or her blood.

• The baby’s skin turns yellowish and the whites of the eyes may change color—called jaundice.  This condition is easily treated and is not serious if treated.

• The baby may have trouble breathing and need oxygen or other help—called Respiratory Distress Syndrome.

• The baby may have low mineral levels in the blood.  This problem can causes muscle twitching or cramping, but can be treated by giving the baby extra minerals

Why pregnancy Diabetes is different from Diabetes in other time?

This is one situation where we strongly recommend controlling diabetes very strictly with particular emphasis on postprandial sugar checking (two hours after food). Also it is very important to remember that dose requirement of Insulin in pregnancy always increase as the baby grows bigger. This is because placenta increases in size through out the pregnancy to keep the baby well. Placenta secretes some hormones which works against Insulin. If the dose of Insulin does not increase we feel worried with the function of the placenta.

Is the diet different in Pregnancy?

As the demand is more the calorie intake should be more in pregnancy. In average an increase of 500 calorie is advised. If you are overweight then there is no need to increase this, also you should not try to diet strictly or loose weight. It is better to see a professional dietitian at the time of diagnosis. Three meal and three snack regimen is very much indicated in pregnancy.

Why can not I use tablet for Diabetes in pregnancy?

Tablets available for treatment of Diabetes cross the placenta. We do not give tablet in pregnancy with the fear that baby’s blood sugar may drop. Also tablets take long time to work and we need to change the treatment in pregnancy very frequently, so tablets are not good.

What is the best way of monitoring Diabetes in Pregnancy?

In pregnancy we strongly recommend using glucometer, so that control will be there in your hand. It is important to remember that we check all postprandial sugar, rather than checking only after breakfast, as is the common practice. HbA₁C checking can be of some value to keep an eye on average control.

How often to monitor sugar in pregnancy?

It is important that we keep a close eye on the sugar in pregnancy. Normally in pregnancy we prefer monitoring fasting and 2-hr after meal sugars i.e., fasting, 2 hrs after breakfast, 2 hrs after lunch and 2 hrs after dinner. This set; we would prefer should be done twice a week 2-3 days apart.

Fasting

2-hr after breakfast

2-hr after lunch

2-hr after dinner

What is the sugar control to be achieved in pregnancy?

In pregnancy the targets are much stricter. We want fasting sugar <90mg/dl, but surely <100mg/dl and 2 hr value <125mg/dl, but surely <140mg/dl.

Why my Insulin dose is changing every time?

This is very important to understand. As pregnancy advances, particularly from after 28 weeks, placental activity increases to keep the baby in good health. To do this placenta produces some hormones which act against Insulin and your dose of Insulin goes up and up, sometimes on daily basis we need to increase Insulin dose.

So, increment of Insulin dose in pregnancy is normal, if the dose does not go up, we get worried whether the placenta is working normally or not.

What exercise is good in Pregnancy?

Standard antenatal exercise should be fine from sugar point as well. Walking would be the best and weight lifting or strainous exercise should be avoided. Swimming is also a very good exercise.

What extra care needed during delivery?

At the time of delivery, a normal or near normal sugar is very important. Most of the time during delivery you will not be eating, particularly if the delivery is by section. So we commonly connect you to a glucose drip (to give you nutrition) with Insulin. At this time for a strict control we check blood sugar by pricking finger frequently, sometimes once in every hour. In case of gestational diabetes we disconnect Insulin soon after delivery of the placenta. If you had diabetes from before your dose of Insulin reduced to that before pregnancy. If you were on tablet before, you should continue Insulin till the time you are breast feeding.

What happens to the sugar of my baby?

The baby’s sugar is usually normal. If at the time of delivery, the mothers sugars are not under control, then there is a chance that the baby’s sugar can be on the lower side. Early initiation of breast feeding after delivery is advised.

What follow up is required?

People with gestational diabetes should get glucose tolerance test 6 weeks after delivery to make sure that diabetes is disappeared. You must remember that you will have a high risk of diabetes in future, so take precaution. Eat healthy food, take some form of regular exercise and do not become fat.

Follow up for people with type 1 or 2 diabetes would be the same as in non-pregnant time. If you are planning to conceive again, make sure your control at the time of conception is very good and you take Folic acid vitamin 5 gm every day.

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