If a young woman with
diabetes (or previous gestational diabetes) is
planning a pregnancy soon, there's a list of things to do.
Here's some advice to review with your physician and diabetes team:
Tighten up your targets.
Blood sugar values should be as close to
normal as possible prior to conception to minimize risk to the developing
fetus. It is suggested that the fasting blood glucose should be between
60 and 90 mg/dl
(3.3-5 mmol/L).
Before meals aim for 90-100 mg/dl
(5-5.6 mmol/L).
At one hour after a meal, blood glucose
should be less than 130 mg/dl
(7.2 mmol/L).
At two hours
following a meal
it should be less than
120 mg/dl
(6.7 mmol/L).
Aim for blood sugars below 140 mg/dl (7.8 mmol/L) all the time, preferably
averaging about 85 mg/dl (4.7 mmol/L).
And begin adjusting insulin doses, based on frequent blood sugar levels, to meet your new targets.
Do more blood sugars.
Eight to twelve
blood sugar tests a day will probably
be needed to get the very tight control of blood sugar that is desired. Definitely start checking
after meals. (There are different times to check after eating, either 60, 90, or 120 minutes. Discuss
with
your diabetes nurse educator or doctor about which might be best in your circumstances.)
Check your blood sugar before driving. If it's low, eat and wait before putting the car in gear -- don't risk a car crash from hypoglycemia!
And keep some quick-acting carb,
and some "real" food (such as peanut butter and crackers) in your automobile.
Start telephoning
your doctor's office weekly with blood sugar reports (or faxing them) to help decide if changes in your insulin doses are needed.
Plan on taking lots of shots. Three or four insulin injections per day, and sometimes
more, will actually make it easier to get the very tight blood sugar control needed.
Maybe start an
insulin pump, especially if you have elevated blood sugar
levels despite your best efforts.
If you are presently taking Humalog
or
Novolog
insulin:
These insulins have been used in pregnancy for several years now without apparent ill effect. If you have good control using
this type of insulin, then continue with it.
(See
Pregnancy Update.)
If you are presently taking
Apidra
or
Lantus
or
Levemir
insulins:
These insulin products are new on the market, and there are no clinical studies
available about their safety in pregnancy.
You should discuss with your physician about what to do.
Start folic acid supplementation.
Babies of mothers with diabetes are
at increased risk of spina bifida. Folic acid (folate) has been shown to
reduce this risk. The most recent recommended amount is 4 to 5 mg/day
which is much more than in prenatal vitamins. Therefore the extra amount
will have to be prescribed by a physician. Folic acid should be started
at least one month prior to conception and continued for at least the
first 6 weeks of pregnancy
Stop ACE inhibitors or ARBs.
If you are taking a medication in either of these two classes of medications
because of renal disease (protein in your urine) or hypertension (high blood pressure),
then this drug needs to be stopped prior to
conception. However, the protein in your urine may return during the
pregnancy. If you do have kidney disease then you should consult with
your endocrinologist and a high-risk pregnancy specialist. There are
additional increased risks to a pregnancy. The decision for a pregnancy
in this circumstance should be made very carefully.
Talk to a dietitian if it's been a while. There are lots of new ideas, such as
carb counting, that you might not know about.
Get your
eyes
examined.
If the blood sugar levels are aggressively lowered to obtain tight control, there's a chance of
developing worsening retinopathy. Therefore, the eyes
should be checked by a qualified opthalmologist, preferably
before conception, or during the first trimester of pregnancy, and perhaps again during the third trimester of the pregnancy.
Get a 24-hour urine sample to assess how your
kidneys
are doing. The two lab tests that should be checked
are called "creatinine clearance" and "24-hour urine protein".
Start checking urine ketones every morning. It'll be recommended during pregnancy,
and you might as well start now.
Carry quick-acting carbohydrate
to treat possible
hypoglycemia.
Be sure
your spouse and anyone else nearby knows how to give you a
glucagon shot if you're knocked out by low
blood sugar. Keep a Glucagon Emergency Kit handy (and be sure your spouse where it is!).
Stop smoking.
There are several ways of doing this.
Consult with your physician about how to approach it.
Always wear identification
that you have diabetes. With the very tight control that is recommended, you might have a severe
insulin reaction that would need help from someone else.
Plan to stay very active
both before and during pregnancy, until your obstetrician tells you to slow down.
Diabetes is not a reason to slow down; actually the reverse seems true: the more
you
exercise, the easier it should be to keep your blood sugar levels down.
Be sure that you are comfortable
with the obstetrician who will be caring for you. If you don't yet have an
"OB," get one, and be sure you discuss each other's expectations about diabetes care during pregnancy,
before you become pregnant.
That's quite a list, but with good planning and lots of work, the chances for a successful pregnancy for the woman with diabetes is excellent.
And thanks to Dr. Bill Jones and others who have advised about the content
of this webpage!
Also see
Family Planning for young women with diabetes.
At the
DiabetesMonitor
Using an insulin pump as part of the treatment of diabetes.
At the
DiabetesMonitor
Pregnancy and Family Planning
(a listing of other websites discussing pregnancy and diabetes).
At the
DiabetesMonitor
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