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Diabetes in Pregnancy
Diabetes is a common disease that occurs when the body is unable to make or properly use insulin Insulin is a hormone that you need to change sugar, starches, and other food into energy needed for daily life Left untreated, diabetes can cause serious problems with vision, kidney function, and with the cardiovascular system There are two main types of diabetes, based on onset and type of treatment The first type is diabetes mellitus type 1 Onset for this is usually during childhood or young adulthood because the pancreas makes no insulin It is treated with insulin injections, diet and exercise In diabetes mellitus type 2, the pancreas is making some insulin, but not enough, or the bodys cells cannot use the insulin that is made Many women with type 2 diabetes can keep their blood sugar in control with diet and exercise Often, pills are used to help the cells better use the bodys natural insulin During pregnancy, insulin shots may be needed The goal of treatment is to keep the blood sugar within a certain range
Pregestational Diabetes
When a woman has type 1 or type 2 diabetes before pregnancy, it is called pregestational diabetes Most of these women have type
1 diabetes, but some may have type 2, especially if they are very overweight It is vital to get ready for pregnancy by keeping blood sugar levels close to normal levels High blood sugar levels during the first two to eight weeks of pregnancy are linked with serious problems for the baby Keeping good control over blood sugar levels may take some time, and it is vital to follow the guidelines set by your doctor You may be asked to change some of your usual routines, such as checking your blood sugar more often, changing your diet and maybe changing your medicine Eating right and exercising wisely are two good ways to help keep your blood sugar in control Talk to your doctor about what type of activity is best for you and how often you should exercise If you are taking insulin, you may need to change your dose based on your activity and blood sugar level
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Checking your blood sugar levels at home and at different times during the day will tell you about the effects of food, medicine, activity, exercise, stress, and illness on your blood sugar, and how each relates to diabetes control Blood sugar can be tested with a glucose meter using a drop of your blood
Gestational
Diabetes
Diabetes that occurs during pregnancy is called gestational diabetes It occurs in about four percent of all pregnant women or about 135,000 cases in With the right treatment and good control of blood sugar, the United States each year It is both mom and baby will have no usually first seen during the second increased risk of complications or third trimester It occurs when the body is not able to make enough insulin to meet the increased demands of pregnancy, or the body cannot use the insulin that is made It is usually temporary and goes away after the baby is born With the right treatment and good control of blood sugar, both mom and baby will have no increased risk of complications, and the pregnancy will progress normally Risk factors for gestational diabetes: Overweight before you became pregnant Family history of diabetes Birth of a baby weighing nine pounds or more Age 25 or older Hispanic, African American, Native American, Asian American or Pacific Islander
Prenatal Testing
Screening for gestational diabetes is commonly done between the 24th and 28th weeks It is at this time that the placenta begins to make greater levels of the hormones that affect insulin
use The screening test involves checking a blood sample one hour after you drink a sweet-tasting liquid If results are over 140 mg/dl, further testing will be done All women with gestational diabetes should have their blood sugar tested six to eight weeks after their baby is born to make sure it has gone back to normal levels If levels are normal, the test should be done again at least every three years If the results are high, further treatment may be needed
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Complications
No matter what type of diabetes you have, your doctor will tell you what to do to control it If this problem is not managed properly, and blood sugar levels stay too high for too long, your health can be harmed It can cause many of the following problems for both mother and baby
FOR MOM
High ketone levels are made by your body burning stored fat for energy Large amounts of ketones may harm you or your baby When the mother does not eat and drink enough for both her and the baby, large amounts of ketones can build up To prevent this, the mother needs to eat meals and snacks at her normal, scheduled times Preeclampsia is high blood pressure during pregnancy with protein in the urine Symptoms include swelling
of the face, hands and legs Urinary tract infections UTIs are more likely to occur when your blood sugar levels are higher than normal Left untreated, they may spread to the kidneys or cause preterm labor
FOR BABY
If your blood sugar is too high, the extra sugar will go to your baby causing your baby to grow larger than normal This is called macrosomia baby weight over nine pounds Giving birth to a very large baby can be hard for both you and your baby The high blood sugar levels may also be harmful to your babys lung development It can cause the placenta to age earlier than it should, making it less able to carry nutrients to your baby the way a healthy placenta would If your baby makes extra insulin as described above, he will keep making it for a time after birth This will cause the babys blood sugar level to fall below normal levels and can cause serious problems if it is not treated This is called hypoglycemia low blood sugar Often the baby will be given sugar water from a bottle or by intravenous IV line during the first few hours after birth to fix this problem Your baby may need to stay in the hospital a little longer or may need to stay in the special care
nursery
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Weight Gain
Knowing how to plan meals is an important part of managing all types of diabetes What you eat not only affects your blood sugar levels from day to day, but also how much you weigh and how well your baby grows If you weigh too much, your diabetes may be harder to control By understanding the connection between food, weight, and diabetes, you will be able to make good choices about what, when and how much you eat
Eighty to ninety percent of people with type 2 diabetes are overweight This extra weight makes it harder for your body to use its insulin You also have a greater risk of other health problems like high blood pressure and high cholesterol Although losing weight may make diabetes easier to control, pregnancy is not the time to diet If you were overweight before your pregnancy, you may look at this pregnancy as a chance to lose weight Perhaps you are thinking, I know I will lose weight automatically after the baby is born So if I can just stay the same weight through my pregnancy, in nine months I will instantly be 25 pounds lighter This, however, would be a mistake You may weigh less, but what shape will your baby be in? If you are plump, doctors often
suggest that you gain about 10 pounds less than what they would normally have you gain You must gain a reasonable amount of weight from the right foods to keep your baby growing Pregnancy is a time for you to look closely at your eating habits and make good choices in the foods you eat This may require a change in eating, exercise, and everyday lifestyle habits Old habits are hard to break and new ones are hard to start You may not be aware of the habits that are causing you to make poor food choices, or you may not know how to change these habits It takes time to exercise and plan meals You may feel that you do not have the extra time to do this Here are some tips: Talk to your doctor about how much weight you need to gain during your pregnancy Develop a plan for healthy eating It is easier to eat properly if you have a plan for how much and what type of food to eat A registered dietician
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You must gain a reasonable amount of weight from the right foods to keep your baby growing
RD is a good person to help you set up a plan to match your food preferences and lifestyle Your doctor can refer you to an RD Eat regular meals and snacks Meals should be about the same size
Spreading your food evenly across the day helps to keep your blood sugar levels stable Meals should include foods from all of the food groups Keep a record of what you eat Writing down what you eat for each meal and snack makes you think about your food choices and portions Increase your activity level Find someone to exercise with you and you will be more likely to stick with it Always check with your doctor before starting any exercise program She will tell you how much and what types of exercise are best for you during your pregnancy Try not to use food to cope with stress or feelings such as anger, sadness, or boredom Try to find healthy ways to cope — such as taking up a new hobby, talking with a friend, taking a warm bath, watching a favorite movie, taking a walk or sipping a mug of tea If needed, your doctor may refer you to a mental health professional to help you with any emotional problems that are associated with your eating habits
Blood Sugar — the Highs and Lows
HYPERGLYCEMIA is another way of saying that your blood sugar is too high It
usually occurs slowly, over hours or days A blood sugar of more than 140 mg/dl or more than 95 mg/dl fasting is considered
too high and of concern for you Hyperglycemia is caused by not enough insulin, eating too much, less physical activity than usual, illness, or changes in your schedule such as a special occasion Physical or emotional stress may also cause high blood sugar There are two ways to know if your blood sugar is too high: 1 Any time your blood sugar reading on your meter is greater than 140 mg/dl if your doctor told you a different number, use that instead 2 You feel different:
Thirstier than usual Hungrier than usual Pass urine more often
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Blurred vision More tired than usual Headache
For Women With Type 1 Diabetes
During hyperglycemia, your body breaks down fats to use for energy because of a lack of insulin This causes ketones, which are acids, to appear in the blood When hyperglycemia is not treated, ketones appear in the urine This is a warning sign of ketoacidosis, a severe form of hyperglycemia To avoid high blood sugar, follow these tips: Measure your blood sugar as soon as you think you may have high blood sugar Eat the right amounts of food at the right time Take insulin as prescribed Get regular physical exercise Drink adequate amounts of fluids Keep a diary of your
blood sugar readings Wear easy-to-see identification that says you have diabetes for patients treated with insulin
HYPOGLYCEMIA is another way of saying that your blood sugar is too low It
happens quickly, usually within a few minutes Too much insulin if you take insulin, too much exercise, and/or too little food can cause low blood sugar Physical or emotional stress can also cause low blood sugar Women with type 2 diabetes or gestational diabetes treated only with diet and exercise should not experience low blood sugar unless meals are missed There are two ways to know if your blood sugar is too low: 1 Anytime your blood sugar reading is 65 mg/dl or lower would be considered low and a dangerous level for most people 2 You feel different:
Shaky trembly Sweaty Hungrier Decreased concentration Drowsy Confused Irritable grouchy Seizure Coma
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Rapid, pounding heart beat Dizzy or weak Blurred vision Headache Loss of coordination Unusual behavior Slurred speech Loss of consciousness
Low blood sugar is easy to treat if you know what to do before it happens If you feel that your blood sugar is low less than 65 mg/dl, test your blood sugar In pregnancy, the best treatment for low blood
sugar is one cup of milk skim or low-fat It has protein and 12 grams of carbohydrates If milk is unavailable, take three to four glucose tablets Check your blood sugar 15 minutes after you drink the milk If it is still 65 mg/dl or lower, treat it again The second treatment is the same — one cup of milk or three to four glucose tablets Check your blood sugar 15 minutes after the second treatment If it is still less than 65 mg/dl and it is time for your next meal, eat If it is not time for your next meal, have a snack of one-half sandwich and a glass of milk Once your blood sugar is above 65 mg/dl, check it again in one hour to be sure it stays above 65
In pregnancy, the best treatment for low blood sugar is 1 cup of milk skim or low-fat
If your blood sugar gets low during the night or after exercise, be sure to have one-half starch and one-half meat exchange after you get your blood sugar above 65 mg/dl This will prevent your blood sugar from falling again Remember, if you feel like you have low blood sugar and do not have your meter to check it, treat yourself anyway Learn your signs or symptoms of low blood sugar Everyone feels different when their blood sugar drops below 65
mg/dl You may feel symptoms when your blood sugar is a bit higher, or you may not feel early symptoms at all If you cannot count on feeling your symptoms when your blood sugar is low, then you may need to check your blood sugar more often To avoid low blood sugar, follow these tips: Eat the right amounts of food at the right times Take the right amount of diabetes medicine at the right time Plan ahead for exercise or increased physical activity Keep a log of your blood sugar readings Carry something with you at all times to treat low blood sugar
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Check blood sugar before driving Never drive when your blood sugar is low, or when you are having symptoms of low blood sugar Have a good source of sugar in your car at all times Wear easy-to-see identification that says you have diabetes Write down the time of day, blood sugar reading, and anything you think may have caused the low blood sugar If you take insulin, you should have glucagon on hand to treat unconscious low blood sugar blood sugar so low that you need help and cannot, or will not, take carbohydrates by mouth Teach key people you live and work with how to recognize severe hypoglycemia, where you keep your glucagon,
and how to prepare and inject it if you have a severe reaction Discuss your blood sugar readings with your doctor Talk to him about how this fits with your personal blood sugar goals Everyones blood sugar goes out of range now and then Refer to the log you keep when you talk with your doctor about the cause of your low blood sugar and what changes need to be made in your plan of care
A1C Testing
Hemoglobin A1C, or glycosolated hemoglobin or just A1C is a laboratory blood test that shows your average or overall blood sugar levels for the past three to four months This test, along with the daily finger sticks done in your home and those done when you see your doctor, will help you manage your diabetes during pregnancy Hemoglobin is the part of the red blood cells that carries oxygen throughout the body The sugar in your blood attaches to the hemoglobin and stays there for the life of that red blood cell The sugar-hemoglobin part of the red blood cell is called the A1C It measures the percent of hemoglobin that has sugar attached to it Since red blood cells live for about 90 days, they carry the memory of all your blood sugar levels The A1C test shows your average blood sugar for the
past three to four months, much like a videotape of your blood sugar control In contrast, a finger stick blood sugar test is like a snapshot of your blood sugar control — what is happening at that moment During pregnancy, your A1C may be checked as often as every six weeks to help with your blood sugar control
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The normal range for A1C for people without diabetes is generally between 46 When your test results fall within the normal range, it means that your blood sugar levels have been within the target range for the past three to four months Results may vary slightly from one lab to another so check with your doctor to find out what the normal range is for the lab she uses Research has shown that maintaining A1C at less than 6 during pregnancy is critical to achieving pregnancy outcomes as good as those of the non-diabetic population Good blood sugar control has also been associated with fewer diabetes complications Your doctor should tell you the results of your A1C and what those results say about your overall diabetes care Together, you should review your blood sugar control and what steps, if any, are needed to improve the management of your diabetes
Morning Sickness and
Diabetes
Morning sickness is a problem that occurs in about 70 of all pregnancies In spite of its name, morning sickness can occur at any time of the day, not just in the morning It most often happens from weeks six to 12 of the pregnancy, but in some cases lasts longer For pregnant women with diabetes, the nausea and vomiting linked with morning sickness can make blood sugar control a big problem Those with gestational diabetes are often over morning sickness by the time gestational diabetes is found Making changes in food choices can usually solve any remaining problems Women with pre-existing diabetes may have to make changes in food, insulin, and testing, to treat the nausea and vomiting Here are some simple tips for managing morning sickness: Eat six small meals per day Keep within the total calories for your meal plan It is best to eat every 2 1/2 to 3 hours Keep dry starchy foods such as low-fat crackers, rice cakes, or dry cereal at your bedside Eat a snack with both carbohydrates and protein — such as cheese and crackers or half a sandwich — before going to bed Avoid spicy foods, fatty foods, and caffeine Do not eat any food that causes nausea Drink liquids between
meals rather than with meals Eat slowly in a relaxed atmosphere
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Take vitamins after dinner or at bedtime Avoid sudden changes in body position Stand up slowly and get out of bed slowly in the morning Keep a log of foods and activities to find out what things might trigger nausea or vomiting Always carry food with you to treat nausea or low blood sugar If smells bring on nausea, try the following:
If possible, avoid offending smells such as strong perfumes, household cleaning products, or coffee pots left on too long Have someone else do the cooking and grocery shopping if possible Try cold foods — they have less odor than hot foods Get some fresh air Try sniffing lemon wedges
There are many variations of foods that appeal to women when they have morning sickness While some find that salty foods work well, others find that sour foods work best for them Below is a list of foods you might substitute for one carbohydrate portion
SALTY FOODS BLAND FOODS
6 saltine crackers 3/4 oz or 80 calories worth of pretzels 1 oz of potato chips or tortilla chips 1 cup of soup 12 oz of tomato juice 3 cups of salted popcorn
BITTER OR SOUR FOODS
1/3 cup of rice 1/2 cup of pasta 1 small
baked potato 1/2 cup of mashed potatoes 1/2 cup of c 
ooked cereal 3/4 cup of dry cereal
1/2 cup of lemonade 1/2 cup of grapefruit juice 1 small sour apple 1 oz of salt and vinegar potato chips 1/2 cup of sugar-free pudding
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1/4 cup of regular pudding 1/2 cup of regular caffeine-free soda 1/2 cup of unsweetened applesauce 1 small banana
For protein, some foods that may be less likely to cause nausea are: chicken, turkey, ham, cheese, cottage cheese, ricotta cheese, and eggs Pre-meal low blood sugar is often the cause of nausea Eating frequent meals, having a bedtime snack, and checking blood sugar often to avoid low blood sugar can help If it continues to be a problem, your doctor may make changes in your insulin doses or schedule to avoid the problem
WHAT TO DO IF YOU VOMIT AFTER MEALS OR CANNOT STOP VOMITING
If you are taking insulin and vomit after eating, your doctor may suggest several options One way is to try a liquid source of carbohydrate and then, once the vomiting has subsided, try to eat your meal Another option is to take a small dose of glucagon 015mg This dose may need to be repeated every one to two hours until the peak of the short-acting insulin has declined
In either case, it is vital to check your blood sugar and urine ketones often If your vomiting does not stop, it is very important to call your doctor If your vomiting continues for 12 hours or more, you may need to stay in the hospital to prevent any further problems
Sick Day Guidelines
It is very important to take care of your diabetes when you are sick Sick means you have a fever, nausea and vomiting, diarrhea, a cold or sinus infection, rather than the normal nausea and vomiting of pregnancy Illness is a time when blood sugar may rise, even if you are not eating or are vomiting It is very important to continue to check your blood sugar when you are ill You are never too sick to check your blood sugar and urine ketones
Ask someone to stay with you if possible
1 Test your blood sugar at least every two to four hours, more often if you are not sure how you are doing Write down the results in your log 2 If you are able to eat, follow your usual meal plan, plus: Drink plenty of sugar-free liquids, at least eight ounces one cup every hour Sip the liquids slowly over the hour
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If you cannot eat your usual food, try crackers, gelatin, clear soup, Popsicles, or unsweetened
applesauce If you are vomiting, try to drink something with sugar in it such as ginger ale, regular soda not diet, clear soup, decaffeinated tea, water, or Gatorade 3 Call your doctor when: Your blood sugar is less than 65 mg/dl or more than 160 mg/dl twice in a row, or your urine ketones are moderate or large Your illness continues without getting better for more than 24 hours Your temperature is higher than 100F You vomit more than once in six hours You have diarrhea that occurs more than five times per day or lasts longer than 12 hours You feel sleepier or weaker than usual or you cannot think clearly You have trouble breathing You cannot keep any fluids down You are not sure you can take care of yourself 4 Tell a family member that you are sick Ask someone to stay with you if possible 5 When you call your doctor be ready to tell her: Your temperature Your symptoms vomiting, diarrhea, pain, etc Your blood sugar levels during the time you have been sick List of foods and fluids you have eaten/drunk List of any medicines cough syrup, pain relievers, etc you have taken How long you have been sick Any questions or concerns you have 6 If you must go to the hospital
or the emergency room, tell the doctors and nurses that you have diabetes
Gestational Diabetes Managed by Diet
Follow all of the above guidelines plus: 1 Test urine ketones every time you test your blood glucose 2 Sometimes insulin is needed for a short time to bring blood glucose down
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Diabetes Managed by Insulin
Follow all the previous guidelines plus: 1 Take your usual dose of insulin You still need it, even if you are not eating or are vomiting In fact, you may need extra doses to bring your blood sugar down 2 If your blood sugar continues to go up or vomiting continues after you have taken an extra dose of insulin, GO TO THE EMERGENCY ROOM 3 Difficulty in breathing can be a sign of diabetic ketoacidosis and it is an emergency medical condition requiring emergency room treatment If you have difficulty breathing, ask a family member or friend to call 911 4 Be sure to tell the emergency room staff that you have diabetes and if you are taking insulin
Diabetes Managed by Insulin Pump
Follow all the above guidelines plus, if your blood glucose reading is over 180 mg/dl twice in a row: Change your pump site, needle, tubing, and syringe reservoir Check your urine for ketones
Give your sliding scale correction factor insulin by separate syringe Continue to re-test your blood glucose every two hours after giving a correction factor dose Increase your fluid intake
Infections and Diabetes
Infections are more common and more serious when your diabetes is poorly controlled High blood sugar levels aid the growth of germs and reduce your bodys ability to fight off infection Good health habits are an important part of controlling your diabetes Women get more urinary tract infections UTIs than men because a womans urethra is shorter The urethra is a flat tube that drains the bladder A longer urethra provides greater protection against UTIs In women, the urethra is fairly short and straight making it easier for germs to travel into the bladder UTIs are also more common in women with diabetes A common germ, E coli, causes most UTIs When your kidneys are removing excess sugar from your blood, they dump it into your bladder, to be sent out of your body in your urine In your bladder, the E coli feeds on the sugar and can eventually cause an infection
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Pregnant women tend to have more UTIs because the fetus presses on the bladder and hinders the bladders ability
to empty out all the urine When a lower UTI or bladder infection is not treated it can progress to an upper UTI or kidney infection, which is quite serious If you have a UTI, you may notice some or all of the following signs:
Burning or pain while you urinate Urinating more often than usual Feeling like you need to urinate but are unable to Cloudy or bloody urine Pain in the lower part of your stomach and/or back Fever
A urine test can be done to see if you have an infection, and determine what form of medicine will work best Women who are pregnant are also more likely to get vaginal yeast infections, because pregnancy alters the climate of the vagina making it easier for bacteria to grow there Women with diabetes often have yeast infections if their blood sugars are high for long periods of the time The signs you may notice are: Vaginal itching and/or burning Thick, white, cheesy discharge Pain when you urinate Report these signs to your doctor for advice and treatment Do not try to treat the infection yourself Do not ignore small problems; they may become bigger problems Good health habits are vital for everyone, with or without diabetes Here are some helpful tips: Keep
blood sugar levels within your target range After urinating, wipe from front to back to prevent germs from the rectal area from spreading to the vaginal area Empty your bladder every four to five hours Holding your urine increases the risk of infection
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Pass your urine before and after sex Wear underwear with a cotton crotch, loose pants and clothing Learn to notice the early signs of infection Call your doctor right away if any should occur Tell your doctor if you notice signs of anything unusual Again, do not delay Time can play an important role in limiting an infection When you do need to see your doctor about an infection, make sure you understand your test results, the treatment he orders, and how long it will take to heal Talk to your doctor about ways to prevent getting the infection again Review any changes needed to improve your control and maintain good health
Positive and challenging events like a marriage, a new baby, or a new job can also cause a stress response
Stress and Diabetes
Stress can cause you to feel challenged, threatened, strained or depressed Your stress level is determined by how you view a certain situation — what is stressful for you may not
be stressful for someone else Other things happening in your life may change how you react to stress A certain event might feel very stressful one day and not stressful at all on another day Everyone has stress from time to time Life would be boring without it Challenges help us grow stronger Both positive and negative events can be stressful Major life stresses, such as illness or a death in the family are stressful for everyone Positive and challenging events like a marriage, a new baby, or a new job can also cause a stress response Minor life stresses are the irritating, frustrating pressures of daily life, such as work deadlines, heavy traffic, phone calls, or doctor visits Holidays and vacations can cause stress Too much stress or a long, intense, physical response to stress can lead to health problems and affect your diabetes control When you are stressed, your immune system cannot fight disease as well Reducing your stress or coping with it in a positive way is vital for your health
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Your body responds to stress by releasing special hormones that raise your heart rate and blood pressure, make your breathing fast and shallow, and may cause your blood sugar to rise
Sometimes the symptoms of stress and hypoglycemia are similar Your blood sugar rises to give your brain and muscles energy to either fight off the stress or run away from it That is why it is called the fight or flight response If this extra energy is not used to fight or run away, it can leave you feeling tense or cause headaches Stress makes management of diabetes harder In a person who does not have diabetes, the insulin that is made by the pancreas prevents blood sugar levels from rising too high In a person with diabetes, the pancreas may not make enough insulin and blood sugar levels and ketones for type 1 diabetes may get too high Despite this, some people actually have a drop in blood sugar as the first response to stress The result of stress may be erratic blood Learning to handle sugar and ketone levels If stress is stress in a positive short-lived but happens often, way is a vital part blood sugar and ketone levels may of leading a bounce quite a bit Some people healthy life find they are less able to deal with stress after they learn they have diabetes — their energy for coping is being used up on diabetes Some people are less able to deal with stress when their blood
sugar is out of control Everyone responds to stress in different ways Often, we choose ways that are familiar to us This is called coping Various methods are needed to cope with different events Some methods work and some do not If you find that a certain coping method leaves you feeling tense, tired, angry, or sick, try a different method until you feel relaxed, less tense, and more in control Some people cope with stress by eating too much, smoking, drinking too much, or abusing drugs, which can cause other problems Learning to handle stress in a positive way is a vital part of leading a healthy life Learning to use a variety of coping methods and being flexible in your approach to tough situations can lower the effects of stress on your overall health
Tips for Managing Stress
To get a better idea of how you handle stress, make notes in your log for three to four days Jot down what the stress was, how you reacted, how
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you felt during and after the stressful event, and what your blood sugar levels were By watching your stress events, you will be more in control and can learn which methods work best for you to lower or even avoid stressful events Another method for handling
stress is to do less Are you doing too much at home, work, or in your community? Review a typical day or week and make a list of your tasks Are there things on your list that you can let someone else do? Set aside some time each day for yourself Check your thoughts about diabetes and other stressful events in your life Your thoughts can affect your feelings and how you act For example, you may view Relieve stress with diabetes as a disaster, or choose to see it as a relaxation techniques challenge such as meditation, yoga, biofeedback, The healthy approach is to stay away from deep breathing, and stressful events as much as possible Wait visual imagery until you have time to think about how you might deal with them in a positive way Redirect your reaction to stress Use that energy in a physical way Daily exercise walking, swimming, biking is a great way to let go of tension and help you feel and think positively Exercise also gives you more stamina, which helps with long-term stress Hobbies writing in a log, talking with friends, joining a support group are also helpful Another way to relieve stress is with relaxation techniques such as meditation, yoga, biofeedback, deep
breathing, and visual imagery They relieve tension by allowing your muscles to relax These methods are usually done in a quiet, comfortable place where you will not be disturbed by the phone or other people There are books that describe, in detail, proven methods to cope with diabetes, and common coping methods for other stresses Look for classes in your community to help you learn these methods Massage therapy can be helpful to ease muscle tension, improve circulation, and lower heart rate and blood pressure It can relax your
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whole body Just as stress can cause tense muscles, releasing muscle tension through massage can help ease emotional stress Licensed massage therapists who are nationally certified can be found in most communities Keep your sense of humor Laughter is like a massage on your insides It releases endorphins and helps to decrease stress levels Support groups can be helpful Sometimes just being with people who have problems like yours helps to reduce stress Talking about problems can help you solve them List what is stressful for you Note how you feel when you are in a stressful situation, how it affects your diabetes control, how you tell the difference
between a response to stress and a low blood sugar reaction, and how you usually handle stress Develop and practice some new methods for coping with stress If you would like help managing your stress, your doctor can refer you to someone who specializes in stress management for people with diabetes or stress management in general
Prenatal Testing
There are several tests that can be done to see how the pregnancy is progressing
TRIPLE SCREEN, MATERNAL ALPHA-FETOPROTEIN MSAFP is a test done
on the mothers blood at about 1518 weeks that screens for certain problems in the baby A level that is higher or lower than average may mean that further testing is needed
ULTRASOUND is a painless exam that is done by passing a sensor over the
abdomen allowing ultrasound waves to make a picture of the pregnant womans uterus and the baby
AMNIOCENTESIS is a test in which a small amount of amniotic fluid is taken
from around the baby A very thin needle is passed through the mothers abdomen and into her uterus using ultrasound as a guide Fluid can be tested to find a genetic problem or a birth defect The test is commonly done between 15 and 20 weeks and results are back within two weeks Late in
pregnancy, an amniocentesis may be done to see if your babys lungs are mature enough for the baby to breathe on her own
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FETAL KICK COUNT is a way of checking how often your baby moves Babies
go through sleep/wake cycles just like adults You should know how much your baby usually moves, and at what times of the day Let your doctor know of any change in the usual pattern
NON-STRESS TEST NST is a test that monitors your babys heart rate and
movements and any uterine contractions using an external fetal monitor It is usually done in the last third of pregnancy and may be done as often as once or twice a week
BIOPHYSICAL PROFILE BPP is a test that uses ultrasound and external fetal
monitoring to test the well-being of the baby It measures the following:
Fetal breathing movements Fetal body movements Fetal tone flexion and extension of muscle groups Non-stress test NST Amniotic fluid volume
Each of these measures is given a score of 0, 1, or 2 and added up A score of 810 is normal If the baby scores lower than eight, your doctor will decide if you need more tests
Labor and Delivery and Postpartum
Your doctor will watch your pregnancy very closely Most women with diabetes will
go into labor on their own and have a vaginal birth Some women will have their labor induced early Depending on the status of your diabetes, you may need to have small amounts of insulin administered during labor
BREAST-FEEDING
There is usually no problem with breast-feeding your infant It is a great way to help you bond with your baby and breast milk gives the baby antibodies to ward off infection It is always ready, and it is free Breast-feeding your baby for at least three months has been reported to help prevent type 1 diabetes in your baby as he grows If you cannot or do not want to breast-feed, do not feel bad Formulas have enough nutrients to help your baby thrive While you are breastfeeding, it is very important to eat a well-balanced diet set up by your doctor or dietician, and to drink plenty of fluids It is not unusual for the amount of insulin you require to change during the postpartum period
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In Conclusion
A pregnancy with diabetes must be thought of as high-risk It is vital for you to keep your blood sugar as close to normal as you can Research has shown that keeping It is vital for you to keep blood sugar within the target range can your blood sugar as close to
normal as you can reduce problems Keeping a balance between food, exercise and insulin if needed can do this The goal is to keep normal blood sugar levels for a healthy pregnancy outcome See your doctor as scheduled Ask for help with your meal plan, blood sugar checks, exercise plan, and any other concerns Check your blood sugar as ordered See if your food, exercise, and insulin if taken keep your blood sugar levels in the target range Stick with the meal plan your doctor advises Talk with your doctor about the best exercise program for you Take all your medicines as ordered Know how each works and what the side effects may be You need to check your blood sugar often when you have diabetes This helps you know if your blood sugar levels are well-controlled by diet, or if you need to start taking or adjust your insulin Checking your blood sugar and following a meal plan helps you: Control blood sugar levels Support your babys growth Lower the risk of giving birth to a large baby It is very important to communicate well with your physician and the rest of your health care team They are there to help you understand your condition and make the best health care decisions for you
and your baby
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Source:suhichicago.org
