The taskmaster cometh: Managing Diabetes during your pregnancy

Okay, ladies, this is where you, as my mother would say, will put your nose to the grindstone. For some of you, having diabetes during your pregnancy will be the most challenging aspect of these several months, and possibly the most attention you have paid to a medical issue in your entire lives. In case you have not grasped the importance of what I have been trying to convey for the past few weeks, I will say it one more time: THIS IS NOT TIME TO SLACK OFF.{{more}} FOR THE SAKE OF YOUR HEALTH AND YOUR BABY’S, PAY ATTENTION AND GET A HANDLE ON YOUR BLOOD SUGARS BEFORE AND DURING PREGNANCY. I don’t mean to be rude, but sometimes you have to shout to get a message across…

This week we will focus on those who need insulin during the pregnancy. Some of you will not: you will be able to get your blood sugars under control with some changes in your diet, but you will still need to check your blood sugars regularly. I already hear people asking: What about pills? The vast majority of diabetes pills currently are not approved for use during pregnancy. This does not mean they definitely will hurt you, but we do not have enough evidence to say they are entirely safe. That said, many obstetricians have given their patients diabetes pills, most often Glyburide or Metformin. To my knowledge, no harmful effects have been reported in babies, but the Endocrine world tends to be more conservative, so we generally do not give pregnant patients diabetes pills. If your diabetes cannot be managed with dietary changes, insulin is the next step.

The insulin regimen can be one of many, including between 2 to 6 shots a day – yes, you heard me right. Your doctor will choose a regimen for you mainly based on what works best in your situation, and also what you are able to do consistently. Regardless of what medications you take, there are some specific goals to be met:

1) Your fasting blood sugar when you wake in the mornings should be 95mg/dl (5.27 mMol/L) or less. Keep in mind that you don’t want to be too low either: anything less than 60mg/dL(3.3mMol/L) is too low.

2) Your blood sugars 1 hour after eating should be140mg/dL( 7.7mMol/L) or less.

3) Blood sugars 2 hours after eating should be 120mg/dL(6.7mMol/L) or less.

There is only one way to know these numbers – blood sugar checks. Pregnant diabetic women need to check their blood sugars at minimum four times a day to know if they are having good control or not. Ideally you check even more: before you eat each meal, then 1 or 2 hours after eating and before bedtime-a total of 7 times a day. During my own pregnancy I checked 6-8 times a day depending on how many meals I ate. As much as it is a pain, anyone taking insulin HAS to keep a close eye on their blood sugars for the safety of all concerned.

Can you do all this work? Of course you can! Keep the goals in mind: healthy you and healthy baby. It is all well worth it, and you know I am right on that one.

Until next week, stay healthy Vincy Mamas!

Anita Ramsetty,

MD endodocs@endocrinehelp.com
Medical Director Endocrine Care Group
www.endocrinehelp.com
Tel: 843-798-4227