Most women with diabetes will have a normal pregnancy resulting in a healthy baby, but it’s important that the condition is managed properly. Usha Daniels, Registered Advanced Midwife Practitioner, NMH explains about treating diabetes in pregnancy.
Starting a family is a big decision for anyone. If you have diabetes, it’s a decision that will require some consideration and planning ahead. However, most women with diabetes do go on to have healthy pregnancies and healthy babies. Diabetes is a condition where there is too much sugar (glucose) in the blood. Glucose comes from the digestion of starchy foods, such as bread and rice. Diabetes occurs because a hormone called insulin, which is produced by your pancreas is not working as it should. Insulin helps our body to use glucose for energy.
There are three types of diabetes:
1. Gestational Diabetes: This type of diabetes occurs only in pregnancy and can occur at any stage, however it’s more common in the second half. It can be similar to Type 2 diabetes, as you are usually making insulin but the insulin is not working.
2. Type 1 Diabetes: Some people don’t make any insulin and need to have insulin injections. This is called Type 1 diabetes and happens when the body attacks the cells that normally make insulin in the pancreas and they no longer make insulin. This type of diabetes is usually diagnosed in children and young adults but it can be diagnosed in later life.
3. Type 2 Diabetes: This type of diabetes occurs over time – people usually do make insulin, but their body doesn’t allow the insulin to work, so blood sugar levels get too high.
How is diabetes treated?
The first step to controlling your diabetes is to look at your diet and lifestyle. Even small changes to these can improve your control of the condition. If you have type 1 or 2 diabetes, you should contact your maternity hospital as soon as you discover you are pregnant. During pregnancy, it becomes difficult to control your blood glucose and your medications or insulin dose will need to be adjusted immediately and regularly throughout your pregnancy. You should also take a higher dose of folic acid during the first 12 weeks of pregnancy; your doctor will prescribe this higher dose for you.
Diabetes and pregnancy
Women who have diabetes before they become pregnant are at a higher risk of some of the complications of pregnancy, so it is important that anyone with the condition has good control of their blood sugars before they become pregnant. Having poorly controlled diabetes during pregnancy can lead to a number of issues including having a large baby for gestational age. This can lead to problems during your baby’s birth and means that women with diabetes are more likely to need assistance during labour or to have a Caesarean section. The babies of women who have gestational diabetes are also more likely to develop diabetes themselves in later life.
Treating diabetes in pregnancy:
Watch your diet
Most women who develop gestational diabetes can manage their blood sugar levels by changing what they eat and being more physically active. It is recommended that all women with gestational diabetes see a dietitian for advice on diet. Here are some tips for managing diabetes:
1. Do not leave long gaps between meals, as this can affect your blood glucose levels. Ideally, eat breakfast within one hour of waking up in the morning.
2. Cut out all junk and sugary foods.
3. Eat the right carbs. Carbohydrates are important for energy, but they turn into glucose when you eat them. It is best to choose types that break down more slowly. These are sometimes called low glycaemic index (GI) foods. They include wholegrain high-fibre choices, such as brown bread and granary bread, porridge, brown or basmati rice, wholewheat pasta, couscous, baby potatoes and new potatoes. Dairy product type carbohydrates, such as yoghurt and milk are very important for your baby’s bone development during pregnancy. Ask your dietitian about the right amount for you. Fruit and vegetables also contain carbohydrate or sugar. They are very important for nutrition and provide many essential nutrients.
4. Eat plenty of protein. Protein-rich foods can slow the release of glucose into your blood and allow your insulin more time to act. Try eating low-fat protein options at all your meals and snacks. Sources of protein include nuts, cheese, turkey, chicken, fish, beef, lamb, egg, tofu, beans and lentils.
5. It’s a good idea to read nutrition labels on food packaging. All of the ingredients are listed in order of their descending weight. For example, the closer sugar is listed to the top of the list of ingredients, the more sugar the food contains. But remember with diabetes, you need to look at the total carbohydrate.
Getting some regular exercise will help to ‘use up’ the sugar in your blood and keep blood sugar levels healthy. If you are on medication or insulin for your diabetes, check with your doctor and dietitian about avoiding a low blood sugar during or after exercise. Some women will need to have insulin injections or take medication if they cannot reduce their blood sugars by changing what they eat or doing more exercise. Your doctor will decide what treatment is the best for you.
The best way to prevent gestational diabetes is by ensuring you are a healthy weight when you become pregnant. This is important for your next pregnancy and women who lose weight or return to their pre-pregnancy weight afterwards are less likely to develop diabetes in their next pregnancy.
Some women will develop gestational diabetes for other reasons, for example, it runs in the family, but by following a healthy diet and entering pregnancy at a healthy weight you can still improve the control of your diabetes. If you maintain normal blood glucose levels during pregnancy (3.5 – 7.0 mmol/l), your baby should grow in a normal healthy way. If your blood glucose remains too high your baby will get too much sugar. This can result in your baby growing larger than they should, which may lead to complications. If your blood glucose is high you are also more likely to develop high blood pressure in pregnancy. So it’s important to control the blood glucose levels during pregnancy.
Breastfeeding reduces your risk of diabetes
Research has shown that breastfeeding reduces your baby’s chance of developing diabetes in later life. It also reduces their chance of being overweight in childhood. Breastfeeding will help your blood glucose to return to normal levels post natally. If you have type 1 diabetes you may need less insulin than you did before pregnancy, so keep in touch with your maternity hospital and diabetes team to adjust your doses.
For more information:
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