treating diabetes in pregnancy
Health

Treating diabetes in pregnancy

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

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.

Get moving

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.

Prevention

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:

More like this:

Keeping fit through pregnancy
Overweight and pregnant
Eating for two

ASK LUCY

Q My son is 18 months old and has just started saying his first words. It is an extremely exciting time in our house and my husband and I are eager to encourage his speaking as much possible. What advice would you give us on how we can foster this without bombarding and confusing him?

AThere is nothing better than hearing your baby begin to talk. All the hard work you have put in over the last two years is coming back tenfold.
Toddlers will vary significantly with ability and speed of which they talk however a guide would be about 50 words by 2 years of age. The most important thing to watch for is that your baby/toddler is cooing and babbling and begins to string sounds together like “Mama/Dada” They should have a wide range of speech sounds and like to imitate you and things they hear.
There are many ways that you can promote Speech and Language development at home:
1. Slowing down your own speech and taking time over conversations with your little one. Every day is a new experience when you are 18 months, nappy changes, bath time, baking a cake brings endless opportunity for you to interact and offer new words for them to hear and repeat. Make eye contact, smile and use exaggerated tones to keep things interesting and fun for your tot.
2. Review the toys that you have on offer to your tot and ensure that they give plenty of open ended play opportunities. Role play is a wonderful way to allow children to take the lead. Kitchens with lots of plates, cups and pots. Fill the pots with dry pasta and allow your child to cook and serve you. Playdoh, painting, gardening and sandpits are also great for allowing your child to take the lead and babble about what they are doing. Read plenty of books together and point and allow them time to answer any questions that you ask.
3. Limit screen time. Overuse of televisions and iPads do not give your child opportunity to interact in a two way manner.
4. Ask your child lots of open ended questions “What’s that?” “Where are we?” Point at things they know the answer to for boosting confidence (Car/ Car, etc.) When they don’t know the answer, explain it to them. Limit baby talk and speak clearly with good pronunciation, remember you are the teacher and they will copy you.
If you are concerned about your child’s speech and language development, be sure to speak with your GP or developmental Health Nurse. They are very skilled at understanding the difference between speech delays and spotting something that may require professional attention.
Enjoy watching their little brains absorb the world around them and listen to what they have to say. It won’t be too long before they won’t stop talking to you, asking “Why Mummy/ Daddy?” every 5 minutes….

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Ask Tracey

Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

A
Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.