Twin pregnancy and diabetes

Twin pregnancy and diabetes

Pregnancy with twins is exciting but daunting. A twin pregnancy carries more risk for many things including preeclampsia, premature delivery and also gestational diabetes (GDM). The placenta is larger and there are more of the hormones that block how insulin works circulating in the mother. In addition the mother does not move around as much so there is less glucose being used by her muscles. This all generates a need for more insulin than a single baby pregnancy and hence GDM is more common. A woman with Type 1 or Type 2 diabetes who becomes pregnant with twins or triplets will need even more insulin than a routine pregnancy.

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Just how accurate is the glucose meter?

Just how accurate is the glucose meter?

Testing one’s blood glucose with meters has been a great boon to managing diabetes.  The glucose testing meters are fairly accurate and they let us know what is going on.  But they are by no means perfect (See Research GDM 25th Mar 2011) and if you are a stickler for detail they can drive you to distraction.

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Timing of Delivery

Timing of Delivery

There are many points of discussion around Gestational Diabetes (GDM):- how to diagnose it, when to use insulin but a thorny issue is the timing of the delivery.  In the clinic I am sometimes asked “Do I have to be induced early?”  I feel this is more an obstetrical than diabetes related decision and I work with obstetricians I trust but that does not mean the decision should not be questioned.   Understanding the background knowledge can inform those questions.

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Exercise can be helpful in Gestational Diabetes

Exercise can be helpful in Gestational Diabetes

With the treatment of gestational diabetes we are trying to control the blood sugar levels so that they will not go into the baby. The sugars rise after a meal and peak between one and two hours and so most centers ask women to check their glucose levels at either one or two hours after  the mealtime (See Blog of 21 Feb 2013).   If the sugars are high consistently despite attention to diet, then some treatment is usually introduced, typically insulin.   But is there anything else that can be done before taking medicines for the higher sugar levels?

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Day of Delivery for Gestational Diabetes

Day of Delivery for Gestational Diabetes

Months of hard work controlling your blood sugar and now it all comes down to some hours of labor that still needs good glucose control for the baby. If the sugar levels are high in the mom just prior to delivery this gets carried into the baby causing its pancreas to make extra insulin.  If the baby is then delivered there is no more sugar coming from the mom so the baby gets a low blood sugar, neonatal hypoglycemia.  The normal sugar in a healthy newborn can dip down to 2.2 mmol/L (40mgs/dL) – much lower than adults can tolerate.   Babies born to women with diabetes are more likely so have low blood sugars in the first few hours after birth.

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When does the clock start ticking- just at what time should I check my blood sugars if I have gestational diabetes?

When does the clock start ticking-  just at what time should I check my blood sugars if I have gestational diabetes?

Gestational diabetes is typically a milder diabetes so does not have much in the way of symptoms or complaints.  Most of what people feel that may be symptoms of diabetes, going to the bathroom frequently, tiredness, feeling warm or hungry relate much more to the pregnancy itself and not the diabetes.  Because of this we have to check the blood sugar as how one feels does not give an accurate sense of how high the blood sugar may be.  Some people may feel their sugar is high or low but it does not answer how high or how low.  So we need real numbers as it is on these absolute values a decision on whether more treatment needs to be started is based.  However, a question we face in the clinic is to decide when should one test the blood sugar and if we do suggest one or two hours after a meal just when does the clock start ticking?

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