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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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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Type 2 diabetes and pregnancy, a modern condition

Type 2 diabetes and pregnancy, a modern condition

The older name for type 2 diabetes is Maturity Onset Diabetes reflecting the fact that it usually develops over the age of 50.  As we grow older our pancreas seems to make less insulin. This is just at the time of our lives when we exercise less and gain weight, so the amount of insulin needed to keep the glucose in check increases. Just like the household budget must balance for happiness, if you need more insulin that your pancreas can’t make – there will be problems this time  in the form of diabetes. The obesity epidemic and its presence in younger women pushes up the need for insulin and so we are seeing more diabetes in women of a fertile age.

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The toll of toiling with Type 1 diabetes – you deserve a medal

The toll of toiling with Type 1 diabetes – you deserve a medal

Managing Type 1 diabetes demands a lot of work.  At meal times the quality and quantity of food has to be dealt with, the glucose measured, forth coming activity considered, the dose of insulin calculated and administered.  Sometimes I think the amount of work diabetes engenders is about the same as a two year old, you have fed them, changed them, given something to drink, put them down, sit down to have a cup of coffee and “Waahh”;  with diabetes you calculate your carbs, adjust for your glucose level, exercise the right amount, take the appropriate insulin and wham – your glucose is low or high –go figure!

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Insulin therapy in Gestational Diabetes, the ouch is more expectation than reality

Insulin therapy in Gestational Diabetes, the ouch is more expectation than reality

People with Type 1 diabetes have to take insulin and although no one likes insulin injections or shots in fact they are not the major irritation in the handling of diabetes.  Certainly when I was caring for people who had islet transplants and  these people had come off insulin, it was the freedom from the regimen of diabetes, the attention to meals, the timing of meals, the monitoring rather than just escaping the insulin injection that was the bigger deal.

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