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.

Read More

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.

Read More

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.

Read More

Keeping weight gain in pregnancy in check

Keeping weight gain in pregnancy in check

Controlling weight gain in pregnancy is a challenge.  Weight gain is normal but too much carries more risk for a large baby, for gestational diabetes and maybe even long term risk for obesity in the offspring.  In a previous blog we have looked at what amount of weight gain is normal but for many the pounds just seem to pour on regardless of what they do.  Keeping track of your weight is useful to guide things and you may find the chart we made from the Institute of Medicine recommendations useful. What can be done to keep the weight gain in check.  A recent study came up with a simple approach which seemed to work and may help.

Read More

What is A1c and is it an accurate reflection of blood sugar in pregnancy?

What is A1c and is it an accurate reflection of blood sugar in pregnancy?

In diabetes a lot of attention is paid to the A1c. What is it and is it good at reflecting over sugar levels?
Simple average blood sugars are not that great at telling how the blood sugar control is really like.  Consider Mr Smith who has sugars ranging from 2 to 20 mmol/l (36 – 360 mgs/dl) and Mrs Dixon with sugars of 10 to 12 mmol/l (180 – 216 mgs/dl).  Both have the same average of 11 mmol/l (198 mgs/dl) but the control of sugar in Mr Smith sounds much worse.  The A1c is a much more stable reflection of overall sugar control.

Read More

Just how low can a normal blood sugar go in pregnancy?

Just how low can a normal blood sugar go in pregnancy?

Recently in the clinic I was asked “Is 3.8 mmol/l (68 mgs/dl) two hours after my lunch too low? The blood sugar normally varies though out the day:  lower before breakfast, peaking just over an hour after a meal and coming back down by two hours.  Firstly, sugars at this level do not harm the baby but let us look at what normal sugars in people without GDM are and then we can look at the situation in gestational diabetes and for those with pre-existing diabetes, either Type 1 or Type 2 diabetes.

Read More

Early Gestational Diabetes

Early Gestational Diabetes

A couple of weeks ago in the clinic we had a woman, just over three months gestation, who was diagnosed with gestational diabetes (GDM).  She had GDM on the last pregnancy when it was found at 28 weeks so was surprised when she got it so early this time round. What is going on?

Read More

Weight Gain in Pregnancy

Weight Gain in Pregnancy

Just how much weight gain is normal in pregnancy?  We know the baby, placenta and fluid around the baby comes to about 5 Kg (11 lbs) but the mom also has a bigger blood volume, lays down some more fat stores and may carry excess fluid.  The Institute of Medicine in the US released suggestions for weight gain in pregnancy in May 2009 and Health Canada are using much the same.  I find it easiest to plot the weight gain on a page over the course of the pregnancy. You can down load the sheet I created based on the IOM recommendations as a PDF file, found under charting,  just print it in landscape format and use it yourself.

Read More