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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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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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.

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How much is too much – insulin

How much is too much – insulin

145 units of insulin a day, is this dose of insulin too much?

A person without diabetes makes approximately 30 to 40 units of insulin a day.  We usually think of the dose in terms of body weight and people with Type 1 diabetes (non-pregnant) use about 0.5 to 1.0 unit per kg of body weight, so about 35 to 70 units a day typically.  If some one with type 1 diabetes becomes pregnant then the  hormones from the placenta block how insulin works, they become insulin resistant and so need more insulin. The dose will often go up one and a half to two fold, ie if you were on 60 units a day pre pregnancy you could easily end up on 100 – 120 units a day.

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