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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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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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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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.

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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.

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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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Why the fuss about the A1c in early pregnancy?

Why the fuss about the A1c in early pregnancy?

When someone with Type 1 or Type 2 diabetes becomes pregnant the main things to think about are: the mom’s own situation with regards to diabetes complications, her blood sugars and the baby.  The big issues for the baby are that he or she might have a congenital malformation, be too large at birth or have low blood sugars just after birth.  Of these the congenital malformation is by far the most important.  A large baby can be delivered by Caesarian section, a low sugar in the baby is readily treated but if the heart, kidney or spine are not formed correctly we can’t turn back the clock.

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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?

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