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.
Type 2 diabetes tends to be a more stable trouble maker than its relative, Type 1 diabetes. In Type 1 there is a total deficiency of insulin leaving a need for a fine balance of insulin, food and activity or else the sugar can swing either up or down.  Glucose is harder to keep steady in Type 1 diabetes. In Type 2 diabetes there is some insulin from the pancreas, just not enough to handle the situation so the sugar values are high but tend to be consistently so.  However don’t be fooled by the wolf in sheep’s clothing. High sugars are bad for the baby especially at the time of conception.
Perhaps it is because the sugars are more stable or maybe it is the older population that is not thinking of pregnancy but sometimes people with type 2 diabetes or their care givers are not as focused on pregnancy as they might be and oops, the person becomes pregnant.  An unplanned pregnancy in Type 2 diabetes is just as concerning as in Type 1. The high glucose levels are associated with increased risk of congenital malformations just like in Type 1 diabetes.  The mother’s sugar still goes into the baby and can give large babies.  Most women with type 2 need large doses of insulin because they have underlying insulin resistance coupled with the insulin resistance of pregnancy.
If you have Type 2 diabetes and are fertile then do not risk an unplanned pregnancy.  Pregnancy is safe when the A1c is under 7%.  Plan the pregnancy and make sure your health care team are on the same page.  Many women in this group may also be on a statin for cholesterol or an ACE inhibitor or ARB blocker for blood pressure. The statin should be stopped and the ACE/ARB drug switched to a safer alternative for pregnancy.  Finally some women with Type 2 diabetes have irregular periods from polycystic ovarian syndrome (PCOS). Metformin, a diabetes drug often used in this setting may improve fertility so problems with periods do not preclude conception and the need for care re pregnancy.