Type-2 Diabetes and Pregnancy FAQ’s

Will my baby be born with diabetes?

No. The infant will not have diabetes at birth and will not be expected to develop diabetes. Your baby does, however, have the same genes as you and therefore has a slightly increased risk of developing diabetes.

Will I automatically get a Caesarian-Section?

Not usually, for the usual diabetic patient, a vaginal delivery is suggested. As outlined above, however, if any complications arise during pregnancy, a C-section may be suggested. About 50-60% of women with diabetes have a C-section.

Can I breastfeed?

Absolutely yes and it is encouraged. Most women find that their diet is more easily managed if they breastfeed. It is also better for your baby. Bottle-feeding is fine, too, if breast-feeding does not work out for you. As mentioned above in women with Type 2 diabetes metformin and glyburide seem safe for breast feeding but some prefer to continue with insulin if breast feeding.

What will happen to my eyes during the pregnancy?

Generally, pregnancy may be associated with a 5-10% chance of diabetes related eye changes. The more damage there is at the start, the more likely there will be changes throughout the pregnancy. You should try and see an opthamologist during the pregnancy. There is a risk that the eyes may show changes up to a year after the baby is born, so the eye doctor should continue to check your eyes during the first year post-delivery.

What will happen to my kidneys during the pregnancy?

Normally your kidney function drops slightly but returns to normal after the baby is born. However, if you have significant kidney disease at the start, your kidneys may show some deterioration and will not revert to their pre-pregnancy state.

What will happen to any nerve damage I have during the pregnancy?

Generally this stays the same. Some women get tingling in the hand or carpal tunnel syndrome that improves after the birth.

If I took oral hypoglycemic agents (metformin or glyburide) in the first trimester is there a concern for the baby?

Although not formally approved for use in pregnancy the general feeling is that no harm will come to a baby exposed to these tablets in early pregnancy. Less information is known about the newer oral hypoglycemic agents such as pioglitazone or sitagliptin.

Are analogue insulins safe?

The short acting insulins (insulin lyspro and aspart, Humalog and Novorapid in Canada) are considered safe. Studies have shown no issues for concern in humans with the long acting analogue insulins (detemir and glargine, Levemir and Lantus in Canada).

What about insulin pumps?

Insulin pumps work well in pregnancy though they do not necessarily give better results than an intensive multiple daily insulin regimen. Because Type 2 diabetes tends to be more stable even if more insulin is required, insulin pumps are less used in Type 2 diabetes. If the pump malfunctions there is a risk of loss of diabetic control. Ketoacidosis (DKA) developing in a short period of time is a concern for those with Type 1 diabetes, much less so for those with Type 2 and is important as it can be fatal for the fetus. Thus, if on a pump and the correction doses do not seem to be working, confirm the pump is functioning properly and use insulin by pen or needle in the interim to make sure the glucose comes down.

Should I test for ketones routinely?

Ketones are a sign of starvation: if the body senses it is starving it will break down body fat and these fats are converted into ketones that are tested for in the urine. Ketones should be specifically tested in two main situations.

  1. Pregnancy needs extra calories for both mother and to feed the growing fetus. Since obesity is usually an issue in Type 2 diabetes and some patients try to restrict their calories, not enough food is sometimes an issue in pregnant Type 2 diabetic patients. If you are not gaining weight appropriately it is worthwhile checking the urine for ketones first thing in the morning and if positive it is a sign more calories are needed particularly at bed time. Overweight women need to gain less weight than their lean counterparts during pregnancy.
  2. If the glucose is uncontrolled in the mother because of a lack of insulin especially in the presence of infection, the body senses this as starvation, breaks down fat, forms ketones which in excess will build up as diabetic ketoacidosis (DKA), a very serious situation for the mother and baby. This is much more an issue for people with Type 1 diabetes but can occur in Type 2. Thus if the sugars start to rise unexplainedly as may happen if you have an infection, you should check your urine ketones and if positive take extra insulin and fluids. If the situation persists for more than three hours you should go to the emergency room or talk to your care givers. In this setting if you start vomiting and can’t keep fluids down for more than an hour you need intravenous fluids at the hospital. Do not delay.

Outside these two times the testing for ketones once a week or so is reasonable.

Are lows bad for the baby?

Low blood sugars do not seem to harm the baby. Low sugars are more common in the first trimester but in later pregnancy as the mother is so resistant to insulin they are less of a problem. Animal studies suggest the hypoglycemia has to be very severe and very prolonged before any harm could come to the baby.

As a general guide a fasting sugar below 3.5 mmol/l (63 mgs/dl), a one hour after meal value of 4.5 mmol/l (81 mgs/dl) or a two hour after meal value of 4.0 mmol/l (72 mgs/dl) would be considered low and if on therapy would prompt a reduction in the insulin or glucose lowering therapy.

Does the insulin go into the baby?

Insulin does not cross the placenta and thus will not harm the baby. The high glucose if left untreated crosses the placenta and can harm the baby. There are rare situations where antibodies to insulin can cross the placenta but the antibodies to the newer human insulins are usually very low and do not cause problems.

What new research is going on in Type 2 diabetes in pregnancy?

In Canada a new study of using metformin in Type 2 diabetes is about to get under way. Led by Dr Denice Feig in Toronto the study involves many sites across the country. The primary endpoint is to see if using metformin in type 2 diabetes pregnant women reduce the bad outcomes for the baby. Further information is available from www.mity.ca

If you have any other questions, ask your physician. If any questions come to mind at home, write them out as you think of them so that you can remember everything you want to ask your doctor or health care team.

Other sites that may be of interest:

CDA website about followup after GDM

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Canadian Diabetes Association

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American Diabetes Association

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