Diabetes During Pregnancy – Incidence and Risk Factors
Type 1 or Type 2 Diabetes Mellitus During Pregnancy, Diagnosis
Type 1 diabetes (type 1 diabetes mellitus) and type 2 diabetes (type 2 diabetes mellitus) are long-term (chronic) diseases. Your diabetes may be caused by one or both of these problems:
- Your pancreas does not make enough of a hormone called insulin.
- Your pancreas does not respond in a normal way to insulin that it makes.
Insulin lets sugars (glucose) go into cells in the body. This gives you energy. If you have diabetes, sugars cannot get into cells. This causes high blood sugar (hyperglycemia).
If diabetes is treated, it may not hurt you or your baby. Your doctor will set treatment goals for you. In general, you should have these blood sugar levels:
- After not eating for a long time (fasting): 95 mg/dL (5.3 mmol/L).
- After meals (postprandial):
- One hour after a meal: at or below 140 mg/dL (7.8 mmol/L).
- Two hours after a meal: at or below 120 mg/dL (6.7 mmol/L).
- A1c (hemoglobin A1c) level: 6–6.5%.
Follow these instructions at home:
Questions to ask your doctor
- You may want to ask these questions:
- Do I need to meet with a diabetes educator?
- Where can I find a support group for people with diabetes?
- What equipment will I need to care for myself at home?
- What medicines do I need? When should I take them?
- How often do I need to check my blood sugar?
- What number can I call if I have questions?
- When is my next doctor’s visit?
General instructions
- Take over-the-counter and prescription medicines only as told by your doctor.
- Stay at a healthy weight during pregnancy.
- Keep all follow-up visits as told by your doctor. This is important.
Contact a doctor if:
- Your blood sugar is at or above 240 mg/dL (13.3 mmol/L).
- Your blood sugar is at or above 200 mg/dL (11.1 mmol/L), and you have ketones in your pee (urine).
- You have been sick or have had a fever for 2 days or more and you are not getting better.
- You have any of these problems for more than 6 hours:
- You cannot eat or drink.
- You feel sick to your stomach (nauseous).
- You throw up (vomit).
- You have watery poop (diarrhea).
Get help right away if:
- Your blood sugar is lower than 54 mg/dL (3 mmol/L).
- You get confused.
- You have trouble:
- Thinking clearly.
- Breathing.
- Your baby moves less than normal.
- You have:
- Moderate or large ketone levels in your pee.
- Vaginal bleeding.
- Unusual fluid coming from your vagina.
- Early contractions. These may feel like tightness in your belly.
Summary
- Type 1 diabetes (type 1 diabetes mellitus) and type 2 diabetes (type 2 diabetes mellitus) are long-term (chronic) diseases.
- If diabetes is treated, it may not hurt you or your baby.
- Your doctor will set treatment goals for you.
Type 1 or Type 2 Diabetes Mellitus During Pregnancy, Self Care
When you have type 1 or type 2 diabetes (diabetes mellitus), you must keep your blood sugar (glucose) in a healthy range. You can do this with:
- Nutrition.
- Exercise.
- Lifestyle changes.
- Insulin or medicines, if needed.
- Support from your doctors and others.
If diabetes is treated, it is unlikely to cause problems for the mother or baby. If it is not treated, it may cause problems that can be harmful to the mother and baby.
How to stay aware of blood sugar
- Check your blood sugar every day, as often as told.
- Call your doctor if your blood sugar is above your goal numbers for 2 tests in a row.
- Have your A1c (hemoglobin A1c) level checked at least two times a year. Have it checked more often if your doctor tells you to do that.
Your doctor will set personal treatment goals for you. In general, you should have these blood sugar levels:
- After not eating for a long time (fasting): 95 mg/dL (5.3 mmol/L).
- After meals (postprandial):
- One hour after a meal: at or below 140 mg/dL (7.8 mmol/L).
- Two hours after a meal: at or below 120 mg/dL (6.7 mmol/L).
- A1c level: 6–6.5%.
How to manage high and low blood sugar
Signs of high blood sugar
High blood sugar is called hyperglycemia. Know the early signs of high blood sugar. Signs may include:
- Feeling:
- Thirsty.
- Hungry.
- Very tired.
- Needing to pee (urinate) more than usual.
- Blurry vision.
Signs of low blood sugar
Low blood sugar is called hypoglycemia. This is when blood sugar is at or below 70 mg/dL (3.9 mmol/L). Signs may include:
- Feeling:
- Hungry.
- Worried or nervous (anxious).
- Sweaty and clammy.
- Confused.
- Dizzy.
- Sleepy.
- Sick to your stomach (nauseous).
- Having:
- A fast heartbeat.
- A headache.
- A change in your vision.
- Tingling or no feeling (numbness) around your mouth, lips, or tongue.
- Jerky movements that you cannot control (seizure).
- Having trouble with:
- Moving (coordination).
- Sleeping.
- Passing out (fainting).
- Getting upset easily (irritability).
Treating low blood sugar
To treat low blood sugar, eat or drink something sugary right away. If you can think clearly and swallow safely, follow the 15:15 rule:
- Take 15
grams of a fast-acting carb (carbohydrate). Some fast-acting carbs are:
- 1 tube of glucose gel.
- 3 sugar tablets (glucose pills).
- 6–8 pieces of hard candy.
- 4 oz (120 mL) of fruit juice.
- 4 oz (120 mL) of regular (not diet) soda.
- Check your blood sugar 15 minutes after you take the carb.
- If your blood sugar is still at or below 70 mg/dL (3.9 mmol/L), take 15 grams of a carb again.
- If your blood sugar does not go above 70 mg/dL (3.9 mmol/L) after 3 tries, get help right away.
- After your blood sugar goes back to normal, eat a meal or a snack within 1 hour.
Treating very low blood sugar
If your blood sugar is at or below 54 mg/dL (3 mmol/L), you have very low blood sugar (severe hypoglycemia). This is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).
If you have very low blood sugar and you cannot eat or drink, you may need a glucagon shot (injection). A family member or friend should learn how to check your blood sugar and how to give you a glucagon shot. Ask your doctor if you need to have a glucagon shot kit at home.
Follow these instructions at home:
Medicine
- Take insulin and diabetes medicines as told.
- If your doctor says you should take more or less insulin and medicines, do this exactly as told.
- Do not run out of insulin or medicines.
Having diabetes can put you at risk for other long-term conditions. These include heart disease and kidney disease. Your doctor may prescribe medicines to prevent these problems.
Food
- Make healthy food choices. These include:
- Chicken, fish, egg whites, and beans.
- Oats, whole wheat, bulgur, brown rice, quinoa, and millet.
- Fresh fruits and vegetables.
- Low-fat dairy products.
- Nuts, avocado, olive oil, and canola oil.
- Meet with a food specialist (dietitian). He or she can help you make an eating plan that is right for you.
- Follow instructions from your doctor about what you cannot eat or drink.
- Drink enough fluid to keep your pee (urine) pale yellow.
- Eat healthy snacks between healthy meals.
- Keep track of the carbs you eat. Do this by reading food labels and learning food serving sizes.
- Follow your sick day plan when you cannot eat or drink normally. Make this plan with your doctor so it is ready to use.
Activity
- Exercise for 30 minutes or more a day during your pregnancy or as much as told by your doctor.
- Talk with your doctor before you start a new exercise or
activity. Your doctor may need to tell you to change:
- How much insulin or medicines you take.
- How much food you eat.
Lifestyle
- Do not drink alcohol.
- Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your doctor.
- Learn how to deal with stress. If you need help with this, ask your doctor.
Body care
- Stay up to date with your shots (immunizations).
- Get an eye exam during your first trimester.
- Check your skin and feet every day. Check for cuts, bruises, redness, blisters, or sores.
- Get regular foot exams as told by your doctor.
- Brush your teeth and gums two times a day. Floss one or more times a day.
- Go to the dentist one or more times every 6 months.
- Stay at a healthy weight during your pregnancy.
General instructions
- Take over-the-counter and prescription medicines only as told by your doctor.
- Talk with your doctor about your risk for high blood pressure during pregnancy (preeclampsia or eclampsia).
- Share your diabetes care plan with:
- Your work or school.
- People you live with.
- Check your pee for ketones:
- When you are sick.
- As told by your doctor.
- Carry a card or wear jewelry that says that you have diabetes.
- Keep all follow-up visits with your doctor. This is important.
Questions to ask your doctor
- Do I need to meet with a diabetes educator?
- Where can I find a support group for people with diabetes?
Seek Additional Information
To learn more about diabetes, visit:
- American Diabetes Association: www.diabetes.org
- American Association of Diabetes Educators (AADE): www.diabeteseducator.org
Summary
- When you have type 1 or type 2 diabetes (diabetes mellitus), you must keep your blood sugar (glucose) in a healthy range.
- Check your blood sugar every day, as often as told.
- Take insulin and diabetes medicines as told.
- Keep all follow-up visits as told by your doctor. This is important.