Type 2 During Pregnancy
What will happen during the pregnancy?
What will happen during the pregnancy?
During this time, it is important that your doctor or caregiver measures your how your kidneys are working and also assesses whether you have any nerve or eye damage from the diabetes. It is recommended to see an eye specialist (opthamologist) within these first three months.
Some blood pressure tablets used to protect the kidneys, called ACE and ARBs, and cholesterol lowering tablets, called statins, are not considered safe in pregnancy. Ideally, the consumption of these tablets should be stopped pre-conception. There are other blood pressure tablets that are safe for pregnancy. Taking prenatal vitamins and extra folic acid is recommended. Talk to your physician if you have any concerns.
In order to achieve excellent blood glucose control, it is recommended that you measure your blood sugar before breakfast, lunch, supper and at bedtime as a minimum. It is also advisable that you check some values two hours after a meal to make sure that the sugar is not rising too high.
Your diabetes team will give you advice on how best to adjust the insulin. To obtain the target blood sugar values, most women need to take insulin at least four times a day. If you are on large doses of insulin, it is best to measure your glucose before breakfast, lunch, supper, and at bedtime with some checks about two hours after meals. If you are on a small dose of insulin, concentrate your measurements before breakfast and two hours after breakfast, two hours after lunch, and two hours after supper to guide the insulin dose. Each person is different and your doctor will advise you on what is best and tailor your measurement schedule accordingly.
The suggested target blood sugar values on your meter for pregnancy are:
3.5 – 5.3 mmol/l (63 – 95 mgs/dl)
3.5 – 6.0 mmol/l (63 – 108 mgs/dl
5.0 – 7.0 mmol/l (90 – 126 mgs/dl)
1 hour after a meal
less than 7.8 mmol/l (140 mgs/dl)
2 hours after a meal
less than 6.7 mmol/l (121 mgs/dl)
These targets are quite strict and may be associated with some mild low blood sugar reactions, but low blood sugars do not harm the baby unless very prolonged and severe. If the low blood sugar reactions become severe, let your caregiver/physician know so that your target values can be re-set at a higher level.
When aiming for these low blood sugar values, it is advisable that you keep something to treat a low blood sugar reaction in the car. If it is coming close to a snack or mealtime (a high risk time for a reaction) and you need to drive it’s advisable to check your sugar before you get behind the wheel. If you have any problem sensing low sugars you must check your glucose each time you drive. Talk to your diabetes team about safe solutions.
Owing to the increased risk of birth defects in babies of women with diabetes, an ultrasound can be done at this time to check for any malformation that may have occurred during the first three months. This is usually arranged in conjunction with the obstetrician. If there are abnormalities, your obstetrician will discuss these with you.
The insulin requirements will usually rise gradually during these second three months. This is because the placenta or afterbirth is releasing hormones that circulate in your body and block the action of the insulin that you are giving yourself. This is perfectly normal but it does mean you will need more insulin and so you should be prepared to adjust the insulin every few days and keep adjusting it as needs be to match the insulin resistance. Sometimes people with Type 2 diabetes require very large doses of insulin and this can be normal for them. This is perfectly normal. Rarely in Type 2 diabetes does the mother’s pancreas start to make more insulin and the insulin needs do not change much.
The amount of insulin you need usually continues to increase, though it typically levels out from about thirty-six weeks on. In about two-thirds of women it may drop by as much as 10-20%. If it drops dramatically (more than 20%) over the course of a few days, it may be a warning sign that the placenta is not working as well as it should be. In this scenario, your obstetrician will most likely monitor you more closely for a few days. In Type 2 diabetes a decrease in insulin needs is more difficult to judge as the mothers own pancreas can be making extra insulin.
Depending on the duration of the diabetes and any other problems, your obstetrician will most likely suggest a normal vaginal delivery. However, if any problems arise, you should talk to your doctor about a C-section.
For the delivery, insulin and glucose are administered intravenously in most centers. Blood sugar levels will usually be checked every hour so that the insulin can be regulated accordingly. If you know you are going to be induced on a certain morning, you should take less long-acting insulin the night before.
After delivery of the baby and afterbirth the insulin will be stopped and your blood sugar will be checked regularly. The insulin or oral hypoglycemic agents (metformin or glyburide) are restarted once the glucose rises over 10 mmol/l (180 mgs/dl). If you’ve had a C-section and are unable to eat for a couple of days, the insulin will be given intravenously. If you’re eating normally then you may go back to what you were on pre-pregnancy. Recent studies suggest metformin and glyburide can be safe in breast feeding but some women prefer to stay on insulin if the sugars are not controlled on diet alone. Talk to your physician about scheduling a check-up 6 weeks after the baby is born.