Diabetes - Complications with Pregnancy

If the blood-glucose levels are kept normal from prepregnancy through delivery, the chances of having a normal baby are the same for a diabetic woman as they are for a nondiabetic woman. If the blood,glucose levels are not controlled during the first trimester of pregnancy (the first three months), there is a 14 percent chance of congenital malformations, fetal loss, or maternal complications. The goal is to maintain the blood, glucose levels in the range of 60-90 mgfdl (3-5 mmol) fasting, and 70-120 mgfdl (4-7 mmol) 2 hours after a meal. This is true for women with gestational diabetes (diabetes just during pregnancy) as well as for women with Type 1 or Type 2 diabetes. If a woman has been on oral agents, she must be started on insulin during pregnancy because of the potential side effects of oral agents on the fetus. If a pregnant woman has more difficulty in controlling blood, glucose levels, insulin is given via an infusion pump or in four or more doses of short, acting insulin per day.

Diet

A carefully controlled diet is important to your health and that of your developing baby. You will need a personalized diet plan, which you should evaluate and adjust during the months of your pregnancy.

Snacks in addition to your three regular meals, will help avoid extreme blood sugar levels and provide the developing baby with a constant supply of nutrients.

Morning Sickness
Your doctor may prescribe a drug to reduce nausea (morning sickness). Sometimes, simply eating a dry cracker will help, but crackers are a simple starch and thus, your insulin doses need adjustments in order to eat crackers. You may want to experi-ment with various foods.

How Diabetes and Pregnancy May Affect Baby

A common problem among the babies of pregnant diabetic women is a condition called "macrosomia," which means "large body." In other words, babies of diabetic women are apt to be considerably larger than others.

This occurs because many of these babies receive too much sugar via the placenta because their mothers have high blood sugar levels. The baby's pancreas senses the high sugar levels and it produces more insulin in an attempt to use up all the extra sugar. That extra sugar is converted to fat, making a large baby.

Complications During Travel

Much preplanning must be done so that travel, whether for pleasure or for business, is a safe and rewarding experience. If you are going over, seas, some names and numbers to know are as follows: Centers for Disease Control International Travelers Hotline: 1-800-311-3435, International Association for Medical Assistance to Travelers: 1 (716) 7 54A883; Traveler Assistance International: 1-800-821-2828; Travelers Emergency Network: 1-800-275A836; and Travelex Insurance Services, Inc.: 1-800-228-9792 can give you the names of doctors in other countries who know about diabetes management. As noted earlier in the book, this company can also tell you what supplies are available in what countries and how to ask for assistance in other languages.

If you will be crossing more than two time zones, many specialists advise you to change to multiple doses of short,acting insulin, which may be given just before meals (usually every 4 hours on an overseas flight). An insulin, infusion pump or baseline insulin (Ultralente Humalog insulin works very well for travel since it is given right with the meal and lasts about 4 hours) make it even easier to travel. You only need to take insulin in bolus or injection before a meal, whenever it occurs. It is usually recommended that

you stay on multiple doses for 24 to 48 hours after you reach your destination. The two cardinal rules for travel: Always keep your insulin with you (not in your suitcase), and always keep some food in your possession.