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Question:

From St. Louis, Missouri, USA:

I am 4 1/2 months pregnant and losing my mind. I can't keep my sugars under control for anything and I am looking for any advice at all on the situation. It is so hard to find information that isn't about gestational diabetes. I want to know about Type 1 diabetes and pregnancy.

Answer:

Type 1 diabetes and pregnancy is much more complex than gestational diabetes. It is important that you are working with a team consisting of an obstetrician, internist (endocrinologist/diabetologist) and dietitian to appropriately manage your diabetes. Sometimes it is very difficult to maintain adequate control of blood sugar, but I encourage you to work with your team and do the best you can. Below is my basic instruction to pregnant mothers with preexisting diabetes.

Probably one of the most significant factors contributing to successful pregnancy outcome is preconceptual glucose control. Basically the closer that fasting and postprandial blood sugar values are to normal (I use <105 mg/dl fasting, and <130 mg/dl at 1 hour postprandial as guidelines) the greater the likelihood that the risk of congenital abnormalities will be minimized. However, do not drive yourself crazy over an occasional elevated blood glucose value. Similarly, your hemoglobin A1c should also be in the normal range. Check with your doctor's office to find out what the normal values are (usually between 6 and 7% depending on the assay).

The more times you check your blood sugar the more information can be gained about your glucose control. However, you have to be practical. At a minimum I would recommend checking a fasting, before lunch, before dinner and bedtime blood sugar. If you want to check at 1hour after meals this would also be useful but not necessary after each meal.

Depending on your blood sugar control and any other problems, you will be seeing your obstetrician once a week to maybe once every two weeks.

Your overall medical condition is important. As long as your blood pressure is normal and you have no evidence of kidney disease then the risk to a pregnancy is minimized. Therefore, it is important to assess these factors prior to conception. As I mentioned above it is important that you work with a diabetes team (an obstetrician, an internist or endocrinologist with expertise in diabetes during pregnancy, and a dietitian). This group usually will have established contacts with other useful specialists such as an ophthalmologist.

OWJ

[Editor's comment: You might find additional support in the Adults Chat Room. JSH]

Original posting 27 Sep 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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