Monday, December 5, 2022

Type 1 Diabetes And Pregnancy

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Find A Team Of Caregivers That Supports Your Approach To Diabetes Management

Type 1 Diabetes and Pregnancy: First Trimester

Talk to enough women who have gone through pregnancy with Type 1 diabetes, and it becomes clear that obstetricians and hospitals have wildly differing attitudes when it comes to taking care of pregnant women who have pre-existing diabetes. Some caregivers and hospitals will automatically want to induce you or perform a c-section at 38 weeks, while others will be fine letting you go to your due date . Some hospitals have policies in which they insist on taking over your glucose management during labor others will let you continue to manage your glucose on your own. Its a good idea to find out early in your pregnancy what your caregivers approach is , so that you can make any necessary changes in your care team or delivery location before you get too far along.

Getting Pregnant With Type 1 Diabetes

Research has shown those with type 1 diabetes have fewer children than their siblings who are unaffected.

Uncontrolled blood glucose levels are also associated with an increased risk of miscarriage.

So, where possible, its important to plan ahead if you want to get pregnant.

Speak to your care provider about planning for pregnancy with type 1 diabetes.

You will need to keep your blood glucose levels within your specific target range.

Maintaining a health body weight and improving diet and exercise are other ways to increase your overall health and reduce your risk of complications during pregnancy.

Your care provider will also assess any other complications of diabetes you might have, such as high blood pressure, damage to kidneys, nerves or eyes, and problems with thyroid function.

All medications you are taking will be reviewed as well, to make sure they are safe for use during pregnancy.

What Kinds Of Health Care Providers Do You Need To Treat Preexisting Diabetes During Pregnancy

To best manage your diabetes during pregnancy, you need a team of health care providers who work together to give you the best all-around care. Your team is led by:

  • Your prenatal care provider
  • Your endocrinologist. This is a doctor who treats people with diabetes and other diseases of the endocrine system. The endocrine system is all the glands in your body that produce hormones that control how your body works.

Your team also may include other providers, including:

  • A perinatologist. This is a doctor who treats women with high-risk pregnancies.
  • A diabetes educator. This person has training to help you control your blood sugar.
  • A registered dietitian . This health professional has training to help you use diet and nutrition to help you stay healthy.
  • Your babys health care provider, especially as you get closer to your babys birth.

Before you try to get pregnant, make sure each provider knows about your pregnancy plans and the other providers you see. All your providers work together with you to help you get ready for pregnancy and stay healthy during pregnancy. They make sure that any treatment you get is safe for your baby. Share their contact information so you and your providers can connect easily.

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What Causes Diabetes During Pregnancy

Some women have diabetes before they get pregnant. This is called pregestational diabetes. Other women may get a type of diabetes that only happens in pregnancy. This is called gestational diabetes. Pregnancy can change how a woman’s body uses glucose. This can make diabetes worse, or lead to gestational diabetes.

During pregnancy, an organ called the placenta gives a growing baby nutrients and oxygen. The placenta also makes hormones. In late pregnancy, the hormones estrogen, cortisol, and human placental lactogen can block insulin. When insulin is blocked, its called insulin resistance. Glucose can’t go into the bodys cells. The glucose stays in the blood and makes the blood sugar levels go up.

What Are The Risks Of Having A Pregnancy With Type 1 Diabetes

Pregnancy with Type 1 Diabetes â âA Labor of Loveâ?

You have an increased risk of experiencing these health complications during early pregnancy if you have type 1 diabetes:

  • Insulin resistance can occur because of hormone changes associated with pregnancy.
  • Preeclampsia is high blood pressure during pregnancy, which can be a serious condition. Women with diabetes are already predisposed to have high blood pressure, and pregnancy increases this risk.
  • Diabetic nephropathy is kidney damage that develops due to diabetes. The kidneys work extra hard during pregnancy, and the high blood pressure that can come with diabetes adds more strain to these organsâraising the risk of damage.
  • Miscarriage or stillbirth is more likely to happen in a type 1 diabetes pregnancy.

Your baby is also at risk of having the following health problems:

  • Birth defects can occur if your blood sugar levels are outside the normal range. High blood sugar levels can harm a baby’s development in the womb, leading to problems with the lungs, heart, brain, spine, kidneys, gastrointestinal tract, and limbs.
  • Larger than normal size is another complication of type 1 diabetes during pregnancy. All the additional glucose in your body can cause your baby to grow to a larger-than-average size in the womb. This can increase the risk of requiring a C-section during delivery.

Fortunately, itâs often possible for diabetic mothers to avoid complications like these and have a healthy pregnancy by working closely with their diabetes care team.

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Who Is At Risk For Diabetes During Pregnancy

The risk factors for diabetes in pregnancy depend on the type of diabetes:

  • Type 1 diabetes often occurs in children or young adults, but it can start at any age.

  • Overweight women are more likely to have Type 2 diabetes.

  • Overweight women are more likely to have gestational diabetes. Its also more common in women who have had gestational diabetes before. And its more common in women who have a family member with Type 2 diabetes. Women with twins or other multiples are also more likely to have it.

What Are Type 1 Diabetes Pregnancy Symptoms That Women Without Diabetes Dont Experience

As with any area of diabetes management, there are side effects or symptoms we can measure and quantify, and then there are side effects we cant really measure. Some symptoms moms with type 1 diabetes might notice include:

  • Increased anxiety related to blood sugar management and the impact on the growing baby
  • Insulin resistance
  • Large gestational size for baby

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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. If the pump malfunctions there is a risk of diabetic ketoacidosis developing in a short period of time which 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.

Low Carb For Type 1 Diabetes And Pregnancy

Type 1 Diabetes and Pregnancy: Post-Pregnancy

Standard advice for all types of diabetes can be conflicting.

Sadly, most advice is not enough to help many people get their blood sugar levels stable, and under control.

I often see women with gestational diabetes being prescribed high carb, low fat diets, and its very concerning.

Interestingly, theyre given shopping lists with specific brand names mentioned smells like sponsorship to me.

High carb, low fat diets serve to keep diabetics blood sugar levels high, their bellies hungry and craving more carbs.

For a type 1 diabetic, this can mean its harder to get your blood sugar levels under control or stable with insulin.

Read about this team of doctors who previously had type 1 or 2 diabetes, and have completely managed their condition with a low carb diet.

Also, I highly recommend The Diet Doctor website, full of great information written by doctors who are educated about nutrition.

Also Check: Ways To Manage Type 2 Diabetes

How Is Diabetes During Pregnancy Diagnosed

Nearly all nondiabetic pregnant women are screened for gestational diabetes between 24 and 28 weeks of pregnancy. A glucose screening test is given during this time. For the test, you drink a glucose drink and have your blood glucose levels tested after 2 hours.

If this test shows a high blood glucose level, a 3-hour glucose tolerance test will be done. If results of the second test are not normal, gestational diabetes is diagnosed.

My Breastfeeding Experience With Type 1 Diabetes

This is a weird little thing I experienced while breastfeeding. My blood sugars werent all that difficult to manage, but when my blood sugars would be higher , I would produce more milk! Like a lot more!

Back then, I did not have a CGM so I didnt have the luxury of seeing what my blood sugar was 24/7. BUT, I could always tell if my blood sugar was higher because I would produce more milk. It was so odd. Without fail, anytime Id wake up in the morning and feel more full, sure enough my blood sugar was higher than normal. Now, Ive never been able to find a research study thats looked at this, but it is a weird quirk I noticed with both of my breastfeeding experiences!

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Prevention And Risk Factors

The incidence of GDM is increasing worldwide. The global prevalence of hyperglycemia during pregnancy has been estimated at 16.9% using the World Health Organization criteria . A higher proportion of women entering pregnancy at an older age and/or with obesity contribute to this increase in prevalence, along with changes in screening strategies and diagnostic criteria. There is a need for an effective and acceptable intervention that will prevent the development of GDM. Such an approach has the potential to improve maternal and child health, with significant savings to the health-care system.

Understanding the pathophysiology of GDM and its risk factors is important for the development of preventive strategies. The GDM population includes a heterogeneous group of women with different metabolic profiles when exposed to pregnancy hormones. Various presentations include:

  • Hyperglycemia that likely preceded the pregnancy , elevated first trimester fasting glucose, overt diabetes in pregnancy, monogenic diabetes)
  • Reduced and/or falling insulin secretory capacity
  • Significant insulin resistance from early pregnancy
  • A combination of factors ).

Before You Get Pregnant

Texting My Pancreas: Pregnancy And Type 1 Diabetes.

Use this planning checklist pdf icon to learn how you can boost your health and get ready for pregnancy. Being in good overall health before you become pregnant is important.

Manage your blood sugar. Many doctors will recommend that you reach and keep your A1C goal for a few months before becoming pregnant.

Review your medicines. Some medicines and supplements arent safe to use while pregnant. You should speak with your health care team about each medicine and supplement you take before you get pregnant. Dont stop taking prescribed medicines without talking to your doctor first.

View this guide to planning a pregnancyexternal icon with type 1 diabetes for more info.

Your insulin needs may change throughout your pregnancy. Be sure to talk to your doctor about how to manage your blood sugar.

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Pregnancy With Type 1 Diabetes

Over 130 million women give birth each year and for women with Type 1 diabetes, while the risks and challenges are of course magnified, the reality is that you can absolutely successfully navigate the before and after phases of pregnancy. At Beyond Type 1, youll find resources for each stage of your pregnancy and whatever risks you may face along the way.

Having a community of women with Type 1 diabetes who understands the ups and downs of pregnancy is invaluable. Join the Pregnancy + Type 1 group for pregnant T1D women on the Beyond Type 1 app for additional support.

What Causes Complications If Youre Pregnant And Have Type 1 Diabetes

Maybe youâve heard that conceiving with type 1 diabetes can be risky for you and your baby, but you might not know why.

Type 1 diabetes and pregnancy complications relate to the way your body changes when youâre carrying a baby. To support your pregnancy and help your baby grow in the womb, the placenta develops. Its goal is to send water and nutrients to the baby. It also makes hormones to help sustain the pregnancy.

In early pregnancy, the placenta makes hormones that can increase insulin secretion and decrease glucose production. This leads to relatively low blood sugar levels. Then, as the pregnancy progresses, these hormones can cause insulin resistance. If your body does not have enough insulin, it could have serious consequences on your and your babyâs health. For this reason, itâs a good idea to ask your healthcare provider about what medications can raise blood sugar levels so your provider can recommend safe prescription options for you during your pregnancy.

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Are Analogue Insulins Safe

The short acting insulins are considered safe. Studies are ongoing for the long acting analogue insulins . Neither of these two long acting analogues are officially approved for use in pregnancy in North America although both are used in Europe during pregnancy. That being said most just continue on the long acting insulin analogue.

Fact: Your Blood Sugars And A1c Level Prior To Getting Pregnant Can Have A Big Impact On Your Babys Development

Type 1 Diabetes and Pregnancy: Third Trimester

Your diabetes management during the 6 months before getting pregnant can have a significant impact on the health of that growing fetus, because your blood sugar levels impact the health of your eggs.

While not all pregnancies are planned, one of the best things you can do as a woman with type 1 diabetes who wants to become pregnant is to spend at least 6 months preparing for pregnancy by maintaining an A1C below 7 percent, recommends Jennifer Smith, RD, CDE, pregnancy coach and coauthor of Pregnancy with Type 1 Diabetes.

That way, by the time a pregnancy test turns up positive, the mindset of keeping your blood sugars mostly in the 80 to 150 mg/dL range will feel more natural and it will boost your confidence for doing so when theres a bun in the oven, too!

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What Is Insulin Resistance

Some pregnant women with diabetes become insulin resistant. This means your body makes insulin but doesnt use it well. During pregnancy, the placenta grows in your uterus and supplies food and oxygen to your baby through the umbilical cord. The placenta also makes hormones that help your baby develop. But these hormones can make you insulin resistant. You may need more and more insulin the longer youre pregnantup to 3 times as much as you needed before pregnancy. Youre most resistant to insulin in your third trimester.

Can Preexisting Diabetes Cause Problems During Pregnancy

Yes. If its not managed well, diabetes can increase your risk for complications during pregnancy, including:

Most babies born to women with preexisting diabetes are healthy after birth. But preexisting diabetes can increase your babys risk for health problems, including:

  • Autism spectrum disorder. A group of developmental disabilities that can cause social, communication and behavior challenges. Developmental disabilities are problems with how the brain works that can cause a person to have trouble or delays in physical development, learning, communicating, taking care of himself or getting along with others.
  • Enlarged organs if your baby is very large
  • Jaundice. This is when a baby’s eyes and skin look yellow because his liver isnt fully developed or isnt working.
  • Obesity later in life. Obesity is being very overweight. It means you have an excess amount of body fat and a body mass index of 30 or higher. To find out your BMI, go to cdc.gov/bmi.
  • Hypoglycemia and polycythemia. Polycythemia is when the body makes too many red blood cells which causes the blood to be thick.
  • Respiratory distress syndrome . This is a breathing problem caused when babies dont have enough surfactant in their lungs. Surfactant is a protein that keeps the small air sacs in the lungs from collapsing.

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When Do Women With Type 1 Diabetes Give Birth

This is a very personal event and decision. You will decide this over the course of your pregnancy with input from both your OB and endocrinologist. Many OBs like to recommend induction at 39 weeks. And, some are fine letting baby come when they are ready. Whether or not this is the right decision for you and your baby, remains up to you and your care team.

Your Mental And Emotional Endurance Will Be Tested Daily

Pregnancy and Type 1 Diabetes: Everything You Need to Know ...

Even when you are not pregnant, living with diabetes can take a significant toll on your self-esteem, your confidence, and your energy to face it again the next day.

As a woman with diabetes pursuing pregnancy, you should prepare yourself emotionally and mentally as much as possible.

During pregnancy, stubborn high blood sugars can come with guilt, tremendous stress, and a feeling as though youre already failing as a mother. But there will be high blood sugars. And there will be lows, too.

Learning how to talk yourself through those hours by reminding yourself that youre doing the very best you can at any given moment is crucial.

Address the blood sugar rationally by taking a carefully calculated correction dose of insulin or contacting your healthcare team to help adjust your medications. And then take a deep breath, and move on.

This is not a journey you can quit when things get tough. Bring your A-game and talk yourself through it.

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Animal Models In Dm Type 1 Research

Animal models are used in autoimmune diabetes research to understand the pathogenesis and etiology of this disease, and to find and test predictive biomarkers and therapeutic interventions. Currently available models of T1D can be divided into spontaneously autoimmune, chemically induced, virus induced and genetically induced.

Spontaneous autoimmune

  • Non-obese diabetic mouse

The NOD mouse is the best known and most widely used animal model for type 1 DM research. It is an inbred, genetically well characterized mouse strain that spontaneously develops T1D. The onset of insulitis occurs at 3â4 weeks of age. The islets of Langerhans are infiltrated by CD4+, CD8+ T lymphocytes, NK cells, B lymphocytes, dendritic cells, macrophages and neutrophils, similar to the disease process in humans. Insulitis leads to destruction of β-cells, resulting in the apparent occurrence of T1D, which varies by sex. The incidence is about 60-80% in females and 10-30% in males. In addition to sex, breeding conditions, gut microbiome composition or diet also influence the onset of T1D. NOD Mice are used to understand the pathogenesis and etiology of the disease, to identify novel autoantigens and biomarkers or to test new intervention strategies.

  • BioBreeding Diabetes-Prone rat
  • LEW -1AR1 / -iddm rat

Chemically induced

Genetically induced

Virally induced

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