Blood glucose control during pregnancy
Regardless of the type of diabetes you have, a goal of optimal blood glucose control is essential for a healthy pregnancy. The blood glucose control goals suggested by the American Diabetes Association are lower for pregnant women than for the general population with diabetes. (See “Blood Glucose Goals for Pregnancy” for specifics.) Since your blood glucose goals also depend on the type of meter you use for self-monitoring, be sure you know whether your meter gives whole blood or plasma glucose values. Most health-care professionals prefer the use of a meter that gives plasma-correlated glucose values during pregnancy, if possible.
The following are some strategies for maintaining optimal blood glucose control before and during pregnancy:
Management by a diabetes team. Working with a health-care team that specializes in pregnancy and diabetes is vital to your well-being. Diabetes management team members include a physician to manage your diabetes (such as an endocrinologist); your obstetrician; certified diabetes educators, including a registered nurse and registered dietitian; as well as a pediatrician/neonatologist and perhaps a social worker. Support specialists such as an ophthalmologist and perinatologist may also be members of your health-care team. A reliable health-care team can provide care and support through the process of planning a pregnancy so that when pregnancy occurs, you have help managing both your diabetes and your pregnancy.
Nutrition. If you are planning a pregnancy, meeting with a registered dietitian who specializes in diabetes is recommended. Nutrition assessment generally focuses on calorie and carbohydrate needs for ideal body weight and optimal blood glucose control. A folate supplement to reduce the risk of neural tube defects is recommended for all women of childbearing age.
Physical activity. A good exercise plan that enhances physical fitness assists you with meeting goals for optimal blood glucose control. Physical activity can also be helpful in relieving stress.
Blood glucose self-monitoring. The American Diabetes Association suggests frequent blood glucose monitoring during pregnancy, on a schedule of once before each meal, one hour after each meal, at bedtime, and once in the middle of the night, for a total of at least eight checks per day. Your diabetes management team may individualize your monitoring schedule to meet your specific needs.
Medication. The medicine most commonly used for blood glucose control during pregnancy is insulin. Women with Type 1 diabetes always require insulin as part of their treatment plan. Women with Type 2 diabetes who take oral medicines as part of their diabetes treatment plan will usually find that insulin, rather than pills, is recommended during pregnancy. With a physician’s guidance, a woman with Type 2 diabetes contemplating pregnancy may switch to insulin therapy prior to becoming pregnant. Using insulin may allow a woman to control her blood glucose levels as tightly as possible both prior to and during the early weeks of pregnancy.
The types of insulin used during pregnancy and the method of delivering the insulin should be decided on by a physician with the expertise to manage diabetes. Insulin can be delivered with a syringe, an insulin pen device, or an insulin pump. This article focuses on the use of insulin pump therapy in pregnancy.
Insulin pump therapy
Insulin pump therapy has become an increasingly popular option for diabetes management in the past couple of decades. In fact, the number of insulin pump users grew from 6,600 users in 1990 to 500,000 in 2013. The growing numbers of pump users include women with diabetes who choose to use pump therapy as a means to obtain and maintain the tight blood glucose control necessary for a healthy pregnancy.