Diabetes Self-Management Articles

These articles cover a wide range of subjects, from the most basic aspects of diabetes care to the nitty-gritty specifics.

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Thinking About Having a Baby

by Laura Hieronymus, MSEd, APRN, BC-ADM, CDE, and Patti Geil, MS, RD, CDE

If you have severe complications of diabetes, you and your diabetes care team may decide that it is not safe for you to become pregnant. Discuss any risks you have with your team and work with them to determine a plan that is best for you.

Drugs and pregnancy
Some drugs that are commonly used in the treatment of diabetes may not be safe to take during pregnancy. Some examples include the cholesterol-lowering drugs known as statins, which are pregnancy category X, meaning there is positive evidence of risk to the fetus from the drugs, so they should not be used during pregnancy. Statins should be discontinued before conception, if possible. Blood-pressure-lowering drugs in the classes known as ACE inhibitors and ARBs are also not recommended during pregnancy and should also be discontinued before conception. If necessary, your physician may prescribe alternative drug therapies for controlling your cholesterol or blood pressure while you are planning for pregnancy.

The use of oral blood-glucose-lowering drugs for Type 2 diabetes management during pregnancy is controversial. Oral drugs are generally not recommended because there have been very few randomized controlled trials evaluating their safety during pregnancy. However, most retrospective studies and published clinical experience have not demonstrated an increased risk of birth defects in the infants of women treated with oral diabetes drugs during pregnancy. Therefore, if you currently take such drugs and are planning a pregnancy, it is best to discuss with your health-care provider what plan is best for you and your diabetes treatment.

The usual drug of choice for treatment of diabetes during pregnancy is insulin, and your physician may want to switch you to insulin before you become pregnant, both to get your blood glucose levels into goal range as well as to give you time to adjust to insulin therapy before having to also adjust to being pregnant.

Other injectable drugs for diabetes treatment, namely pramlinitide (brand name Symlin) and exenatide (Byetta), may not be recommended during pregnancy because, like oral diabetes drugs, neither has been studied in pregnant women.

Keep in mind that you should never discontinue any prescribed medicines without consulting your diabetes care team first. But if you suspect you’re pregnant, find out for sure as quickly as possible so your team can address how to take care of your health while also protecting that of your baby.

It is well known that smoking, drinking alcohol, and using illegal drugs can have negative effects on fetal health. If you use any of these substances, the best time to stop is before you become pregnant. If you have trouble stopping, ask your health-care team about safe options that might help.

The children of parents with diabetes have a somewhat higher risk of developing diabetes themselves. When a mother has Type 1 diabetes, her offspring have a 1% to 4% chance of developing diabetes during their lifetimes. The risk varies depending on the mother’s age when she gives birth: If a woman with Type 1 diabetes delivers a child before she reaches age 25, the baby’s chance of developing Type 1 diabetes is about 4%; if she has the baby after age 25, the risk goes down to approximately 1%. Having a father with Type 1 diabetes raises the risk of a child developing Type 1 diabetes to about 6%.

Having either a mother or a father with Type 2 diabetes may raise a child’s risk of developing Type 2 diabetes during his lifetime. When both parents have Type 2 diabetes, the child’s risk is higher than when just one parent has it. But while some cases of Type 2 diabetes have a strong genetic basis, others do not. Many cases of Type 2 diabetes can be delayed or even prevented by staying active and maintaining a healthy weight.

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Also in this article:
Pregnancy Resources
Pre-Pregnancy Blood Glucose Targets



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