Pharmacological Interventions Insulin Therapy
Initiation and optimization of insulin therapy in hyperglycemia during pregnancy.
In the past, regular insulin and NPH were commonly used to treat GDM. However, currently rapid-acting insulin analogs are preferred over regular insulin in pregnancy as they are associated with less risk of hypoglycemia, and may also provide better PP blood glucose control., Both lispro and aspart insulin are approved to be used in pregnancy. There is no data regarding the safety of glulisine in pregnancy. The long-acting insulin analogs do not have a pronounced peak effect as NPH, and therefore, cause less nocturnal hypoglycemia. Insulin detemir has not shown to have adverse maternal or neonatal effects, and has been approved by the Food and Drug Administration to be used in pregnancy. The use of insulin glargine in pregnancy is not approved yet, but the existing studies did not show any contraindications, and the outcome with glargine treatment was not different from, or superior to, NPH insulin.,
Birth Complications Associated With Insulin Therapy
3.7.1 Cesarean section
A Cochrane analysis of 1481 women with GDM showed that in the treatment group there was a higher number of induced labors versus the group with standard antenatal care, but with no difference regarding the number of births by CS . Another meta-analysis did not demonstrate a correlation between the use of different types of insulin-like aspart, lispro and the birth by CS . Although the risk is not influenced by insulin treatment, it can be reduced by induction of labor in 38th39th week of gestation with better outcomes for the fetus .
3.7.2 Vacuum-assisted birth
Although pre-gestational diabetes raises the risk for vacuum assisted birth , in GDM the risk was similar to that in the general population and could not be related to insulin therapy . A particular situation is with GDM that appeared in pregnancies obtained by assisted reproductive technology where the risk for perinatal and obstetrical complications is probably increased by the adverse effect of hyperglycemia, not by insulin treatment .
3.7.3 Fetal morbidity
Do Exercise To Improve Blood Sugar
Appropriate regular physical activity is often recommended during pregnancy, even without diabetes. But if you have gestational diabetes, being active is a must. Regular exercise is also beneficial to overall health and may help to improve glucose metabolism, advises Heard. Respect your pregnant status and choose exercises that wont put you at risk. For example, swimming, water aerobics, and walking are all great choices, while high-impact aerobics or activities such as basketball, which could lead to impacts or falls, should be sidelined for a while.
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Maternal Complications Associated With Insulin Therapy
3.8.1 Maternal hypoglycemia
Hypoglycemia threshold is specific for every individual. In pregnancy, there is a reduction of this threshold by 20% . Patients with GDM that are treated with insulin must maintain a glycemia above 3.7;mmol/l according to CDA, or above 3.9;mmol/l according to ADA .
Insulin analogs are superior to human insulin because the hypoglycemic events are less frequent in type 1 diabetic pregnancies . The use of multiple daily injections is as effective as continuous subcutaneous insulin infusion .
Maternal hypoglycemia affects the fetus just in severe cases when is associated with loss of consciousness or secondary to trauma. Also, it was observed that repeated episodes could lead to growth over the 90th percentile . These episodes are more likely to be present in the first trimester in women who had pregestational diabetes than in GDM .
3.8.2 Hypertension
There is moderate quality evidence that indicates higher hypertension associated hypertension without giving details in insulin-treated GDM.;This fact should be further researched because it is in contradiction with a non-modified risk for pre-eclampsia .
Treatment For Gestational Diabetes
You can do a lot to manage your gestational diabetes. Go to all your prenatal appointments and follow your treatment plan, including:
- Checking your blood sugar to make sure your levels stay in a healthy range.
- Eating healthy food in the right amounts at the right times. Follow a healthy eating plan created by your doctor or dietitian.
- Being active. Regular physical activity thats moderately intense lowers your blood sugar and makes you more sensitive to insulin so your body wont need as much. Make sure to check with your doctor about what kind of physical activity you can do and if there are any kinds you should avoid.
- Monitoring your baby. Your doctor will check your babys growth and development.
If healthy eating and being active arent enough to manage your blood sugar, your doctor may prescribe insulin, metformin, or other medication.
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How Is Gestational Diabetes Treated
If youre diagnosed with gestational diabetes, your treatment plan will depend on your blood sugar levels throughout the day.
In most cases, your doctor will advise you to test your blood sugar before and after meals, and manage your condition by eating healthy and exercising regularly.
In some cases, they may also add insulin injections if needed. According to the Mayo Clinic, only 10 to 20 percent of women with gestational diabetes need insulin to help control their blood sugar.
If your doctor encourages you to monitor your blood sugar levels, they may supply you with a special glucose-monitoring device.
They may also prescribe insulin injections for you until you give birth. Ask your doctor about properly timing your insulin injections in relation to your meals and exercise to avoid low blood sugar.
Your doctor can also tell you what to do if your blood sugar levels fall too low or are consistently higher than they should be.
How Is Gestational Diabetes Managed After Pregnancy
Research has shown that women with gestational diabetes have a 3 to 7 percent chance of developing type 2 diabetes within five to 10 years which is why its so important to make those healthy habits routine during pregnancy and keep a check on your health even after your pregnancy is over.
Here are a few ways to stay healthy after baby is born:
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Do Eat Carbohydrates On Your Gestational Diabetes Meal Plan
Brace yourself:;Carbohydrates are an important part of your gestational diabetes diet. They are fuel for your body and for your growing baby. The average person needs 135 grams of carbohydrates daily, but if you have gestational diabetes, that increases to 175 grams a day, says registered dietitian and certified diabetes educator Meredith Nguyen, RD, who is a member of the diabetes self-management program staff at Methodist Charlton Medical Center in Dallas. Pregnancy;hormones;can make it hard to control morning blood sugar, says Nguyen, so you might be spreading carbs more through lunch and dinner. Eating a wide variety of foods, including whole grains, fruits , vegetables, and dairy products, will give you the carbs you need. High-fiber or low-glycemic foods will help keep your blood sugar more even and help you feel full longer as well.
Can Gestational Diabetes Be Prevented
Its not possible to prevent gestational diabetes entirely. However, adopting healthy habits can reduce your chances of developing the condition.
If youre pregnant and have one of the risk factors for gestational diabetes, try to eat a healthy diet and get regular exercise. Even light activity, such as walking, may be beneficial.
If youre planning to become pregnant in the near future and youre overweight, one of the best things you can do is work with your doctor to lose weight. Even losing a small amount of weight can help you reduce your risk of gestational diabetes.
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What Is Gestational Diabetes
During pregnancy, some women develop high blood sugar levels. This condition is known as gestational diabetes mellitus or gestational diabetes. Gestational diabetes typically develops between the 24th and 28th weeks of pregnancy.
According to the Centers for Disease Control and Prevention, its estimated to occur in 2 to 10 percent of pregnancies in the United States.
If you develop gestational diabetes while youre pregnant, it doesnt mean that you had diabetes before your pregnancy or will have it afterward. But gestational diabetes does raise your risk of developing type 2 diabetes in the future.
If poorly managed, it can also raise your childs risk of developing diabetes and increase the risk of complications for you and your baby during pregnancy and delivery.
The exact cause of gestational diabetes is unknown, but hormones likely play a role. When youre pregnant, your body produces larger amounts of some hormones, including:
- human placental lactogen
- hormones that increase insulin resistance
These hormones affect your placenta and help sustain your pregnancy. Over time, the amount of these hormones in your body increases. They may start to make your body resistant to insulin, the hormone that regulates your blood sugar.
Youre at a higher risk of developing gestational diabetes if you:
- are over the age of 25
Do Get Plenty Of Sleep With Gestational Diabetes
Research published in BMC Womens Health;shows a strong correlation between not getting enough sleep and the risk of gestational diabetes. Snoring;is also related to poor blood sugar control, which can be a consequence of not following your gestational diabetes diet. Although many women accept that;poor sleep;is part of pregnancy and raising children, you should let your doctor know if youre finding it impossible to sleep well.
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How Does Gd Affect Your Baby After Birth
Babies who are born to mothers with gestational diabetes should be tested for low blood sugar , even if they have no symptoms, with a simple blood test after birth. This happens immediately after delivery, while you and baby are still in the hospital.
After birth, its essential to keep the focus you had during pregnancy on a healthy lifestyle for your whole family; you may find that it helps you stick to your resolutions as well.
Teach your child good eating and exercise habits early on: If you had gestational diabetes, your baby could be at a higher risk for health problems, including obesity as a child or teen and an increased risk for type 2 diabetes later in life, according to the CDC.
To help avoid a type 2 diabetes diagnosis for your child, aim to ensure that he or she:
- Eats nutritious meals. The same diet you follow during pregnancy and beyond is good for your child, too. When he gets old enough, have him help you in the kitchen children who help prepare dishes are more likely to eat them.
- Gets plenty of exercise as he grows. Start by taking walks. As he gets older, toddler soccer and other activities are a great way to get him interested in healthy movement.
- Maintains a healthy weight. Talk to his pediatrician to make sure his BMI is on target, and talk openly to him about healthy weight and the increase in obesity he might notice in school.
How Do I Give Myself An Injection
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Checking Your Blood Sugar
Your body changes as the baby grows. Because you have diabetes, these changes will affect your;blood;sugar level. Pregnancy can also make symptoms of low;blood sugar hard to detect.
During pregnancy, your diabetes control will require more work. The blood sugar checks you do at home are a key part of taking good care of yourself and your baby before, during, and after pregnancy.
Blood sugar targets are designed to help you minimize the risk of birth defects and miscarriage, and help prevent your baby from getting too large. If you have trouble staying in your;target range;or have frequent low blood sugar levels, talk to your health care team about revising your treatment plan. Target blood sugar values may differ slightly in different care systems and with different diabetic teams. Work with your health care team on determining your specific goals before and during pregnancy.
We suggest;the following targets for women with preexisting diabetes who become pregnant. More or less stringent glycemic goals may be appropriate for each individual.
- Before a meal and bedtime/overnight: 60-99;mg/dl
- After a meal : 100-129 mg/dl
- A1C: less than 6%
*Postprandial glucose measurements should be made one to two;hours after the beginning of the meal, which is generally when levels peak in people with diabetes.
Check your blood sugar levels at the times your diabetes care team advises; this may be up to eight tests daily and will probably include after-meal checks.
Insulin And Diabetes Pills
Insulin is the traditional first-choice drug for blood sugar control during pregnancy because it is the most effective for fine-tuning blood sugar and it doesnt cross the placenta. Therefore, it is safe for the baby. Insulin can be injected with a;syringe, an;insulin pen, or through an;insulin pump. All three methods are safe for pregnant women.
If you have;type 1 diabetes, pregnancy will affect your insulin treatment plan. During the months of pregnancy, your body’s need for insulin will go up. This is especially true during the last three months of pregnancy. The need for more insulin is caused by hormones the placenta makes to help the baby grow. At the same time, these hormones block the action of the mother’s insulin. As a result, your insulin needs will increase.
If you have;type 2 diabetes, you also need to plan ahead. If you are taking diabetes pills to control your blood sugar, you may not be able to take them when you are pregnant. Because the safety of using diabetes pills during pregnancy has not been established, your doctor will probably have you switch to insulin right away. Also, the;insulin resistance;that occurs during pregnancy often decreases the effectiveness of oral diabetes medication at keeping your blood sugar levels in their target range.
For women with gestational diabetes, meal planning and exercise often work to keep blood sugar levels in control; however, if blood sugar levels are still high, your doctor will probably start you on insulin.
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Exercise As Treatment For Gestational Diabetes
Regular physical activity is important to help keep your blood glucose under control.
Women with gestational diabetes should get at least 30 minutes of moderate to intense exercise at least five days a week, according to the Centers for Disease Control and Prevention.
This can include walking briskly, swimming, dancing, low-impact aerobics, or actively playing with children.
Potentially dangerous activities including basketball and soccer , horseback riding, and downhill skiing should be avoided.
During the first trimester of your pregnancy, you should also avoid exercises that require you to lie on your back, which could put pressure on certain blood vessels and accidentally limit blood flow to your baby.
Ask your doctor before lifting weights, jogging, or performing other muscle- and bone-strengthening exercises during your pregnancy.
Who Is Most At Risk For Gestational Diabetes
While researchers aren’t certain why some women get gestational diabetes while others dont, they do know that you may be at an increased risk if:
In the U.S., about 90 percent of pregnant women have at least one risk factor for gestational diabetes, which is why universal screening is thought to be the most practical approach.
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Diagnosis Of Gestational Diabetes
Initial screening for gestational diabetes is accomplished by performing a 50-g, one-hour glucose challenge test at 24 to 28 weeks of gestation. Patients do not have to fast for this test. To be considered normal, serum or plasma glucose values should be less than 130 mg per dL or less than 140 mg per dL . Using a value of 130 mg per dL or higher will increase the sensitivity of the test from 80 to 90 percent and decrease its specificity, compared with using a value of 140 mg per dL or higher.14 Thus, the lower screening level of 130 mg per dL identifies more patients with gestational diabetes at the cost of more false-positive results. Current recommendations from the American Diabetes Association 4 and the American College of Obstetricians and Gynecologists 15 accept either value for defining an abnormal initial screening result.
An abnormal one-hour screening test should be followed by a 100-g, three-hour venous serum or plasma glucose tolerance test. After the patient has been on an unrestricted diet for three days, venous blood samples are obtained following an overnight fast, and then one, two, and three hours after an oral 100-g glucose load. During the test period, patients should remain seated and should not smoke. Two or more abnormal values are diagnostic for gestational diabetes.
Myths About Insulin Therapy
According to the American Diabetes Association , several common myths surround the use of insulin therapy for people with type 2 diabetes.
People who take insulin may sometimes hear others make the following statements, but they have no basis in research or fact:
- Insulin can cure diabetes. There is, at present, no cure for diabetes. However, insulin can help a person control its effects.
- It will cause disruption in your life. While a course of insulin takes some getting used to, a person can enjoy a full and active life, as long as they stick to their insulin schedule.
- Insulin injections cause pain. Many people have a phobia of needles. However, modern insulin pens cause almost no pain. People using pumps can avoid injections altogether.
- Insulin will increase the frequency of severe hypoglycemia. While insulin can increase the risk of hypoglycemia, certain insulins can limit a sudden drop in blood sugar.
- Insulin causes weight gain for as long as a person uses it. Insulin might increase weight at first, but this is not an ongoing effect. The body first needs to adapt to insulin supplementation.
- The injection site is not important. Where on the body a person inserts a needle or pen determines the speed at which insulin has an effect. This can be vital after meals when quick drops in blood glucose levels reduce the impact of the food.
- Insulin is addictive. Insulin is not an addictive drug and is vital for any person whose pancreas does not produce insulin.
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