Introduction
Gestational diabetes mellitus (GDM) is a form of diabetes that occurs during pregnancy. Women who have type 2 diabetes prior to getting pregnant are at higher risk of complications during pregnancy related to their diabetes. Proper management of diabetes is crucial for the health of both mother and baby. This article will provide an overview of managing type 2 diabetes for women before, during, and after pregnancy.
Blood Sugar Control is Key
Keeping blood sugar levels under control should be the main focus when managing type 2 diabetes in pregnancy. High blood sugar levels can lead to risks for both mother and baby. For the mother, consistently elevated blood sugars increase the risk of preeclampsia, a dangerous rise in blood pressure that can lead to seizures or coma. High blood sugar also increases the chances of needing a C-section delivery. For the developing baby, elevated maternal blood sugar increases the risk of excessive growth, early delivery, respiratory distress, and low blood sugar after birth.
To optimize blood sugar control, pregnant women with type 2 diabetes should monitor levels frequently through regular finger stick checks or use of a continuous glucose monitor (CGM). Testing blood sugar 4-6 times per day, including both before and after meals, allows women to determine if diet, exercise, or medication adjustments are needed to maintain target ranges. These targets are determined individually based on factors like prior blood sugar control and diabetes complications but generally aim to keep fasting blood sugar under 95 mg/dL and post-meal under 140 mg/dL.
Diet and Lifestyle Changes
Making appropriate changes to diet and lifestyle habits is essential when managing type 2 diabetes in pregnancy. The ideal pregnancy diet focuses on whole, minimally processed foods with plenty of vegetables, fiber, lean protein, and healthy fats. Complex carbohydrates from whole grains, beans, lentils, and starchy vegetables help provide consistent energy while minimizing blood sugar spikes. Portion control is also important to prevent excessive weight gain as minimal weight gain has been shown to reduce maternal and fetal complications.
In addition to dietary changes, regular exercise such as walking, swimming, or pregnancy yoga helps lower blood sugar. Women should aim for 20-30 minutes of mild to moderate intensity exercise most days of the week. Staying well hydrated by drinking water instead of sugary beverages is also beneficial for controlling blood sugar. Avoiding stress and getting adequate sleep are other lifestyle factors that support blood sugar regulation.
Oral Medications and Insulin
Some women with type 2 diabetes will require medication to manage blood sugar levels in pregnancy. Metformin is generally considered safe to continue using during pregnancy and helps improve insulin sensitivity. Other oral medications like glyburide or insulin itself may be added if metformin alone is not sufficient.
The quick-acting insulin analogs lispro and aspart are preferred over regular insulin in pregnancy as they better mimic natural pancreatic insulin secretion. Short and intermediate-acting insulin types are also commonly used. Dosages need to be adjusted frequently based on blood sugar trends, diet, and exercise. All insulin types are considered low risk in pregnancy as insulin does not cross the placenta to reach the baby.
Frequent monitoring by a knowledgeable healthcare team is key when using medications and insulin to control gestational diabetes. Women should be empowered to self-adjust medication dosing within set parameters based on blood sugar readings. This helps avoid prolonged periods of hyperglycemia or hypoglycemia.
After Delivery
After giving birth, women with type 2 diabetes still require close monitoring and management of blood sugars, especially if breastfeeding. However, there is often a period of enhanced insulin sensitivity right after delivery leading to reduced insulin needs. Oral medications and insulin dosages normally need to be decreased and closely watched to prevent hypoglycemia.
Over time, as the pregnancy hormones wear off, blood sugars tend to rise again and previously effective medication regimens can be resumed. Ongoing blood sugar monitoring and long-term lifestyle management is important after having gestational diabetes to reduce risks of developing type 2 diabetes. Getting screened regularly by a healthcare provider can help detect any progression from gestational to overt diabetes.
Conclusion
Managing Diabetes Type 2 in Pregnancy reduces risks of complications and supports the best possible health outcomes for mother and baby. Consulting knowledgeable healthcare providers and diabetes educators is key when planning pregnancy with preexisting diabetes. With proper management, women with type 2 diabetes can have healthy pregnancies and thrive in the motherhood journey.