Sugar Matters
February 27, 2009
A sad story – Diabetes and pregnancy

I am jumping ahead a bit to the effect of diabetes in pregnancy because of something that happened this week.

I saw a patient this week that I have been following very closely. She is 24 years old and had been under the care of another doctor prior to my clinic, but she was switched to me after he left for another job. The first time I saw her, she was already 4 months pregnant.{{more}} I read in her prior medical notes that the previous doctor had asked her to be careful not to get pregnant because her diabetes control was terrible, but somehow it happened anyway. Her A1C was over 14 per cent when she got pregnant. That first visit was grave; I spoke of possible bad effects of diabetes on her pregnancy, including the chances of birth defects, early delivery, large babies, and other serious health problems or pregnancy problems. I said we needed to get these sugars under control QUICKLY.

Thereafter she had monthly appointments. At every visit I asked that she call me from home later in the week to let me know her sugars, but she never did. She missed some insulin doses at first, and then started taking them later. She did not check her blood sugars often or follow the diabetic diet. But she felt well in general. She was gaining weight and her baby was growing well according to the ultrasound. She was so excited. This was her first, and she was happy to become a mom.

During her appointment in January, she was in pain. After a quick appointment with me she left to visit an emergency room close to her home. This week is the first time I have seen her since that day.

She lost her baby.

This clinic day was the first day I cried and prayed with a patient in my clinic. I cannot even begin to express the grief on this young woman’s face, the pain, and the sadness. I could not find any words to say. Somehow we managed to speak a bit about how she was doing and what we needed to do to get her body healed and healthy again. We hugged goodbye and she left for home. My mind has been on her every day since then.

I do not know if her diabetes was the cause of this sad ending. It will always cross my mind and I am sure will be on hers as well as she grieves the loss of her first child, and her hope of becoming a mother later this year. This is one of the worst possible things I tell women about in my clinic when I speak about the absolute importance of getting diabetes under control. In future, when I have that conversation again with someone, I will see this young woman’s crying face in my eyes, and I will beg again to please, please work hard to get those sugars down, I can only do so much, a lot of this is up to you.

Diabetes is not random numbers on a sheet, it is life. I hope this week’s column reaches some young woman out there who is pregnant or planning. I want your ending to be happier than for my patient this week. It IS worth the effort.

Anita Ramsetty, MD
[email protected]
Medical Director Endocrine Care Group
Tel: 843-798-4227