Sugar Matters
December 21, 2010
Pregnancy and Diabetes: it is not just about you any more

Ah, it seems that every week I have a new story to share with you, in the hope that an experience here will help you at home. This past week, I received a consultation to assist with a pregnant patient who had Type 2 diabetes. There are a couple of very important aspects of her story that REALLY need attention from you, especially if you are a young woman with diabetes, or related/married to a woman with diabetes.{{more}} This information is crucial, seriously.

FIRST: this young woman became pregnant when her A1C was 13 percent. You have no idea of the look of horror on our faces when this was discovered. Why the horror, you ask? Because despite all urging that she use appropriate contraception to avoid getting pregnant, she did so anyway, and thus put her developing baby at a high risk of having deformities. YES, you read correctly: having a high A1C early in pregnancy has been associated with a higher rate of birth defects and deformities in children. For all diabetic women, we urge them to get their hemoglobin A1C’s at target, meaning less than 7 percent, BEFORE they get pregnant.

SECOND: this woman is not quite accepting the fact that her glucose targets need to change. She has had blood sugars running in the range of 180-240 much of the time. That’s not so bad, I know some of you are saying to yourselves. IT IS NOT GOOD for anyone, and for a pregnant woman, even worse. The blood sugar targets for pregnant women are fasting glucose less than 95mg/dl, and less than 140mg/dl 2 hours after meals. Her argument to me was that she “felt better” with blood sugars in the 150-200 ranges. She was being treated with insulin and should have been correcting her high blood sugars, but she was just leaving them high and waiting for them to “drift down.” I kept telling her the same thing over and over again: I don’t want you feeling weak and passing out, but this is not about where you feel good, it is about being the healthiest for the pregnancy and keeping your baby healthy. She needs to adjust to lower blood sugars; that is all, simple. Nobody passes out from blood sugar problems with levels between 95-140, which is ideally where hers should be, so that is not an excuse at all.

THIRD: she did not contact her doctor when her recent blood sugars started rising. She had been under good control for a few weeks, and then her sugar levels started to rise. This is quite common in pregnancy because there are many changes happening through those nine months which affect how high and how easily treated diabetes will be, in both Type 1 and Type 2 diabetes. She needed to contact her doc AS SOON AS LEVELS INCREASED, instead of waiting until they were so high she needed to come into the hospital.

Hopefully, you will not make her mistakes. She is 24 years old, an adult to be sure, but not yet quite understanding that as a pregnant woman, the story is not about her alone anymore; it is about the baby too. And high blood sugars do developing babies no good at all.

Until next week, stay safe and healthy, Vincy-mamas-to-be!

Anita Ramsetty, MD [email protected]

Medical Director Endocrine Care Group

Tel: 843-798-4227