Type 1 and Type 2 diabetes during pregnancy

What are the risks during pregnancy for someone who has diabetes?

• Birth defects
• Polyhydramnios (too much amniotic fluid around the baby)
• Pre-eclampsia (high blood pressure)
• Macrosomia (large baby)
• Cesarean section (May be needed if baby is too large and labor is too long.)
• Hypoglycemia (low blood sugars for baby after delivery)
• Respiratory distress syndrome (breathing problems for baby after delivery)  
• Fetal death (A baby may die before delivery. The reason is not always known. This is rare.)

What can I do to lower the risks for my baby and myself?

1. Keep you blood sugars in target range.

When should I test?

• Type 1: Fasting, before meals, 1 hour after meals, and at bedtime.

• Type 2: Fasting and 1 hour after meals.  

• Test more blood sugars if you are having problems.

What should my target range be?​

• An A1C of 6.0% to 6.5% is recommended. Less than 6.0% is best if you can reach this level without having low blood sugars.

How often should I talk about my numbers with the clinic?

• Type 1: 2 times a week and as needed

• Type 2: 1 time a week and as needed

• If you are not using a Telcare meter, send blood sugars to your care team using MyChart. Choose your OB Diabetes Provider in your MyChart account. Always bring your logs to your visits.

2. Start pre-natal care early.

3. Keep your appointments.

4. Keep insulin, food, blood sugar checks, and physical activity consistent.

• Do not skip meals or stop eating foods in your meal plan. Take snacks and meals to work.
• Call your nurse to talk about other choices if you cannot follow your meal plan due to nausea.
• Have a friend or relative call you each day at the time your blood sugars are most likely to be low, especially if you live alone. 
• Check your urine for ketones if you have type 1 diabetes and your blood sugar is greater than 180 or you are sick.

5. Wear diabetes identification.

How will my insulin needs change during pregnancy?

• During the first 12 weeks, your insulin needs may drop and cause low blood sugar.
• From 12 weeks to 28 weeks, you will need more insulin.
• The last 12 weeks you may need 2 to 3 times more than your normal insulin amount.

What is hypoglycemia (low blood sugar)?

The sugar level in your blood is low. In pregnancy, a blood sugar below 60 mg/dl is too low.

Causes of a low blood sugar:

• Taking too much diabetes medicine.
• Not eating enough food.
• Waiting too long to eat after you take your medicine.
• Exercising more than normal or for a longer time than normal.

Signs of a low blood sugar:

Shaky

Racing heart

Blurred vision

Sweaty

Headache

Nervous

Impatient

Cranky

Hungry

Confused

Dizzy or faint

Numb lips of tongue

Slurred speech

If your blood sugar gets very low you can have seizures or pass out.

Treating a low blood sugar:

1. Test your blood sugar.

   • If it is less than 60 mg/dl, it is too low.

2. Eat or drink 15 grams of carbohydrate. Some choices are:

   • Fruit juice (4 to 6 ounces)

   • Non-diet soft drink/soda/pop (4 to 6 ounces)

   • Skim milk (8 ounces)

   • Honey/jelly/sugar (1 Tablespoon)

   • 5 lifesavers or 6 jellybeans

   • 4 glucose tablets

3. Retest in 15 minutes.

   • Repeat step 2 if your sugar is still less than 60.

4. Eat a snack or meal within 30 to 60 minutes after a low blood sugar.  If it is going to be longer than 30 to 60 minutes until your next meal or snack, you need an extra 15 grams of carbohydrate and a protein.

What is hyperglycemia (high blood sugar)?

The blood sugar level in your body is above your target range.

Causes of high blood sugar:

• Eating more food than is in your meal plan
• Taking less diabetes medicine than you need
• Infection or illness
• Injury
• Surgery
• Emotional stress
• Some medicines, such as steroids

Signs of high blood sugar:

• Blurry vision
• Feeling more tired than normal
• Dry mouth
• More hungry than normal
• Thirst
• Peeing more than normal
• Urination overnight
• Weight loss

Treating and preventing a high blood sugar:

• Follow your meal plan.
• Call your care team if you do not think your plan is right for you.
• Take your diabetes medicines as you were taught.
• Check your blood sugars as advised, at least 4 times per day.
• Test your urine for ketones when your blood sugars are above 180 mg/dl and you have Type 1 diabetes or if you have been in diabetic ketoacidosis in the past.
• Follow sick day guidelines when you have a brief illness.

Sick day guidelines

There may be times when you are not able to eat your normal foods because you are sick. If you have a brief illness, such as the flu, diarrhea, or a cold, follow these guidelines:

• Always take your basal insulin (basal rates on pump or NPH).
• Rest and keep warm.
• Test your blood sugar at least 4 times a day.  
• Test your urine for ketones if you have type 1 diabetes and your blood sugars are above 180. Call your nurse if you have moderate to large ketones.
• Drink 6 to 8 ounces of fluid each hour you are awake to prevent dehydration. You should:
  • Drink fluids without sugar if your blood sugar is over 180, such as clear broth or diet soda. Do not drink caffeine. It can make you lose water through your urine.
  • Drink fluids with sugar if your blood sugar is under 180, such as 4 to 6 ounces of fruit juice or regular soda each hour. Also drink 8 ounces of fluids without sugar, such as clear broth or diet soda, each hour.
• Keep eating normal meals and snacks if you can.
• Take your normal before meal insulin (Humalog or Novolog).
• Take correction insulin if ordered.
• Call your doctor or nurse right away if you cannot eat or drink any foods or fluids, or if you are throwing up.

Call your doctor or nurse if you have:

• 3 or more low blood sugars in 1 week.
• A severe low blood sugar and need help from someone else.
• Vomiting (throwing up) that lasts more than 8 hours.
• Diarrhea more than 5 times or that lasts more than 24 hours.
• Blood sugars greater than 180 for 3 days in a row.
• Moderate or large ketones in your urine and type 1 diabetes.

What testing may be needed?

Ultrasounds

• This test is painless. It uses sound waves across your abdomen (belly) to look at your baby and uterus. It tells your care team:
  • If there is more than 1 baby
  • If your baby has birth defects
  • If there is extra fluid around your baby
• First visit ultrasounds are done to learn how many weeks pregnant you are.
• You can choose to have an ultrasound at 11 to 14 weeks. This is done to screen for chromosome and birth defects. You do not have to do this.
• At 20 weeks you will have a growth and anatomy screening. Then every 4 weeks as needed.

Nonstress test (NST)

• This test is painless. It records the baby’s heart rate and movements.
• You will start having an NST each week starting at 32 weeks. You will also have an ultrasound at that time. This tests how much fluid is around your baby.
• NST must be done every 7 days. This does not replace fetal movement counts.

Urine collection for 24 hours

• This tests how well your kidneys are working.
• Early in pregnancy you will need to collect all your urine for 24 hours. You may need to repeat this test later too.

Eye exam

• It is best to do this during your first trimester. Your doctor may want you to have follow-up exams also.

Electrocardiogram (EKG)

• You might need this to check your heart rate and rhythm early in pregnancy.

How will my diabetes be managed during labor and delivery?

When will my baby be delivered?

• The goal is a vaginal delivery during the 39 weeks.
• Your doctor may decide to induce your labor earlier.

Labor and delivery

• Your care team will manage your blood sugars using a labor and delivery protocol.  People often need regular insulin through an intravenous (IV) catheter.
• Your blood sugars will be checked often.
• If you use an insulin pump, you may be able to use it early in labor if your blood sugars are controlled.

Your care after delivery

• Your body will need less insulin:
  • The need is often less than before pregnancy.
  • Within days or weeks, your insulin needs may return to those before pregnancy.
• It is now safe and healthy for you to lose weight if you were overweight before pregnancy.
• Talk with your dietitian about the right meal plan for you.
• Good care of your diabetes is important to stay healthy.

Can I breast feed?

Yes. Breastfeeding is encouraged for all people and their babies.

You may need extra calories or a change in your insulin. Eat and drink less calories if you do not want to or when you stop breastfeeding.

What should I do if I want to become pregnant in the future?

• Plan your pregnancy so you have the best chance for a healthy baby.

• Schedule an appointment before you become pregnant.

• Make a doctor’s appointment as early as possible after you become pregnant.

• Your care team will follow you closely the first trimester.  This time of the baby’s development is critical.

• Take 400 mcg of folic acid daily before you get pregnant. This will lower the risk of birth defects.

• Good blood sugar control during this time is very important.