Pregnancy update Gestational diabetes, Metformin and Insulin.

With Sophie i suffered from gestational diabetes but i was able to control this with diet even though it was picked up quiet late in the pregnancy, however as it was picked up late my body was HUGE with a lot of fluid and i was stretched tighter than a drum.  With my second pregnancy my body seemed a lot weaker to the diabetes so was at greater risk this was picked up in week 13 because of the previous history and at an early stage my blood test readings seemed to be spiraling ever higher through the coming months.

What is Gestational diabetes? 
Well it is a type of diabetes that arises during pregnancy and occurs when the body does not produce enough insulin to balance the effects of the hormones produced by the placenta, meaning that blood glucose levels will rise higher than normal.

How will it effect the baby?
Baby will not be born with diabetes, but the high glucose in the mothers blood will travel through the placenta and into the baby making the baby bigger than normal which will make delivery of birth difficult.  A close eye will be kepted on the growth of the baby with additional scans measuring the baby at week 28, 32,36 and maybe more.

If diabetes is undiagnosed there could be a risk to fetal abnormalities, the risk depends on how high and how long the blood glucose have been.

What treatment is available?
Mothers will be referred to a special diabetes team where a close regular eye will be kept on the progress of the pregnancy and mother.  In my case i had weekly checks by a diabetes nurse and monthly checks with the specialist.  Mothers will be given a blood glucose meter where the mother will have to perform blood tests on themselves 3 times a a day every day for the duration of the pregnancy the test is either done before or after meals on alternate days.  The aim is to keep blood glucose levels at either.

• Fasting before a meal below 5.9 mmol/l
• 1 hour after meal below 7.8 mmol/l  

For me i found my fingers felt like pin cushions after a while so make sure you use alternate hands.  Managing diabetes with diet can really help cutting out all those naughty but lovely sweet treats as well as fatty foods and choosing healthy foods to eat with good GI helps keeps blood glucose level.

Exercise also is a big help as excessive weight gain will effect the babies size.  I found swimming was a great supportive form of exercise

Metformin
I really struggled keeping my blood sugars level even though i was careful with my diet and exercised but my levels were going crazy and emotionally i felt i was failing some how.  It was great to have a nurse on the end of the phone to talk to and monitor the levels and she reassured me that i was doing everything right and that it was the pregnancy hormone raging out of control and soon i was put on Metformin, which is a tablet form of medicine that can also assist in keeping blood glucose levels in check.  I was put on 1 tablet a day and over a few short weeks this racked up to 3 as the tablets but these were not keeping blood sugars in check, mothers can be put on anything up to 5 tablets a day.  Unfortunately the Metformin and i didn't get along and i was very sick on them spending every day all day nausea and every other day throwing up, diarrhea and having no energy and no will to do anything.  So when the conversation came up to go up to 5 tablets this was dismissed by myself and the specialist and the specialist saw that there is no point going on further as it was not helping.  However this wont be the case for all mothers as many women do just fine on Metformin.

Insulin
Is an injection that is self administered into the thigh and i started on two injections a day one for the morning before breakfast and this was to last me through the food that i ate over the breakfast and lunch period, another injection before the evening meal to last me through the evening food and night.  Most woman who will have to go on insulin will have to continue taking Metformin in conjunction with the insulin as this helps the body absorb the insulin.  Thankfully as i had so much sickness with the tablets i was taken off them and put on a higher rate on insulin around week 21. With Insulin there is no limit to the amount that can be injected.  I started on a dose of 6 but there was a chase between the specialist watching the blood results which i was still doing 3 times a day and the raging hormones being created by the placenta and i was being boosted up ever 2-4 days by 2 doses so after two weeks i was on a dose of 14 shots with no end of this escalation slowing down as the pregnancy went on, and i am wondering how high the dose will go as i have 3 months left to go.  I was also told to eat a few more small snacks to help keep blood sugars level in check.  My thighs are a beautiful artwork of purple bruises and hole marks from the daily injections although the needle is finer is not as bad as the finger blood tests i have to do.

When on insulin mothers also need to be aware of hypoglycemia, which i have had a few episodes of this is  when the blood glucose is a level of 4 mmol this is the defined as the onset of hypo. Causes of hypo are:

• too much insulin
• too little to eat
• to much physical activity
• alcohol
• stress
• heat

Mild effect are

• hunger
• shaking
• sweats and palpitation
• anxiety

Moderate

• lack of co ordination
• blurred vision
• confusion
• speech difficulty

with mild and moderate reactions having a 15g fast acting carbohydrate snack can help such as 5 glucose tablets, 80 ml of lucozade, 150ml cola, 6 fruit pastilles

Severe effects

• fits
• unconsciousness/coma

Seek medial advise asap although severe is more uncommon in gestation diabetes.

Labour
Most women with gestation diabetes will be induced a week early and this was the case with my first Sophie and blood sugars will be monitored during labour, and if blood levels are not maintained some women will be put on intravenous of glucose and insulin as labour is hard work. Some women who's babies get very large will be offered a c section.

After labour when the placenta is delivered diabetes normally goes away however the baby who will have been used to higher levels of glucose may have lower insulin levels making it hypoglycemic so it is very important to breast feed the baby so it gets the all import colostrum to help stabilise the babies blood sugar levels.  The baby will then have blood tests done where blood taken by cutting the heel of the foot every 3-4 hours so it is important feed the baby every 3 hours to keep the babies blood sugars in check.  I found this quiet emotionally distressing with Sophie as she screamed when this was done no mother like to see her child being hurt, plus i was having difficulty getting Sophie to latch on with breast feeding possibly due to the fact i had a c section as my body hadn't had the chance to release hormones to my boobs to tell them to release milk and i ended up having to express and bottle feed her to get the goodness into her to level out her blood sugars.

The Future
If a mother has gestational diabetes with one pregnancy there is a very strong chance that future pregnancies will also suffer from diabetes so it is important to alert the midwife as soon as possible.  There is also a 60% risk of the mother developing diabetes during their lifetime anywhere from 5 to 10 years after delivery so yearly visits to the GP for blood tests are a must to detect this early, it is a good idea that after pregnancy that a careful eye is still kepted on diet and a BMI of 30 maintained to help reduce risk of developing diabetes in the future.


Medical information NHS
Images abc news radio online, Adam, Redmondregional..com sheknows.com healthylifstyle.com andrefit.com

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