DIABETES AND PREGNANCY OBSTETRIX OF THE MOUNTAIN STATES

DIABETES MANAGEMENT WITH MATERNAL FETAL MEDICINE (MFM)

¡ Most visits will be done weekly by phone. Please make sure these visits are scheduled.

¡ Ultrasounds and Non-Stress Tests will be determined by our physicians. We will let you know when you should come into the office.

TYPES OF DIABETES

¡ Gestational Diabetes (GDM):¡ This is a type of diabetes that occurs only during pregnancy. The placenta releases hormones that

counteract your insulin which causes insulin resistance. Therefore, you have too much sugar in your bloodstream causing an elevation in your blood sugar. Left untreated this can be dangerous for both you and your baby.

¡ Our focus is to help you manage your blood sugars by diet and exercise. Sometimes, the use of medication such as Metformin or insulin may be required.

¡ The majority of the time, diabetes will go away once the placenta is delivered. However, you will have an increased risk of Type II in the future.

WHO'S AT RISK?

¡ Who is at risk for gestational diabetes?¡ Women who are overweight

¡ Women who have a family history of Type 2 Diabetes or Gestational Diabetes

¡ Gestational Diabetes in a prior pregnancy

¡ Women who have delivered a >9lbs baby

¡ Women of certain ethnicities

TYPES OF DIABETES

¡ Type 1 and Type 2 Diabetes:¡ Patients with preexisting diabetes will benefit from frequent blood sugar reviews due to increased

insulin resistance. With each trimester of pregnancy the needs for medication, whether oral medications or insulin, will change.

Possible Recommendations¡ A dilated eye exam to detect retinopathy with follow up indicated by findings and ophthalmology

recommendations

¡ A heart exam may be recommended (EKG or Echocardiogram)

¡ Fetal Echocardiogram around 22 weeks

RISKS OF DIABETES IN PREGNANCY

¡ Risks to Baby

¡ Large baby

¡ Polyhydramnios (increased fluid in amniotic sac)

¡ Preterm baby

¡ After birth

¡ Hypoglycemia (low blood sugar), Jaundice, NICU admission

¡ Stillbirth

¡ Possible greater risk for obesity and increased risk for diabetes later in life

¡ Risks to You

¡ High blood pressure and pre-eclampsia

¡ Frequent urinary tract infections, yeast, or vaginal infections

¡ Difficult delivery and increased risk for need of c-section

HOW DO I MANAGE DIABETES?

¡Checking your Blood Sugar

¡Diet

¡Exercise

¡Medications

GLUCOSE METERS

¡ A glucose meter will be called in, start testing you blood sugar as soon as possible. Let us know if you need further instructions with your meter. YouTube has instructions from the manufactures on the meters we frequently prescribe. Click the link below for your meter.

¡ Verio- https://www.youtube.com/watch?v=kyoIVrpssOY

¡ FreeStyle Lite- https://www.youtube.com/watch?v=DixQXe9t-eE

¡ True Metrix- https://www.youtube.com/watch?v=eOjCUI6OXlM&t=9s

¡ Accu-Chek Aviva- https://www.youtube.com/watch?v=u3q6Mh6KlNA

This Photo by Unknown Author is licensed under CC BY-NC-ND

METER TIPS AND INFORMATION

¡ Never share your meter or testing supplies.

¡ Use new lancets each time, wash hands or use alcohol.

¡ Store used needles/syringes and lancets in a sharp's container; never throw sharps in the garbage.

¡ Don’t leave your sharps out and keep them away from children and pets.

¡ Contact your local waste management when you are ready to throw your container away. They will give you instructions; different cities might have different rules.

BLOOD SUGAR GOALS

Check blood sugar when you wake up and 1hour after each meal. Document your numbers.

Blood sugar goals• Fasting- 70-95

• 1 hour after meals- less than 140-OR-

• 2 hours after meal- less than 120

• Middle of the night-70-120

Type1&2 diabetes- A1C: 6-6.5% <7% if risk of hypoglycemia

Date Fasting Break-fast

Lunch Dinner Extra sugars

Example04/01/20

82 138 110 129 72-not feeling well

HYPERGLYCEMIA (HIGH BLOOD SUGAR)

¡ Blood sugar elevations can be caused by:

¡ Consuming too many carbs

¡ Lack of Sleep

¡ Illness

¡ Stress

¡ Increased insulin resistance as pregnancy progresses

If your blood sugars are consistently out of range, please call our office to schedule an appointment!

HYPOGLYCEMIA (LOW BLOOD SUGAR)

¡ Low blood sugar can be caused from taking too much medicine, not eating enough, or exercise.

1. If you feel shaky, sweaty, weak, confused or not well, check your sugar.

2. If sugar is less than 70, have 15 grams of carbohydrate. (Example: fruit snacks, 1/2 cup of juice or four glucose tablets)

3. Recheck blood sugar in 15 min.

4. Repeat until blood sugar is above 70 and eat a meal within one hour.

5. Treat any low blood sugars and contact MFM or your provider if you are having blood sugars less than 70.

EXERCISE AND PREGNANCY

¡ During this time of social distancing, find activities you can do safely in your home. Walking, cleaning, online videos, dancing, yoga. Do not lift heavy weights or do any activities that could cause you to loose balance. Contact your OB if you are unsure if exercise is OK for you. You should not exercise if you are on restrictions or bedrest.

¡ 2.5 hours a week of exercise is encouraged. You should exercise for 10 minutes after meals or 30 minutes each day. Stop exercising if you are experiencing shortness of breath, chest pains, contractions, leakage of fluid, vaginal bleeding or any other concerns, and contact you doctor right away.

¡ Always stay hydrated. If you are on medication for your diabetes, it’s best to exercise after a meal or snack. Do not exercise if your blood sugar is less than 100. Keep a snack and your meter close by for symptoms of hypoglycemia.

RECOMMENDATIONS FOR DIABETES AND HEALTHY EATING

¡ Protein – meat, eggs, fish, nuts, nut butter, Greek yogurt, cheese, cottage cheese at least 71 grams per day and 50 additional grams if you are having twins.

¡ Carbohydrates- fruits, vegetables, wheat bread, beans, wheat pasta, brown rice at least 175 carbs per day

¡ Fiber- fruits, vegetables, beans, nuts 28 grams per day

¡ Healthy Fats- nuts, olive & coconut oil, nut butter 6-8 teaspoons per day

Some people find it helpful to use an app on their phone to track food.

You can also use Google, Siri, Alexa and other internet platforms to find out the nutritional

content in the foods you are eating.

PROTEINS

¡ Protein is very important to our body’s function. It slows down the rate we digest sugar and helps to maintain a healthy blood sugar during digestion. Protein is highly recommended at each meal and snack. Pregnant women should eat 71 grams of protein per day. If you are pregnant with twins, you should have an additional 50 grams of protein daily.

Protein Amount

3 oz. of Fish 19-26 Grams of Protein

4 oz. of Chicken 30 Grams of Protein

4 oz. of Beef 33 Grams of Protein

1 Cup Non-Starchy Vegetables (broccoli)

2.5-5 Grams of Protein

8 oz. of 1% Milk 7 Grams of Protein

1 TBS of Peanut Butter 4 Grams of Protein

EATING CARBOHYDRATES

¡ DO NOT STOP EATING CARBS

¡ Choose healthy carbs such as: fruits, vegetables, beans, whole grains and whole wheat.

¡ Try to avoid processed foods and white products such as white rice and white bread.

¡ Try not to eat more than a ½ cup- 1cup of pasta or rice in any meal, or more than a ½ of a large potato.

¡ Cereals, regardless if it’s “healthy” or not will typically cause elevations in blood sugar. This might be a food you want to avoid during pregnancy.

¡ Try to avoid fruit juices, sugary drinks, candy, cakes, cookies, added sugar and processed sugary snacks.

HOW TO CARB COUNT

¡ Start counting your carbohydrates.

¡ It is recommended to eat:

¡ 45 grams of carbs at EACH meal.

¡ 15-30 grams of carbs at EACH snack.

¡ A pregnant woman should be eating no less than 175 grams of carbs each day, with 3 meals per day and 2 to 3 snacks per day.

¡ Every meal and snack should include a carbohydrate and a protein.

HOW TO READ A FOOD LABEL

¡ Important things to look for on a food label:

¡ Serving Size

¡ Carbohydrate

¡ Protein

CARB COUNTING

This Photo by Unknown Author is licensed under CC BY

EXAMPLES OF 45 CARBOHYDRATE MEALS WITH A PROTEIN

This Photo by Unknown Author is licensed under CC BY-NC-ND

This Photo by Unknown Author is licensed under CC BY-SA

This Photo by Unknown Author is licensed under CC BY-NC-ND

This Photo by Unknown Author is licensed under CC BY-NC-ND

This Photo by Unknown Author is licensed under CC BY-SA-NC

DIETARY SNACK IDEAS

¡ Eating 6 times a day can be challenging. Here are some simple ideas you can keep on hand for snacks between regular mealtimes. *Not all types of snacks are equal. Check the nutrition label on the box to determine the serving amount.

¡ These are mix and match examples. 1-2 carb options and one protein!

1 English Muffin with Peanut Butter

1 Large Apple with Peanut Butter

1 Large Peach with 1 String Cheese

12 Crackers, 2 Cheese Slices

2 Cups of Chicken Noodle Soup

3 cups of popcorn with ¼ Cup of Nuts

2 Cups of Melon and ¼ Cup of Cottage Cheese

2 Graham Crackers and 1 Cup of Milk

12 Crackers, ½ Cup of Cottage Cheese, and Tomatoes

Granola Bar and 1 Cup of Milk

1 Cup of Greek Yogurt with ¼ Cup of Nuts & berries

1 Pita with Hummus and Nuts

Egg Salad Sandwich or Peanut Butter Sandwich

1 Protein Bar and 1 Cup of Milk

ARTIFICIAL SWEETENERS

¡ Artificial Sweeteners: Sugar substitutes are found in sugar free foods. They are an artificial sweetener added to foods that do not elevate blood sugars. Below are examples of sweeteners that have been approved in moderation during pregnancy.

¡ Examples: Splenda, Equal, Stevia, Sunett, NutraSweet, Newtame

WHEN CAN I EAT? HOW OFTEN?

¡ To keep blood sugar steady throughout the day, it is best to eat every 2-3 hours.

¡ Eating 3 meals a day with a snack in between can help prevent your blood sugar from dropping too low or becoming too high.

¡ A bedtime snack is important to make sure you have enough food to last while you are sleeping.

¡ Routine is important. Eating roughly the same time each day will help regulate your blood sugar and help you to remember if you have eaten enough in the day.

DAILY FETAL KICK COUNTS

¡ Do fetal kick counts daily starting at 28 weeks gestation

¡ Do a fetal kick count each day.

¡ Pick a time each day around the same time to monitor movement.

¡ Have a something to eat and drink before starting.

¡ Look at the clock and starting counting movements.

¡ Make sure you feel 10 kicks in one hour. You can stop counting after 10 kicks are felt.

¡ If you DO NOT feel 10 kicks in the hour contact your doctor right away.

CALL YOUR DOCTOR OR SEEK EMERGENCY CARE

¡ Fever greater than 99.4, cough, or signs of Covid-19 (CALL FIRST)

¡ Go to the ER with any difficulty breathing

Call your doctor for instructions on:

¡ Nausea, vomiting or diarrhea greater than four hours

¡ Decreased fetal movement (start daily fetal kick counts at 28 weeks)

¡ Vaginal bleeding or signs of labor such as leaking fluid or contractions

¡ Headaches, swelling, visual changes, or right upper abdominal pain

¡ Any other concerns

Go to the hospital or L&D if immediate care is needed.

¡ Contact MFM if your blood sugars are out of range.

FOLLOW UP CARE AFTER DELIVERY

¡ Glucose Tolerance Test recommended 4-6 weeks after delivery for gestational diabetes. Then diabetes screening every 1-3 years after as directed by primary care physician.

¡ Patients with Type I diabetes should resume care with endocrinologist within one week of delivery. Patients with Type II diabetes should have follow-up care with endocrinologist or primary care within 2-4 weeks, or sooner if concerns.

¡ Diabetes Prevention Program for anyone at risk for Type II diabetes. https://livingwell.utah.gov/ndpp/index.php