Diabetes Pregnancy

When the doctor told us that I have diabetic, I remember feeling very very scared as I have read about the risks associated with diabetes pragnancy. I'd like to share it with you, though I have to warn that it's a little bit long. But if you do have diabetes or suspect that you may have diabetes and you plan to get pregnant, I recommend that you read this.

Diabetes

What is diabetes?

Diabetes is a condition where sufficient amounts of insulin are either not produced or the body is unable to use the insulin that is produced. Insulin is the hormone that allows glucose to enter the cells of the body to provide fuel. When glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death.

What are the different types of diabetes?

There are three basic types of diabetes including:
type 1 diabetes - also called insulin dependent diabetes mellitus (IDDM), type 1 diabetes is an autoimmune disorder in which the body's immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin. Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes in the US. Type 1 diabetes usually develops in children or young adults, but can start at any age.

type 2 diabetes - a metabolic disorder resulting from the body's inability to make enough, or to properly use, insulin. It used to be called non-insulin-dependent diabetes mellitus (NIDDM) and usually develops after age 45.

gestational diabetes - a condition in which the blood glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes.

Diabetes is a serious disease, which, if not controlled, can be life threatening. It is often associated with long-term complications that can affect every system and part of the body. Diabetes can, among other things, contribute to eye disorders and blindness, heart disease, stroke, kidney failure, amputation, and nerve damage.

What happens with diabetes and pregnancy?
During pregnancy, the placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. In early pregnancy, hormones can cause increased insulin secretion and decreased glucose produced by the liver, which can lead to hypoglycemia (low blood glucose levels). In later pregnancy, some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin, a condition called insulin resistance.

As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results or there may be worsening of pre-existing diabetes.

Why is diabetes a concern in pregnancy?
Diabetes in pregnancy can have serious consequences for the mother and the growing fetus. The severity of problems often depends on the degree of the mother's diabetic disease, especially if she has vascular (blood vessel) complications and poor blood glucose control. Diabetes that occurs in pregnancy is often listed according to White's classification:

Gestational diabetes - when a mother who does not have diabetes develops a resistance to insulin because of the hormones of pregnancy.

Non-insulin dependent - Class A1

Insulin dependent - Class A2

Pre-existing diabetes - women who already have insulin-dependent diabetes and become pregnant.

Class B - diabetes developed after age 20, have had the disease less than 10 years, no vascular complications.

Class C - diabetes developed between age 10 and 19 or have had the disease for 10-19 years, no vascular complications.

Class D - diabetes developed before age 10, have had the disease more than 20 years, vascular complications are present.

Class F - diabetic women with kidney disease called nephropathy.
Class R - diabetic women with retinopathy (retinal damage).
Class T - diabetic women who have undergone kidney transplant.
Class H - diabetic women with coronary artery or other heart disease.

It is very important for a mother to maintain very close control of her diabetes during pregnancy. Generally, the poorer the control of blood glucose and the more severe the disease and complications, the greater the risks for the pregnancy.

Maternal complications of diabetes on a pregnancy:
Complications for the mother depend on the degree of insulin need, the severity of complications associated with diabetes, and control of blood glucose.

Most complications occur in women with pre-existing diabetes and are more likely when there is poor control of blood glucose. Women may require more frequent insulin injections. They may have very low blood glucose levels, which can be life threatening if untreated, or they may have ketoacidosis, a condition that results from high levels of blood glucose. Ketoacidosis may also be life threatening if untreated. It is not clear whether pregnancy worsens diabetic related blood vessel damage and retinal changes, or if it causes changes in kidney function.

Complications for fetus and baby:
Infants of mothers with diabetes are at greater risk for several problems, especially if blood glucose levels are not carefully controlled, including the following:

birth defects

Birth defects are more likely in infants of diabetic mothers, especially insulin-dependent women who may have two to six times greater the risk of major birth defects. Some birth defects are serious enough to cause fetal death. Birth defects usually originate sometime during the first trimester of pregnancy. They are more likely in women with pre-existing diabetes, who may have changes in blood glucose during that time. Overall, major birth defects may occur in about 5 to 10 percent of insulin-dependent women. Major birth defects that may occur in infants of diabetic mothers include the following:

Heart and connecting blood vessels
brain and spine abnormalities
urinary and kidney
digestive tract

stillbirth (fetal death)

Stillbirth is more likely in pregnant women with diabetes. The fetus may grow slowly in the uterus due to poor circulation or other conditions, such as high blood pressure, that can complicate diabetic pregnancy. The exact reason stillbirths occur with diabetes is unknown. The risk of stillbirth increases in women with poor blood glucose control and with blood vessel changes.

macrosomia

Macrosomia refers to a baby that is considerably larger than normal. All of the nutrients the fetus receives come directly from the mother's blood. If the maternal blood has too much glucose, the pancreas of the fetus senses the high glucose levels and produces more insulin in an attempt to use this glucose. The fetus converts the extra glucose to fat. Even when the mother has gestational diabetes, the fetus is able to produce all the insulin it needs. The combination of high blood glucose levels from the mother and high insulin levels in the fetus results in large deposits of fat that causes the fetus to grow excessively large.

birth injury

Birth injury may occur due to the baby's large size and difficulty being born.

hypoglycemia

Hypoglycemiais low levels of blood sugar in the baby immediately after delivery. This problem occurs if the mother's blood sugar levels have been consistently high causing the fetus to have a high level of insulin in its circulation. After delivery, the baby continues to have a high insulin level, but no longer has the high level of sugar from the mother, resulting in the newborn's blood sugar level becoming very low. The baby's blood sugar level is checked after birth, and if the level is too low, it may be necessary to give the baby glucose intravenously.

respiratory distress (difficulty breathing)

Too much insulin or too much glucose in a baby's system may delay lung maturation and cause respiratory difficulties in babies. This is more likely if they are born before 37 weeks of pregnancy.

How is diabetes diagnosed?
Women with diabetes before pregnancy have already been diagnosed. Depending on the severity of their disease, they may need continued care by their medical physician along with their obstetrician.

Nearly all non-diabetic pregnant women are screened for diabetes at the end of the second trimester of pregnancy. In addition to a complete medical history and physical examination, diabetes is diagnosed with a glucose screening test, which involves drinking a glucose drink followed by measurement of glucose levels after a one-hour interval.

If this test shows a blood sugar level of greater than 140 mg/dl, another test will be performed after a few days of following a special diet. The second test also involves drinking a glucose drink, and results are measured at three-hour intervals.

If results of the second test are in the abnormal range, diabetes is diagnosed.

Treatment for diabetes:
Specific treatment for diabetes will be determined by your physician based on:
your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference
Treatment for diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:
special diet with controlled amounts of carbohydrate
exercise
blood glucose monitoring
insulin injections

Managing diabetes during the pregnancy:
Special fetal testing and monitoring may be needed for pregnant diabetics, especially those who are taking insulin (because of the increased risks for stillbirth). These tests can include the following:

fetal movement counting - counting the number of movements or kicks in a certain period of time, and watching for a change in activity.

ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

nonstress testing - a measurement of the fetal heart rate in response to the fetus' movements.

biophysical profile - a test that uses the nonstress test and ultrasound to examine fetal movements, heart rate, and amniotic fluid amounts.

Doppler flow studies - a type of ultrasound which uses sound waves to measure blood flow.
Infants of diabetic mothers may be delivered vaginally or by cesarean, depending on the estimated fetal weight and the mother's health. Because infants of diabetic mothers tend to be large compared to fetuses of the same gestational period, they may need to be delivered a few weeks early. This can often help prevent difficulties in labor and birth that can happen when a baby is very large. An amniocentesis may be performed in the last few weeks of pregnancy to check the amniotic fluid for fetal lung maturity. If the lungs are mature, some mothers may have labor induced or a cesarean delivery.

I am diabetic Type 2 which means that I have to inject insulin 4 times a day :(.

I am currently on Actrapid 3 times a day and Insulatard one time a day before bed.

It's no fun believe me.

Well I guess I have to be extra careful with my food intake from now on.

Wish me luck people.

We Are Pregnant :)

After many many boxes of fertility tests...

After many many hours on the bed (ehem! ;) I'm not complaining really)

After many many positions ( ehem! ehem! again, not complaining)

After many many hours waiting and counting and charting..

We are happy to announce that we are 16 weeks pregnant!

Hurraaaaay!

We are so very happy and we can't wait for the arrival of out little one :)


16 Weeks Pregnant

At this point of your pregnancy, your baby is approximately 4.3 to 4.6 inches long and weighs 2.8 ounces. Not only is your baby growing, your uterus and placenta continue to grow to accomodate the growing baby inside of you! Just six weeks ago, your uterus weighed about 5 ounces. This week it now weighs 8.75 ounces!

The amniotic fluid that surrounds the baby is increasing and there is about 7.5 ounces of fluid. You will easily be able to feel your uterus approximately three inches below your navel. This is an important week for testing and you will most likely ahve an AFP test done.

This is a harmless blood test that is done to detect abnormalities such as Down's syndrome or spina bifida. This is a non-invasive test and it carries no risk to your developing baby. Most doctors will offer the test, but in most cases it is completely optional.

Your milk glands start production at this time and this causes some tenderness and swelling in early pregnancy. Your veins will become more visible because there is an increaed amount of blood flowing to the breasts.

Since this is our first pregnancy, we are thrilled and scared at the same time. So every little twitch or pain we'll be calling the doctor just to make sure that everything's fine.

We also found out that we were actually pregnant and had a miscarriage the first month we got married! But since we were not aware of the pregnancy, that was why I didn't know I had a miscarriage though I did wonder why my period flow was very heavy and clumpy.

Anyway, we are just glad that we've passed the first trimester and now we are wee into our second trimester. Had to say I was very worried when I had some bleeding in my 5th week all the way to my 6th week but it seems that the baby is strong.

I have a little pouch that is quite noticeable so I guess people can tell that I'm pregnant :) Been getting some baby stuffs (I know it's way too early but we just couldn't resist!)

I'm so happy :)

LG Viewty

I need a new handphone.

The LG Viewty looks sleek and trendy with 5.0 megapixel camera phone. And for someone who likes to snap away like me, this is just perfect!

But it looks expensive yes?

And handphone is easily obsolete. New designs will come almost instantly.

I'm still using my old Motorola which works well and I never really have any problem with it.

Hmmmph....

Dear Santa, I have been a very very good girl this year, Can I have this LG Viewty? ;)

This phone is definitely in my Christmas wish list.

What's your wish list for this coming Christmas?

Are You A Thumb Sucker?

Does your baby or child suck their thumb? Some children suck their thumbs while others do not. Why? What are the consequences of thumb sucking, healthwise? How can you help your child stop sucking their thumb?

I was a thumb-sucker when I was a child and as a result to that I needed to get braces when I grew up because my teeth were a lil crooked.

Some infants begin sucking their thumb while in their mother’s womb. Many babies are born with calluses from sucking their finger, thumb or wrist. Other babies discover finger or thumb sucking after birth. This non-nutritive sucking is done for comfort. The sucking instinct in newborns is for survival. Babies that are born in countries where they have constant access to their mother’s breast have very little incidence of thumb sucking. The infant’s sucking urge is completely satisfied and they do not need to suck their thumbs.

Most children stop sucking their thumb or fingers on their own without parental intervention somewhere around age one. But, some children continue sucking their thumb long after. Hereafter we will refer to finger, hand or thumb sucking as just thumb sucking to simplify the article.

As most infants develop independence they become more mobile and too busy to bother with thumb sucking and therefore quit. When a child continues to suck their thumb many parents start to use punishment, negativity, yelling and frustration to try to stop them. This only makes the habit more entrenched.

A child who sucks her thumb will have dental and speech problems. The top jaw begins to form a gap in the front where the thumb is always placed causing an open bite. Other problems include a cross bite,crooked teeth, malocclusions, lisps, or a tongue thrust.

Prevention of prolonged sucking into childhood is probably the best defense that parents can take. First of all, a parent must meet their infant and toddler's emotional needs. Give your baby and toddler a structured day. Respond to their crying to soothe them. They are either tired, hungry, cold, bored or wet. Find out what it is and meet their needs. Give your child a feeling that they are safe with you at home or in a daycare they will feel safe at.

If your child is still sucking their thumb after age five intervention is necessary. The timing of this intervention is important. Do not try any intervention when they are starting on a new endeavor in their life. This means a new school, home, sibling, parent etc.

The first step is to validate your child’s feelings when you begin to talk to them about their thumb sucking habit.

Make sure you tell them that you know it is hard for them but you are confident they can be successful at quitting.

Rarely does another bad habit replace the thumb sucking habit: your child can be successful with your support, love and encouragement.

Sugar For My Sweet

Hubby is away for work and he left me a message,

"Left you something in the closet"

To my horror/surprise I found this...

With a little post-it that says "I'll eat it off you when I come back ;)"

Now, how on earth am I going to fit into that??

Lets hope I don't get bitten by ants before I get bitten by Hubby first.

Hahahaha!

Love Making During Pregnancy

Sarah has been complaining to me that ever since she entered her 3rd trimester she has become more...ummm h.o.r.n.y but her husband refuse to have s.e.x with her until the baby is born. Feeling all frustrated she e-mailed me this piece of information that she found on the net. I'm not too sure how this piece of information will benefit me, but I though I'll post it on this blog just in case you might need the info ;)

If you're pregnant, or just found out you were, you're probably wondering what the best pregnant s.e.x positions are. Because your body doesn't change that much in the first trimester, s.e.x can pretty much continue as it has in the past so there really isn't a need to be concerned about pregnant positions for s.e.x. Later, however, as the uterus grows, some natural positions may become more difficult to perform and will require you to choose better s.e.x positions while pregnant. S.e.x expert Pepper Schwartz, PhD, offers these suggestions on the best pregnant s.e.x positions:

Spoon: The spoon position can be very cozy and intimate. In this case you should lie on your side curled in a C, with your partner facing your back and curled around you. He then enters your v@gina from behind while both of you are lying on your sides.

Side by side: Another good choice for late pregnancy, this position will control thrust and keep weight off your belly. You and your husband lie side by side, facing each other. He slips his leg over yours (your leg can be either straight and to the side or bent at the knee) and enters you from an angle. In a variation of this, you lie on your back and he on his side. Put your leg that's closest to him over his legs. He can enter you from the back and side, and still have his face next to yours.

Woman on top: This can be a satisfying position during late pregnancy, allowing you to control pacing and be more comfortable. Make sure, however, that he doesn't enter you too deeply.

Edge of the bed: Try lying down face-up on the edge of the bed, with your legs spread and the soles of your feet on the floor. Your partner can stand or bend over you. This position, however, does allow him to thrust more deeply, so you'll have to tell him how gentle and slow you want him to be.

Content courtesy of American Baby.

Story of Twenty Toes

If my calculation is correct, I should be ovulating by now. So we have been doing a lot of this...

Hahahahahahahaha!