10 Frequently Asked Questions about Pregnancy and Diabetes
1. I use insulin four times a day. Can insulin be used during pregnancy?
It is important to keep the blood sugar level well regulated during pregnancy. Because most tablets should not be used, patients are often converted to insulin just before and/or during pregnancy.
shelf. The new ultra-short-acting insulin agents are also considered safe. The latest long-acting insulin agents are still under discussion. Officially, Lantus has not yet been ‘released’ for use during pregnancy, but it is being applied in practice. Studies on the influence of Lantus on pregnancy have not shown any adverse effects on the mother or child.
2. I also have kidney damage due to diabetes. How does that happen during pregnancy?
Patients with microalbuminuria as a result of diabetes will lose even more protein with the urine during pregnancy. This can increase considerably, especially in the third trimester. Fortunately, this protein loss usually recovers in the weeks to months following childbirth. Kidney function can also deteriorate considerably during pregnancy. There seems to be a connection between the quality of kidney function before and during pregnancy: this quality can decrease during pregnancy. With a reduced clearance before pregnancy (< 80 ml/min) there is a chance of a permanent and even increasing decline in renal function.
3. I have kidney damage due to diabetes. Does this affect the baby?
Patients with microalbuminuria have an increased risk of pre-eclampsia, premature birth, and the need to perform a caesarean section. It is important that the practitioner pays close attention to the severity of the protein loss and to the kidney function as measured by the clearance. With a disturbed clearance, the risk of problems such as growth retardation and premature birth increases significantly. The more severe the kidney function disorders, the greater the chance of problems.
4. I have retinopathy and neuropathy due to diabetes. Does that affect the baby?
No, so far no effects of these complications in the mother have been demonstrated for the baby.
5. My eyes are lasered because of the diabetes. How’s that in pregnancy?
Pregnancy can cause eye damage, also called retinopathy, and if it’s aggravated. It is important that the eyes are checked in time, both before and after pregnancy. The greatest deterioration usually occurs after childbirth. There is a link between a rapid improvement in blood sugar levels at the beginning of pregnancy and the occurrence of retinopathy.
6. Is it wise to check the health of the baby before giving birth, and what can be done?
Women with diabetes are more likely to have a baby with an abnormality. It is recommended to have an ultrasound carried out at 18-20 weeks of pregnancy. Other tests can also be done, such as an amniocentesis after 16 weeks of pregnancy. In general, these tests do not provide much news, although there are some disadvantages, including a small chance of spontaneous abortion. A ‘triple test’ can also be carried out. However, this test is less reliable in women with diabetes.
7. I have diabetes and am 23 weeks pregnant. I inject insulin twice a day and my blood sugar levels vary between 6.7 and 10.2 mmol/l. Does anything have to change?
Yes, blood sugar levels really need to improve and therefore decrease. You can increase the insulin dose, but it might be better to inject insulin 4 times a day. This will make you more flexible and make it easier to control your blood sugar levels. The biggest problem at the moment in pregnancy is that the baby is getting too big. This can lead to problems at birth, both for the mother and the baby. Hypoglycaemia can also occur after childbirth.
8. I have diabetes and am being treated with an insulin pump. During childbirth, I prefer to regulate my blood sugar levels with my pump. Is that possible?
In principle, this is certainly possible, but it does depend on the appointments made with the gynaecologist or internist. Usually, the blood sugar levels during childbirth are regulated with insulin that is administered per infusion. Most treatment teams are used to this. As long as blood sugar levels are measured often enough, it can also be done with a pump. Frequent measurement means every hour or every 2 hours.
9. I am currently being treated with Novorapid and Lantus, schedule 4x daily. Yesterday I discovered that I am pregnant. Do I need to change insulin?
There are several doctors who treat pregnant patients with diabetes with Lantus. Levemir, another long-acting insulin, is also used. However, science is not entirely clear about its safety. In general, people are very cautious about the use of new medicines during pregnancy.
10. I’ve had diabetes for five years, am well regulated with an HbA1c of 6.4, and would like to get pregnant, but it doesn’t work. Is it because of diabetes?
There are a lot of patients who get pregnant with poor or very poor blood sugar regulation. Infertility is a complex problem with many possible causes, both on the female and male side. The chance that it is due to diabetes is not very high. You will, therefore, have to have research carried out in the same way as non-diabetic patients.
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