Type 1 and Type 2 Diabetes During Pregnancy

Women with preexisting diabetes whether type 1 or type 2 have high risk pregnancies. If the diabetes is not controlled, there can be significant problems for the baby. If the diabetes is well controlled, one can expect a normal healthy baby.

There are three major types of diabetes in pregnancy. Type 1 and type 2 diabetes are preexisting, the diabetes was present prior to the woman becoming pregnant. Gestational diabetes is diabetes that occurs only while pregnant. Gestational diabetes is discussed here. Type 1 and type 2 diabetes are very different diseases. They are both called diabetes because the blood sugar is high for both.

Type 1 diabetes tends to come on early in life. It is rare to find someone older than an early teenager get diagnosed with type 1 diabetes for the first time. Type 1 diabetics tend to be thin. They always need to use insulin and are often treated with an insulin pump. Type one diabetics can get something called diabetic ketoacidosis (DKA). DKA is a life threatening problem and usually requires hospitalization. It is unusual to meet a type 1 diabetic that has not been hospitalized for their diabetes at some time. Type 1 diabetes is caused by a problem with the pancreas in which it produces no or very little insulin. Insulin is required to move sugar from the blood stream to the cells. Because there is not enough insulin, the sugar builds up in the blood stream and gets too high. High levels of sugar can harm the developing baby. Blood sugars can be difficult to manage in type 1 diabetics as small changes can cause large change in sugar levels.

Type 2 diabetes usually comes on later in life during adulthood. It tends to affect overweight people. Type 2 diabetics do not get DKA. It is unusual for a type 2 diabetic to need hospitalization for the diabetes at least during the childbearing age. Women with type 2 diabetes when not pregnant can often be treated with diet and oral medication or sometimes with diet alone. Insulin is used in more severe cases. In pregnancy, type 2 diabetics usually need insulin to control the blood sugars. Type 2 diabetes is caused by a problem with the insulin receptors. Type 2 diabetics produce normal amounts of insulin, the body is not able to use the insulin well so the blood sugars get too high.

The issue with diabetes in pregnancy is that the developing baby is very sensitive to the mother’s blood sugars. Very high blood sugars can cause a stillbirth where the baby dies before it is born. High levels of blood sugar that are not lethal can cause birth defects such as heart anomalies. Even mildly elevated blood sugars throughout pregnancy can cause macrosomia, the baby gets too big. This can cause injury to the baby at birth. Because of these issues, diabetes must be much more tightly controlled in pregnancy then when a woman is not pregnant. This can be very challenging.

The treatment for preexisting diabetes in pregnancy is diet, exercise, insulin, and sometimes oral medication. Diet is the most important. Diabetics need to be on a low carbohydrate diet. Carbohydrates are all the sweet foods like candy, ice cram, cake, juice, regular sodas, sweet tea, etc. Starchy foods are also carbohydrates even if they don’t taste sweet. This includes bread, cereal, pasta, rice, tortillas, potatoes, corn, etc. It is important to eliminate or at least significantly limit these foods. Pregnant diabetics need to eat mostly proteins (meat, chicken , fish, and beans) and vegetables. Fruits also need to be limited. Exercise is also important and can greatly help to keep blood sugars down.  Insulin is almost always needed in preexisting diabetics while pregnant. Most oral diabetic medication is safe in pregnancy but unfortunately not usually effective.

Diabetes in pregnancy is definitely dangerous. It is controllable. With a lot of effort on your part, there is no reason you can not have  a perfectly healthy baby even with type 1 or type 2 diabetes.