Preparing for pregnancy
Optimal diabetes control reduces the risk of miscarriage, congenital malformations and antenatal complications. Hyperglycemia increases the risk of congenital malformations from 3% to 6%.
There are some key priorities for this visit:
Antenatal care: Ideal glucose levels during pregnancy
Ideal glucose levels during pregnancy:
Hypoglycaemic events are not harmful to fetal development, but the counterregulatory response and post-hypo hyperglycemia may be harmful. Don’t overtreat hypoglycaemic events.
How to optimize glucose control in pregnancy:
What’s best to eat during pregnancy?
Expected changes in glucose levels during pregnancy
Effects of diabetes on the pregnancy
Maintaining optimal glucose control and avoiding excessive gestational weight gain reduces these risks.
After the delivery, the glucose levels will fall, and insulin will be ceased.
Metformin will be continued to control postpartum glucose levels. It is safe to take while breastfeeding. If post-partum glucose levels rise above 8 mmol/L, insulin will be re-started at low doses.
At the 8-week postpartum check, review the status of your patient’s diabetes:
Lifestyle and practical tips
Insulin resistance is the central pathology of type 2 diabetes, and although some of the diabetes medications address this, it is the lifestyle strategies that can really make a difference. The question is, which lifestyle changes work and which ones are achievable for your patient? The actual lifestyle strategies for people with diabetes are rarely described in detail, even though they are usually the first management strategy mentioned in the diabetes textbook.
The following lifestyle strategies address the pathology of insulin resistance. They are specific, practical and achievable. See which ones most appeal to you and your patient.