Featured articles edition 3
Hypos and pregnancy
During pregnancy, aiming to keep blood glucose levels in the target range combined with the effects of changing hormones can increase the risk of hypos (when blood glucose levels drop below 4mmol/l). Hypos can occur in women with type 1 diabetes or those with type 2 diabetes needing insulin during pregnancy.
The first trimester
In early pregnancy, it’s not uncommon to experience hypos more often. During this time, you can become more sensitive to insulin, which means the insulin you take works more effectively. This often continues throughout the first trimester, until around 14 weeks of pregnancy. Many women need to reduce their insulin doses in early pregnancy to avoid frequent and more severe hypos.
The warning signs
Some women notice that their early warning signs for hypos (such as feeling shaky or sweaty) change when they’re pregnant. This means that hypos can happen without much or any warning, increasing your risk of severe hypos.
Frequent blood glucose checks can help you and your diabetes team with making changes to your insulin doses to reduce your risk of hypos. If you're not recognising your symptoms, your partner, family, friends and workmates may also be able to notice when you are having a hypo. Technology such as continuous glucose monitoring may be helpful during pregnancy - discuss this with your diabetes health professionals.
Hypos and your baby
During pregnancy, many women worry about the effects of hypos on their baby. Hypos have not been shown to cause harm to the baby, but can be a risk to the safety of the mother, so early detection and treatment are vital.
It's important to take care when driving. Always check that your blood glucose levels are at a safe level (above 5mmol/L) before you get behind the wheel. For more information click here.
Sometimes, severe hypos (when you can’t treat your hypo yourself and you need help from someone else) can happen during pregnancy. Your partner, family and friends can be trained to treat severe hypos using a glucagon injection. Your doctor can prescribe this injection. Talk to your diabetes health professionals for more information.
Remember…when you’re pregnant:
- Hypos can be more common, especially in early pregnancy
- Your hypo symptoms may change, so you may be less likely to recognise the early warning signs
- You need to check blood glucose levels more often, treat hypos quickly and stay safe
Keep in touch with your diabetes in pregnancy team, they can help you with making changes to your diabetes management during pregnancy to help reduce your risk of hypos.
If you’re planning a pregnancy, you need to be aware of the medication you are taking. Many medications prescribed by your doctor, as well as those bought over the counter from the chemist or supermarket may not be safe during pregnancy.
For women with diabetes, a medication review is an important part of planning and preparing for pregnancy. All medications you are taking should be reviewed before you fall pregnant (or in the case that your pregnancy was not planned, as soon as possible after you find out that you’re pregnant). This includes all diabetes medications, as well as any tablets you are taking for cholesterol or blood pressure.
What’s safe, what’s not?
Many medications will need to be stopped or changed before pregnancy and then only re-started after pregnancy, or sometimes not until after you have finished breastfeeding. While some medications are not safe to take during pregnancy, other medications are okay to continue during pregnancy and can be necessary for the health of you and your baby.
Common medications prescribed to women with diabetes include:
Insulin is safe to take during pregnancy. It is vital for managing diabetes and will not harm the baby. If you have been prescribed insulin, always continue to take this as recommended by your doctor or diabetes in pregnancy team.
Most diabetes tablets are not suitable for use during pregnancy. However, many women with type 2 diabetes will have been prescribed metformin. This is generally considered to be a safe medication during pregnancy. Many doctors will recommend that you continue to take metformin during your pregnancy. Discuss this with your doctor or diabetes in pregnancy team.
Blood pressure medication
Many blood pressure medications are not safe to take during pregnancy, however your doctor can change your medication to a tablet that is suitable for use during pregnancy. Managing your blood pressure is important for a healthy pregnancy, have your blood pressure checked regularly and discuss suitable medications with your doctor.
Cholesterol lowering medication
Cholesterol lowering medications are not suitable for use during pregnancy. Your doctor will advise you on stopping cholesterol lowering medication and when it is safe to re-start.
Remember: Don’t stop taking any of your prescribed medications without talking to your doctor first.
What about natural medicines and supplements?
Some herbal and traditional medicines, homeopathy products and nutritional supplements may be harmful to you and your unborn baby, so it is important to check this before you fall pregnant.
When you are planning for pregnancy, make a list of any regular medications and find out about the safety of these from your doctor. On this list write all medications that have been prescribed by a doctor, as well as those you have bought from a chemist, supermarket, and health food store or have been recommended by a naturopath.
When planning your pregnancy make an appointment to see an optometrist or an ophthalmologist (eye specialist) to have the back of your eyes checked. Make sure they know you have diabetes. If you have damage to the small blood vessels at the back of the eye (diabetic retinopathy), this needs to be stable before you fall pregnant. Ask your eye specialist if you need any treatment before you fall pregnant. Eye problems may appear or worsen during pregnancy, so you will need to have your eyes checked regularly throughout your pregnancy and then again a couple of months after the birth. Eye problems occurring during pregnancy usually improve after the baby is born.
Recent research out of the UK has shown promising results in early trials on the use of the artificial pancreas during pregnancy*.
This is the first time the artificial pancreas has been trialled in pregnant women with type 1 diabetes and research in this area is continuing. Click here to find out more.
*Note: This technology is not currently available to pregnant women in Australia.
Does having diabetes mean that I will need to have a caesarean section?
Although rates of caesarean section are higher for women with diabetes than those without, a vaginal delivery and natural birth are still possible for many women with diabetes.
If your doctor is concerned that a vaginal birth is not the best option for you, they will discuss this with you when you are making your birth plan. If an ‘elective’ caesarean section is advised, this will be for obstetric reasons such as the position of the baby (for example if it is not ‘head down’) or if the placenta in the wrong place, or if there are concerns about the baby’s size or growth, such as being relatively big for you to deliver. A caesarean section will not just be advised because you have diabetes.
During labour some women may need an 'emergency' caesarean section. This might occur for reasons such as the labour not progressing, concern about the baby's wellbeing prior to or during labour or if there are complications for the mother. If a caesarean section is recommended, your doctor will explain the reasons to you and provide information about the procedure.