Kids at Risk For Diabetes

Registered Nurse, Diabetes Educator, CDE, Obesity, Children, Youth, Lifestyle

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Julie RN CDE

Children need activity every day!

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Children need activity every day!

Being active for children means being active every day. Adult exercise goals are 150 minutes each week. But children need activity every day for at least 30 minutes.

Cut down on screen time!

Kids need to cut down on computer time and video games.  They need encouragement to disconnect. Put a timer on them and make a record of how much time they are spending. Be the parent, stand firm. Use screen time as a reward.

Every day children need to go for a walk, or play at their playground.

3-5 times a week they need a cardio workout that will develop a healthy heart and lungs. There are many different kinds of aerobic exercise. It is important to increase their heart rate into a cardiac range. That range should be determined by your doctor.

Aerobic exercise examples:
  • step exercises
  • cross country running
  • rowing
  • stair climbing
  • wind surfing
  • racquetball
  • tennis
  • squash, you get the idea.

There are many different kinds of aerobic exercise. It is important to increase their heart rate into a cardiac range. That range should be determined by your doctor. One of the easiest way to encourage this type of activity is to get them into an organized sport. Even golf can get them motivated.

In addition, children need muscle strengthening and stretching exercises at least 3 time a week.

Muscle strengthening exercise examples:
  • weights
  • resistance bands
  • calisthenics like push-ups, jumping jacks, or lunges.

It is easy to stretch before you do the muscle strengthening routine and afterwards as a
cool down.

Start slow with 30 minutes each day. Set a goal of 60 minutes per day. Keep a record of all your exercise.

Record your progress on a calendar and celebrate your success!

Remember, a little progress everyday will become a healthier lifestyle over time.

Find an activity that they enjoy doing!

Schedule a time and commit to doing it.

Make your family’s health a priority!

This really is a lifestyle change.  It is so important to help control your weight and exercise is a great way to improve your health. Get started, you’ll feel better.

PRECAUTION NOTE: Before beginning any exercise program consult your physician.

Complications from elevated blood sugars include hypertension, cholesterol problems, eye problems, heart disease, peripheral vascular disease, foot problems, kidney disease or gastroparesis. Adults may be requested to complete a graded exercise evaluation before starting any exercise program due to these complications.

Do you need encouragement to increase your daily activities?  That’s what a life coach does! Email me if you have questions, Julie@kidsatriskfordiabetes.com. Also check out my 30 day virtual course for your whole family! Or schedule a call with me to discuss your specific needs.

Syndrome X

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Syndrome X, aka Metabolic Syndrome or Obesity Syndrome

Syndrome X is a diagnosis you might here if you are at risk for a chronic disease, which is also known as Metabolic Syndrome. This is a group of health conditions that puts an individual at risk for chronic health problems like heart disease, strokes, and diabetes, plus high blood pressure and obesity.

Metabolic syndrome includes: (you must have at least 3 risk factors for this diagnosis)

  • A large waistline or apple shape body
  • High total cholesterol (LDL, HDL  & VLDL)
  • Low HDL cholesterol (HDL improves your blood vessels)
  • High triglycerides (caused by daily overeating)
  • High blood pressure or taking medication for high blood pressure
  • Fasting blood glucose over 126 (early signs include blood glucose 100-125)
  • Other risk factors are your genetics and your age.

Insulin resistance increase your risk for an apple shaped body. Not everyone who gains weight develops an apple shape. However, insulin resistances causes fat to be deposited within your abdominal cavity.

Another common problem in metabolic syndrome is unacceptable levels of triglycerides. Many times triglycerides go up when people eat more calories during the day than they are burning. If you have above range triglycerides or are taking medications to control your triglycerides, then you are at risk for chronic disease.

If your LDL (low-density cholesterol) levels are high, that is another risk factor for a Syndrome X diagnosis. Cholesterol is often a reflection of the food you eat. Typically this is a high fat diet. It amazes me how many adolescents today are on cholesterol lowering medications. If you don’t know your cholesterol numbers, then you need to consult your medical provider and seek a blood test. Total blood cholesterol should be less than 200. If you are taking a medication to lower your cholesterol, then technically you have this medical diagnosis.

Metabolic syndrome includes blood pressure higher than preferred. I will say, trying to get accurate blood pressure reading on teens is difficult at best. First, acceptable pediatric blood pressures are difficult to pin down. You need to be educated in pediatric medicine to know what is acceptable. (Don’t go to the drug store with your children and get a reading; adult blood pressures are different from children’s numbers. Even adult sized machines can give wrong information for children.) Teens blood pressure can swing with changing thoughts (ask them about their personal problems and it will jump quickly).

My point: if a teen is taking medication for blood pressure, then they have been diagnosed with a health problem. At that time, the blood pressure may be within normal ranges, but they still have the diagnoses. This places them at higher risk for chronic disease like heart disease and kidney disease.

Metabolic Syndrome Risk Factors include:
  • insulin resistance
  • stress
  • diet (sugar-sweetened drinks)
  • genetics & age
  • low physical activity
  • disrupted sleep patterns
  • mood disorders
  • excess alcohol
  • smoking (tobacco and other substances)
  • chronic inflammation
  • other chemical imbalances in the blood.
Metabolic Syndrome Associated Health Conditions include:
  • Polycystic ovary disease
  • Erectile dysfunction
  • Hyperuricemia (uric acid in the blood)
  • Acanthosis nigricans
  • Fatty liver & Non-alcoholic fatty live disease

(More later on teens with fatty liver disease. I have been absolutely amazed at the number of preteens that I have seen diagnosed with fatty liver disease!)

 

Source:  National Heart Lung & Blood Institute  www.nhlbi.nih.gov/health/health-topics/topics/ms

https://en.Wikipedia.org/wiki/Metabolic-syndrome

 

Coping skills for children’s stress

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Coping skills for children’s stress

Few people today have developed good coping skills, which are especially important for children. It’s unfortunate that coping skills for children’s stress is not taught in most schools. I am amazed at the number of preteens that are taking antidepressants every day. Parents need to be very aware of the need to help their children learn good coping skills. Good nutrition is important with stress management. Parents really need to teach their children not to turn to carbs for comfort. Many weight problems are directly connected to eating during times of stress.

Unfortunately, coping skills are very individualized. It is possible that the coping skills which parents use may also help their children. But this is not always true.

Things you can do to help your children cope with stress

  • Adequate sleep is always important particularly in stressful situations, but many times stress will interrupt your sleep.
  • Some adults like to work-out to work off frustrations. Kids might like to participate in contact sports.
  • Talking with friends is a way we all de-stress; just be aware of where your children are getting advice.
  • Being over scheduled can cause a lot of stress. Be aware of how many activities your children are involved in.
  • Even being connected to their cell phones and keeping notifications on all night can increase stress hormones. Cell phones should be plugged in outside of their bedroom.

Find what works for you and your children. Many times taking several really deep breaths can calm someone down. Just be aware it may take up to 10 deep breaths. Some people meditate, do yoga, or go walking in the trees. Some people pray, while others find no benefits of prayer. My point, you really have to find what works for your kids and teach them to practice it often.

How stress affects diabetics

Especially if you are borderline diabetic, it is so important to find what coping mechanisms work for you. Learn to monitor your stress load and take care of your emotional health.

The emotional side of diabetes management is very important. Hormones released during stress will increase your blood sugars. Stress will raise your blood sugars unpredictably. Anyone who is diagnosed with a chronic disease will go through the steps of grieving. (The first step is denial!) Good coping skills will help individuals move forward with their lives after they have been diagnosed with a chronic disease.

Good luck and let me know what works for you! For more information contact me at Julie@kidsatriskfordiabetes.com.

The Link between Pregnancy and Diabetes    

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Did you know there’s a connection between Pregnancy and Diabetes? And did you know there’s also a connection between Gestational Diabetes and Type 2 Diabetes?

Read on to understand the connections.

Scenario:

Woman in her late twenties gets pregnant. At 26 weeks, she takes an oral glucose tolerance test (OGTT) and is diagnosed with gestational diabetes. She is challenged to keep her blood sugar within the recommended zone.

At 32 weeks gestation, she starts having trouble with high blood pressure (hypertension). Her doctor admits her into the hospital on mandatory bed rest. They give her drugs to encourage fetal lung development. She is informed she will be induced.

During the induction, it is determined the baby is not in the head down position. She is immediately scheduled for a C-section.

After delivery, the new mother’s blood sugar is higher than normal. Her baby has a poor sucking reflex which makes it difficult to nurse. For some unknown reason, the nurses want the new mother to nurse at least every hour. The medical staff inform her that stress can cause elevated blood sugars and she is not to worry.

Follow-up appointment:

Her doctor recommends she returns for a follow-up appointment at 3 weeks. She feels that is a little odd, but they explain it is the new recommendation and will be covered by her insurance.

At 3 weeks, she is feeling better and the baby is doing better nursing. They take a random blood sugar test and it is a little high. She explained that since she was out of the house, she treated herself to a deep dish pizza. She believes that her lunch was the reason her blood sugars were a little high because every time she ate pizza while she was pregnant, her blood sugars would go up for a long time. Her nurse smiled and said, “We’ll keep an eye on it.”

At her next follow-up appointment, her doctor required an A1c test. Her result was 6.8. She was diagnosed with type 2 diabetes. She now blames her pregnancy on her diagnosis and she is convinced it will go away.

What went wrong?

Chances are she was prediabetic (aka borderline diabetic) before the pregnancy. Her fasting blood sugar tests were normal, because through the night her body could bring her blood sugar into normal range.

The A1c test is an average blood sugar test over the previous 2-3 months. Unfortunately, once you are diagnosed, you will always be flagged as at-risk for high blood sugar.

Pregnancy places a stress on your body in many ways. There are a lot of hormone shifts during pregnancy. Diabetes is caused by the hormones required to grow the placenta. The larger the placenta gets, the more you become at risk for high blood sugar.

This is the reason the oral glucose tolerance test is delayed until 26-28 weeks gestation. After delivery and you expel the placenta, your body should go back to normal.

One complication from uncontrolled blood sugar is eclampsia. This is a chemical reaction that causes uncontrolled high blood pressure. It causes heart problems and sometimes death of the baby and/or the mother.

When blood pressure (BP) starts to increase, doctors are proactive and require strict bed rest to prevent the chemical progression of pre-eclampsia into eclampsia. The doctor will induce as soon as it is safe. Many times, the baby is not in the correct position, so the doctor will do a C-section.

Typically, your blood sugar will go back to normal after delivery. But we all gain weight with pregnancy. It is very possible someone can develop insulin resistance from the weight gain. Hopefully this is a temporary condition. Sometimes it can take over a year to lose the weight. If you have developed insulin resistance, you can have prolonged sugar problems.

Once diagnosed, always a diabetic

The standard for diagnosing type two diabetes has changed. Previously, you needed two fasting blood sugar results over 125. Today, you only need one.

The medical community is trying to diagnose earlier in this disease progression to encourage lifestyle changes. Women who develop Gestational Diabetes are at high risk for developing Type 2.

Over 40% will be diagnosed within 5 years. When this disease is diagnosed early, there is a better chance of reversing it. Your diagnosis may be changed to T2 in remission, but you will always be at risk of it returning as you age.

Knowledge is Power

The internet has a lot of suggestions to reverse diabetes. Unfortunately, many of the suggestions you’ll find online are false or misleading. The American Diabetes Association encourages a balanced lifestyle. Remember, only 1% of people who attempt irrational weight control are successful in the long run. Yo-yo dieting is very hard on your body and can cause other health problems.

Slow and steady wins the race!

Many people need support to make and maintain new habits. If you need help setting realistic goals and sticking to what you really want to do, I can help you.

 

About the author

Julie Stelting is a registered nurse with a bachelor’s degree in nutrition. She is the founder of Kids at Risk for Diabetes LLC. Julie designed a program for gestational diabetes, to help women understand and cope with their diagnosis. She is passionate about preventing or delaying diabetes through holistic lifestyle changes.

For more information go to www.kidsatriskfordiabetes.com, or email Julie directly at Julie@kidsatriskfordiabetes.com.

 

What’s Missing?

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What’s Missing from your Gestational Diabetes Program?

Women diagnosed with gestational diabetes (GDM) get lots of information on how to care for themselves, but many of you will still end up with preeclampsia or C-sections?

How successful is the diabetes training for pregnancy that’s been offered to you?

Could it be improved?

Read on to see My Solution…

The Current Program

Gestational diabetes programs vary greatly. Many areas do not offer support for the confusing disease.

Do you know what to do when your blood sugar is too high?

Do you have someone to contact for emotional support?

Do you know what it means when your blood pressure starts running too high?

Are you afraid of ending up on insulin?

What’s missing?

There are lots of educational resources available. Unfortunately, many of the programs are provided when it is convenient to the provider, for example, classes you need to attend at the hospital. And many programs are missing the emotional support so many women need.

When are Gestational Diabetes women ready to learn?

Whenever someone is diagnosed with a chronic disease like diabetes, their first reaction is shock.

After the shock of the diagnoses, they will progress through the 5 stages of grieving starting with denial.

  • Denial – trying to avoid the inevitable, “Do the test again”
  • Anger or frustration – the coming out of pinned up emotions
  • Bargaining with their provider or with God
  • Depression – the realization of the inevitable
  • Acceptance and finding a way forward in their life

I have heard so many women, who have been diagnosed with gestational diabetes say, “How can this test be right? I must have eaten too much the day before the test.”

Unfortunately, gestational diabetes is 100% driven by the hormones produced during pregnancy.

It is critical that you understand that your condition will get worse before delivery.

Timing is everything!

When you are in denial, it is difficult to remember details.

When I taught our gestational diabetes classes, my patients were within two weeks of being diagnosed. Many of them were frustrated and feeling betrayed by their body. Their providers wanted them to start testing their blood sugar immediately multiple times a day.

For half of one day, I provided diabetes management techniques through a program at the hospital. Only a few of the women took notes. Many were in shock’s first phase of denial.

They knew diabetes caused “big babies” which placed them at risk for C-sections. But they had tunnel vision; they were focusing on the problems and not the solutions.

The Results

They did not know how to reduce their blood sugar when it was too high. In the end, many of our patients ended up with pre-eclampsia, in the hospital on bed rest, with induced labor when their baby’s lungs were developed enough to sustain life. The result was pre-term babies being delivered to save the mother’s life.

The Solution: Emotional support

These women needed a support system. A place where you can ask questions and get workable solutions from people who have had the same experiences. An on-line support system can be a great resource for finding solutions that work. But you must carefully check the source of your information.  On the web, everyone has an opinion.

Also, due to the pregnancy brain fog, women need on-going training. Many times, they are given information that they don’t need to put into practice right away. They forget important information. They need a place to store a resource of information.

Women need encouragement. In the beginning, their blood sugars are not too bad. They don’t want to test their blood five times a day because it makes their fingers hurt. Many of them stop checking because they are in denial. Unfortunately, as the pregnancy progresses, the blood sugars will get worse.

Many clients complain that they don’t know what to do if their numbers are high. They feel helpless! They need someone to answer questions.

My Solution

“Healthy Babies from Preconception to Birth and Beyond” is an online virtual program designed specifically to assist gestational diabetes patients and type 2 patients who are pregnant or want to become pregnant.

  • They will receive daily emails. (currently this is 27 emails)
  • They can store the emails in a file where they can refer back to them as needed.
  • The course includes tips and activities they can do at their convenience.
  • They will also join a private Facebook group where they can ask questions of each other, share stories, and offer support to each other. I monitor the content for accuracy and provide answers.

Join my mailing list right here and I’ll send you more details about the Healthy Baby course.

If you are curious, but not sure if this program is right for you or your loved one, schedule a free call with me and we can talk through it together.

7 Causes of Infertility

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7 Causes of Infertility

It can be a real challenge to determine the true source of fertility problems. This article does not include endometriosis nor is it all inclusive for the causes of infertility. To be properly diagnosed you need to consult with your medical care provider. However, this article will give you food for thought concerning multiple problems and possible underlying causes and solutions.
  1. Emotional Side Effects
  2. Abdominal Fat Storage
  3. Insulin Resistance
  4. Polycystic Ovarian Syndrome
  5. Miscarriages and Ketosis
  6. Preeclampsia
  7. Gestational Diabetes

Emotional Effects

How many times have you been told, ‘just relax, it will happen’? Stress causes increased cortisol production, which promotes weight gain, which causes insulin resistance, which causes increased insulin in the blood stream, which causes multiple problems with fertility.

Fertility problems rank high on emotional issues. Husbands and wives have broken-up over fertility problems. (Berman PhD, 2014) Families have gone bankrupt over infertility treatment costs. (Berman PhD, 2014) Telling you to relax is much easier said than done. (Berman PhD, 2014)

An underlying problem is that schools don’t teach how to handle stress! People can go through their whole life and never learn how to adequately deal with their stress. They turn to smoking, drinking, drugs (prescription and non-prescription) and other addictions to avoid dealing with stress. Everyone could benefit from instructions on how to manage stress. Unfortunately, it is not as easy as taking a college course. Stress management is individualized.

Some people pray, some people meditate, and some people take long walks in the woods. No one can tell you what will work best for you. You have to do your own discovery work. I have a great post, First-Aid Box for Emotions, which talks about how to be prepared for emotional issues.  

Uncontrolled stress can cause fertility problems. It triggers the release of adrenalin to feed your fight or flight mechanism. When you don’t fight or flight (which most of us can’t physically react to stress) then the adrenalin triggers the endocrine (hormone) system to produce cortisol. Cortisol has multiple effects on the body including infertility. Simply put; if you are fighting for your life, then you are not going to get pregnant. Another effect of cortisol is it increases fat storage.

Abdominal Fat Storage

How many times have you been told to lose weight to get pregnant? Abdominal fat can physically interfere with how the egg is delivered. (How can you lose the fat deposited around your ovaries?) Having a body mass index (BMI) over 32 is directly associated with problems of ovulation and conception as well as other challenges during the pregnancy. (Berman PhD, 2014) If you plan to get pregnant it is advisable to lose weight if your BMI is above 24. (BermanPhD, n.d.)

Abdominal fat can also interfere with the many other organs within the body cavity. Fatty liver disease is common with weight challenged individuals. The liver is the largest organ in the body and it has multiple functions. It is affected by the endocrine system. When stress triggers your fight or flight mechanism, the liver releases energy (blood sugar) to enable you to fight for your life or run a marathon. When you don’t use the extra energy, it triggers the pancreas to produce insulin to store the excess energy as fat. Over time, these increased fat stores cause insulin resistance which causes your pancreas to work harder to control your blood sugar.

Insulin Resistance

Insulin resistance and the resulting increased blood insulin are key to many fertility problems. (Insulin resistance means your body loses the ability to use the energy needed in every cell of your body. Your pancreas compensates by producing more insulin.) Thousands of people have insulin resistance and have never been diagnosed. In these women, the required excess insulin also triggers increased levels of testosterone. (Campbell, 2015) The increased testosterone can completely shut down ovulation.

Increased blood insulin can also decrease Follicle Stimulating Hormones (FSH) and Luteinizing Hormones (LH). If ovulation does occur, the quality of the egg produced is reduced which results in difficulties maintaining the pregnancy (i.e. increased miscarriages). (Campbell, 2015) Increased blood insulin also increases the production of androgen from the ovaries. (Nutritionist, 2015) Sixty to eighty-five percent of fertility problems have been identified as having increased androgen or insulin resistance. (Marc A Fritz, 2011) Insulin resistance can be diagnosed using a hemoglobin A1C blood test. Changes in reproductive hormones can be identified with elevated hemoglobin A1C levels. (Nutritionist, 2015)

Additional tests are available but often not covered by insurance. Organic Acid Test (OAT) can measure the carbohydrate metabolism rate. An elevated L-Lactate indicates insulin resistance. (Brar, 2017) Also measuring the bacteria in the gut can indicate problem in digestion. To diagnose preventable diseases before symptoms develop, the standard blood tests are not adequate. Patients need to be proactive with their health care provider by inquiring about other tests to identify preventable diseases.  

You can read more about this in my blog post, Pregnancy Diabetes and Insulin.

Polycystic Ovarian Syndrome

Insulin Resistance also promotes Polycystic Ovarian Syndrome (PCOS). Thirty percent of lean women with PCOS and 95% of overweight women with PCOS also have insulin resistance. (Nutritionist, 2015)  In PCOS, the eggs are not released from the ovary and they form cysts (abscesses) on the ovaries.

This condition can start as early as puberty and be misdiagnosed as irregular periods. The common practice of placing women on birth-control pills to regulate their periods actually allows this condition to continue untreated. Many women are not diagnosed with PCOS until they are experiencing infertility. If diagnosed and treated early, infertility from PCOS can be prevented. Before the age of 40, 55% of women with PCOS will be diagnosed with type 2 diabetes or prediabetes.

If you want to read more on this topic, I have a post, PCOS and Insulin Resistance, which gives more details on the connection between PCOS, Insulin Resistance, and Infertility.

Miscarriages and Ketosis

An increased risk for miscarriages is associated with insulin resistance and undiagnosed prediabetes or type 2 diabetes. (Alkon, 2017) When your body has difficulty using blood sugars, your body will revert to burning protein and fats for energy. This process produced ketones. (Frise, 2010) As the pregnancy progresses, the woman’s body increases in insulin resistance. (Frise, 2010) The breakdown of fats puts you into a state of ketoacidosis (DKA). Typically, if you go more than ten hours between meals, your body will revert to proteins and fats for an alternative energy source. This can be quickly reversed by eating breakfast.

Today, many people with prediabetes are being encouraged to eat a low carbohydrate/high protein diet to “control” their prediabetes. This can be very dangerous to the developing embryo during early pregnancy. (Williams, 2018) (Frise, 2010) Elevated ketones can cause your body to quickly miscarriage. Ketoacidosis can also contribute to elevated blood pressure.

Preeclampsia

Elevated blood pressure during pregnancy is often defined as preeclampsia (Frise, 2010) It is associated with high protein diets. (CNS, 2017) Diagnosis of preeclampsia results from high protein levels in urine tests. (CNS, 2017) . In developing nations, Eclampsia is the leading cause of maternal-fetus mortality. (CNS, 2017) Fifty-one babies out of 1000 are stillbirths and high blood pressure is a major contributing factor in these births. (CNS, 2017) Insulin resistance coupled with high protein/low carb diets increase the risk for high blood pressure in expecting mothers. Women who are pregnant need to eat a well-balanced diet and get regular exercise and monitor their blood pressure.

Gestational Diabetes

Diabetes during pregnancy is not your fault. During pregnancy, your body produces growth hormones as well as other hormones to promote the pregnancy and the embryo’s growth and development. Around 26 weeks, those hormones start to rapidly increase. (Stoppler MD, 2016) Around 26-28 weeks, your doctor will check for gestational diabetes. Gestational diabetes is totally hormone driven. As the hormone produced during pregnancy increase, so does your chances of developing gestational diabetes. After delivery, gestational diabetes will go away. (Stoppler MD, 2016) Unfortunately, diabetes during pregnancy indicates your body has insulin resistance. (Stoppler MD, 2016) This diagnosis places you at greater risk for developing type 2 diabetes before the age of 40.

Pregnancy can be a beautiful thing. Many people view giving birth as a miracle. It is literally the gift of life. As many women delay pregnancy into their thirties, this also increases the chance of fertility problems and other health issues associated with pregnancy. Unfortunately, pregnancy places a lot of stress on a woman’s body. What happens during pregnancy can be an indicator of other health problems you will face. If you want to learn more about how you can avoid gestational diabetes, check out my post, 8 Tips to Avoid Gestational Diabetes.

My hope is that this article, 7 Causes of Infertility, gives you some ideas of what could be going on and what you can do about it if you’re facing infertility. If you want to learn more about my Gestational Diabetes course, I have a 30-day virtual course that you might be interested in. Follow this link to get more information. If you’re not sure what kind of help or support you need, schedule a discovery call with me and we’ll figure it out together. 

Best of luck to you!

 

References

Alkon, C. (2017). Risk of Miscarriage from Pre-Existing Diabetes. Retrieved January 18, 2018, from Demos Health.com: http://www.demoshealth.com/w/risk-of-miscarriage-with-pre-existing-diabetes/

Berman PhD, E. (2014, January 23). When Infertility Affects Your Marriage. Retrieved January 12, 2018, from Huffington Post: www.huffingtonpost.ca/erica-berman/infertility-and-depression_b_4251953.html

BermanPhD, E. (n.d.). Huffington Post. Retrieved January 12, 2018, from 10 Fertility Facts You may not …: http://www.huffingtonpost.ca/erica-berman/infertility-and-degression_b_4251953.html#gallery/542252/1

Brar, R. (2017, December 1). Why Bloodwork is not enough. Retrieved January 15, 2018, from Living Proof Institute: https://thelivingproofinstitute.com/bloodwork-not-enough/

Campbell, L. (2015). Natural Fertility Info. Retrieved Jan 12, 2018, from natural-fertility-info/insulin-resistance.html: http://natural-fertility-into.com/insulin_resistance.html

CNS, J. A. (2017). 5 Ways to Help Prevent Preeclampsia for a Healthier Safer Pregnancy. Retrieved January 12, 2018, from Dr. Axe Food is Medicine: https://draxe.com/preeclampsia

Frise, C. M. (2010, March 15-18). Starvation ketoacidosis in pregnancy. Retrieved January 18, 2018, from Endocrine Connections Endocrine Abstracts (2010) 21 p143: http://www.endocrine-abstracts.org/ea/0021/ea0021p143.htm

Marc A Fritz, L. S. (2011). Clinical Gynecologic Endocrinology & Infertility 8th Ed. In L. S. Marc A Fritz, & S. Seigafuse (Ed.), Clinical Gynecologic Endocrinology & Infertility 8th Ed. Philadephia, PA, USA: Lippincott Williams & Wilkins Wolters Kluwer. Retrieved from Clinical Gynecologic Endrocrinology and Infertility 8th Edition.

Nutritionist, C. G. (2015, November 23). Infertility & Insulin REsistance Explained by a Fertilty Nutritionist. Retrieved January 12, 2018, from Path to Fertility: Https://fertility-news.rmact.com/path-to-fertility-blog/infertility-insulin-resistance-explained-by-a-fertilty-nutritionist

Stoppler MD, M. C. (2016, December 5). Gestational Diabetes. (C. Davis MD, Editor) Retrieved January 18, 2018, from Medicine Net.com: https://www.medicinenet.com/gestational_diabetes/article.htm

Williams, K. (2018). Is Ketosis Dangerous During Pregnancy? Retrieved January 12, 2018, from Pregnancy Week by Week Calendar: www.pregnancyweekbyweekcalendar.info/pregnancy-tips/is-ketosis-dangerous-during-pregnancy.html