Diabetes

The Link between Pregnancy and Diabetes

07/07/2018 By Julie RN CDE Leave a Comment

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.

Prevent Unplanned Pregnancy

08/10/2017 By Julie RN CDE Leave a Comment

Uncontrolled blood sugars can cause serious birth defects.

It is unfortunate that I find a need to present this information. I have experience working with thousands of teens and unfortunately many of them get pregnant. I am located in the American Bible belt. They encourage schools to teach “abstinence only” in sex education classes. In today’s society, it appears to not be effective in controlling unwanted pregnancies.

Never trust your schools to adequately prepare your children for pregnancy prevention.

All parents need to take an active role in the discussion of sex and the importance of contraception. Do not expect your child to be adequately informed by the school’s sex education classes.

Know your risks. Research shows, if the mother has gestational diabetes, the child is at increased risk for diabetes. There are a variety of risk factors that can be found on the CDC’s website on Diabetes. You can take their survey to evaluate your child’s risks.

Type 2 diabetics are at risk for the most serious complications in unplanned pregnancies. About 7% of embryos developed with high blood sugars also develop Spinal Bifida. There are other brain and heart malformations that are associated with uncontrolled diabetes.

Typically, babies born under gestational diabetes are over nine pounds. Doctors recommend C-sections due to the increased possibility of broken bones during birth (particularly the collar bone).

The most serious health issue is high blood pressure in the mothers. This can be life threatening to the pregnant woman. If the mother develops high blood pressure, she will often times be placed in the hospital on bed rest until the baby is developed enough to be induced. There is a risk of underdeveloped lungs in the newborn and high medical cost for intensive care for the newborn.

There is a wide variety of birth defects associate with high blood sugars.

All diabetics need to seek pre-conception counseling before getting pregnant.

If you are interested, I have a 30 day course for gestational diabetes.

What Schools Need to Know: Children with Type 2

07/21/2017 By Julie RN CDE Leave a Comment

Back to School with Type 2 Diabetes

Each new school year brings new challenges, particularly with diabetic students. Back to School Preparations are different when your child has diabetes. A parent’s ultimate responsibility is to teach their children to be independent, no matter what the situation. My experience with parents of school age children with diabetes varies widely.

Many times, school officials do not know if diabetic students are type 1 or type 2. Although the difference between the two conditions is like night and day, students are treated much the same way. It is unfortunate at this time in the USA, that approved medications for Type 2 in children are limited to Metformin and insulin. Insulin is a serious medication with significant side effects if not administered properly. I understand why parents are fearful for unfamiliar staff to give insulin to their child. For this reason, parents need to teach their child about insulin dosing so that the child will be self-assured and assertive to ask questions of adults when needed.

Kids can learn amazing things. While I was medical staff at a Type 1 diabetes camp, I had some amazing experiences. I worked with the youngest group ages 6-8 years old. Danny (fictitious name), was diagnosed at age 2 years and had an older sister who was also Type 1. Although he was 7 years old, he could already feel his blood sugars dropping when he was outside playing and he knew how to appropriately treat his low. He could “guestimate” what he was eating at each meal and calculate his insulin correctly. He had to be supervised, but at a very young age he had learned how to live with his “organ failure” and still be as normal as possible. Kids can learn with parental support.

Diabetes Priorities Vary with Age

According to the American Association of Diabetes Educators (AADE) diabetes priorities vary with age. (BC-ADM, 2014)

*Preschool and early elementary school students (ages 3-7 years) need to develop self-confidence. They need to learn to trust school staff to take care of their unique needs. Parents have the responsibility to educate other caregivers about their child’s specific needs. Many times blood glucose readings are seen as “good” or “bad”. Children have a strong desire to please parents. Fear of failure can cause children to falsify their numbers. Parents need to teach their children that blood glucose readings are just used to monitor their medication needs and never meant to evaluate their child’s behavior. Developing trust with your child is very important in this phase. (BC-ADM, 2014)

*Older elementary school ages 8-11 years need to develop self-esteem with respect to friends and peer groups. Diabetes management needs to center around a flexible regiment to allow participation in many activities. Their education needs to include how to avoid and treat hypoglycemic events. Parents need to observe blood glucose testing. Parents also need to progress in teaching their children about insulin dosing and self-administration. It is also important to teach their children how to participate in special occasions (example: birthday parties particularly at school). (BC-ADM, 2014)

*Early adolescents (ages 12-15 years old) can be very challenging. Normal hormone changes during puberty will cause blood sugars to be unpredictable. Parents need to be cautious about blaming their child of eating extra foods. Although they may be very hungry due to growth hormone, other hormone shifts will cause major troubles with blood sugars. It is important for parents and children to communicate honestly to avoid emotional problems. Diabetes priorities in addition to blood glucose control include monitoring for body image distortion, eating disorders, risky behaviors and depression. Although students may learn maintaining high blood sugars can create weigh lose, they also need to be taught the dangers of complications from uncontrolled diabetes like blindness, strokes and heart disease.

Family conflicts need to be intervened possibly with a professional family counseling. Turmoil between parent and child is very common at this phase. Children want more independence while parents are very fearful of the results. There is a high divorce rate in families with diabetic kids. Counseling may be beneficial for the whole family. (BC-ADM, 2014)

*Young adults (ages 16-19) Diabetes priorities include integrating diabetes into their lifestyle after high school. Young adults need to learn good coping skills for self-management. Teen and parent conflicts are common even without diabetes. There is a normal separation of the child from the family unit. Teens begin planning for their future independence. It is the parent’s responsibility to transition their teen into independent living. This includes developmentally challenged young adults. (BC-ADM, 2014)

When appropriate, it is very important for parents to educate their child about the effects of alcohol on blood sugars. I have seen so many diabetic college students in the emergency room. If you don’t know the dangers of alcohol abuse with diabetes, I encourage you to educate yourself and your child. For more information, see my blog post on alcohol and blood sugars.

BC-ADM, C.B. (2014). Type1 diabetes throughout the life span. IN S.C. Carole Mensing RN, The Art and Science of Diabetes Self-Management Education Desk Reference (pp. 393-400)

Alcohol and Diabetes a deadly combination

03/19/2017 By Julie RN CDE 1 Comment

I know alcohol is never recommended in children under the legal age. But teens often have access to alcohol, so it is important for them to understand the effects on their blood sugar. This is particularly important when parents are preparing their children for college. I worked in a college town and many students end up in the ER with blood sugar problems.

So many people with prediabetes are in denial. This is especially true in teens. But that doesn’t mean they are exempt from the side effects of uncontrolled blood sugars. Parents need to take an active role in educating their young adults in the problems of alcohol before they head to college…..

Alcohol Can Adversely Effect The Body’s Ability To Regulate Energy

As you know, excess alcohol effects your liver functions. Your body’s energy regulation actually starts in the liver. That is the reason doctors use Metformin as the first medication with prediabetes. Improving the function of the liver by 20% will improve blood sugars by 80%.

Initially alcohol could raise your blood sugar (particularly with beer), but alcohol works in the liver to prevent stored sugars from being released. So it can actually cause low blood sugars during the night while you sleep. It is important to eat a snack of protein and carbs before going to sleep. It is even more important to not sleep in late in the morning (like most college student tend to do).

What You Should Do

Set an alarm, and if you can, check your blood sugar and eat breakfast! Then if you want to go back to bed, no problem. The main problem is that your blood sugar could go too low while you’re “sleeping it off”. That feeling of being hung-over may actually be low blood sugar.

Also, please feel free to email me if you have questions that aren’t answered here!

Low Blood Sugar Symptoms

The side effects from low blood sugar looks similar to drunkenness. This is a dangerous situation. Symptoms of low blood sugar without diabetes include:

Paleness
Headaches
Shakiness or trembling
Blurred vision or Dizziness
Lack of energy or fatigue
Poor Coordination
Irritability, anxiety, agitation
Nausea or vomiting
Excess sweating or perspiration
Problems concentrating, confusion
Decreased consciousness or loss of consciousness

This is really important with kids that are going to college. They will drink alcohol. So educate them about it.

Any questions, send me a message at Julie@kidsatriskfordiabetes.com.

http://www.healthclop.mailto:Julie@kidsatriskfordiabetes.comcom/low-blood-sugar-without-diabete

Children’s brains need 130 gms carbs daily

03/04/2017 By Julie RN CDE Leave a Comment

Children need carbohydrates for proper brain development. We should not be placing our kids on a low carbohydrate diet for weight control. Children need a balanced diet for growth and proper brain development.

What Information Is Out There

Much information on the internet today states that if you have high blood sugars, you should switch to a low carbohydrate diet. There is a ton of information about low carb diets. You could get the impression that this is a good way to control blood sugars. But in children, low carbohydrate diets can be harmful to their brain development.

Blood Sugar Is So Confusing!

I once had a lady come for consulting, complaining of unknown sources of blood sugar. She stated she had checked her blood sugar before eating her dinner. Then she ate a steak dinner with NO carbs. (She was very careful, no dinner roll, no potato, etc.) Then after dinner she checked her blood sugar again and it was much higher. She was so confused.

Have you ever gone to bed at night with one meter reading and woke up the next morning with higher blood sugars? I have had parents believing their child was eating during the night causing this rise in blood sugar. Poor kids were begging for my help!

The fact is, when you don’t eat what your body needs, your body will produce it. Your liver is a large reservoir for energy. When you don’t eat carbs and your body needs quick energy, your liver will release it. This causes your glucometer to read higher than expected.

Our Brains NEED Carbohydrates!

Your brain needs carbohydrates to function properly. The adult brain needs about 100 grams of carbohydrates every day for proper brain functioning. Children need 130 grams of carbohydrates every day just for proper brain growth and development. Imagine your children having a hard time concentrating in school because they are not getting the quick energy they need.

We know it is easy for kids to get a sugar buzz. But there are other sources of carbohydrates they need like fresh fruit, yogurt, cereal, granola, whole wheat bread, starchy vegetables like corn and peas, plus many more.

Low carbohydrate diets are not the answer to prevent diabetes. In fact, many people turn to high protein diets which are usually high in fat (aka loaded with calories). They gain weigh causing insulin resistance. It really is about total calories. Living a balanced life is key, particularly in children.

What You Can Do

Are you motivated to make major diet changes like this? Are ready to teach your children to lead a healthy lifestyle with a balanced diet and increased activities? If you’re ready to make changes but don’t know where to begin, I have a 30 day virtual program that is perfect for the whole family! Click here for more info.

Always be careful when accepting information from the internet as truth. Unfortunately, not everything on the internet is correct!

Please check with your medical provider before making significant changes in your diet.

Making and maintaining lifestyle changes is very difficult. If you need a coach, find someone who will work with you. I’m happy to chat with you if you have questions. Schedule a discovery call with me.

www.kidsatriskfordiabetes.com Julie@kidsatriskfordiabetes.com

Help for Diabetes During Pregnancy

03/03/2017 By Julie RN CDE 1 Comment

Your Gestational Diabetes Diagnosis can be Traumatic

When you are pregnant, being diagnosed with gestational diabetes is the last thing you want to hear. You are given a crash course on how to manage your blood sugar with diet and exercise. You are so stressed out, you probably don’t remember one tenth of what was said. Your stress continues as you try to “manage” your blood sugar by testing multiple times each day. You feel like your body has betrayed you. All you want to do is have a healthy baby. I know what you’re going through.

Fasting Blood Sugar Test

The American College of Obstetrics and Gynecology (ACOG) is now requiring new clients to have a fasting blood sugar test during early pregnancy to determine un-diagnosed Type 2 and prediabetes in their patients. Due to the average woman waiting to have their first child later in life and the increasing weight problems they face with age, pregnant women are at increased risk for developing sugar problems. (Get my free gift to evaluate your risk for gestational diabetes.)

How Does Gestational Diabetes Affect You and Your Baby?

At about 12 weeks gestation, your baby starts growing rapidly. This requires increasing amounts of energy, and insulin requirements increase accordingly. Around week 24, your body’s insulin production cannot keep up with your baby’s growth.

Typically, the fasting blood test for gestational diabetes happens between weeks 24-28. The ACOG is allowing your blood sugars to increase enough during the day so that your body can not recover through the night. At that time a random blood sugar test over 200 is a positive result for gestational diabetes.

Your baby continues to grow until about 36 weeks gestation. At delivery, the hormonal effects of the pregnancy disappear and the demand for insulin drops dramatically. Postpartum, your body’s requirement for insulin can go below normal. Many women are placed on IV insulin during labor and they need to be monitored carefully during postpartum.

After Gestational Diabetes Delivery

Because your baby has developed in a blood supply rich in sugar, your baby’s pancreas will also go through an adjustment after delivery. You will see the nursing staff taking blood samples from your baby. Don’t get excited. They will monitor your baby’s blood sugar as needed to keep them safe.

Since insulin requirements shift dramatically during pregnancy, true diabetics need to be monitored carefully for adjustments in their medications. Type 1 diabetics need to be under the care of an endocrinologist throughout their pregnancy. Type 2 diabetes should expect to be placed on insulin during pregnancy. They should also expect to have weekly insulin adjustments.

What to do Before You Get Pregnant

To have a successful pregnancy without complications, all diabetics need to have their blood sugars under good control for six months before conception. The success of their ability to control their blood sugar is often determined by an A1C test.

If you need support in controlling your blood sugars before pregnancy, consider my 1:1 phone consultation program. For a free evaluation please schedule a FREE call with me.

Wishing you a happy pregnancy and a healthy baby!

Julie

P.S. Remember to get my list to evaluate your risk for gestational diabetes.