Managing Diabetes During Pregnancy

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Hello and welcome to our show. I am Deborah Howell. Today our guest is Dr. Rahil Bandukwala. He is a leader in the fields of endocrinology, diabetes, and metabolism, and hangs his hat at Saddleback Memorial as a doctor of osteopathy. Welcome, Dr. Bandukwala.

Rahil Bandukwala, MD: Thank you.

Deborah Howell (Host): Our topic today is diabetes and pregnancy, and whether you have juvenile or type 1 diabetes before you're pregnant or develop gestational or type 2 diabetes during pregnancy, it is so important to manage your blood sugar levels throughout pregnancy to keep you both, and yourself, the baby of course as well, very healthy throughout the entire pregnancy. So let's start at the beginning. Doctor, what is the difference between juvenile or type 1 diabetes and gestational or type 2 diabetes?

Rahil Bandukwala, MD: Yeah, so in juvenile diabetes, the major problem is an absolute deficiency of insulin production. And for most patients, it develops in their preteen or teen years. And so by the time most women get pregnant with juvenile diabetes, they've had type 1 diabetes for, you know, an average of 10 or so years already. And so they have no insulin production from their own pancreas. Whereas a type 2 or gestational diabetic female will develop signs of hyperglycemia during pregnancy and may have complications during and after pregnancy from that.

Deborah Howell (Host): I see. And pregnancy is tough enough already without that complication, right?

Rahil Bandukwala, MD: Right.

Deborah Howell (Host): So what should women with type 1 juvenile diabetes do before and during pregnancy to manage their diabetes?

Rahil Bandukwala, MD: So, you know, if they're planning on getting pregnant, a juvenile diabetic really should take the opportunity as best they can to achieve tight blood sugar control as best they can. And, you know, where that tight control lies is somewhat debatable, but certainly trying to achieve tighter control, tight control, good control is important. It's also very important for those women to make sure their eyes are in good shape and their kidneys are in good shape, because if they're not well controlled during their pregnancy with the fluctuations in the high blood sugars, those organs could suffer further damage.

Deborah Howell (Host): Okay. And at what point in the pregnancy do women typically develop type 2 gestational diabetes?

Rahil Bandukwala, MD: So typically it's diagnosed kind of midway through the second trimester at about anywhere between 22 and 24 weeks. So they will typically have screening tests done by the obstetrician, and that's predicated on perhaps a risk going into the pregnancy that they may develop it if there's a family history. If there's a personal history, if they're overweight, if there are certain ethnic backgrounds, they may be at higher risk.

Deborah Howell (Host): Okay. And what are the causes and symptoms of this type of type 2 gestational diabetes during pregnancy?

Rahil Bandukwala, MD: So often there will be no symptoms. Much like type 2 diabetes, they can not notice much of anything. They may have a little bit of abnormal weight gain because of the high blood sugars, so that may be something that clues the practitioner or the patient in that, you know, something's not right or that we should check. But very often they would not have classic symptoms of insulin deficiency.

Deborah Howell (Host): And how often are women as they are pregnant going to see their primary caregiver?

Rahil Bandukwala, MD: So that depends. If they're, you know, women that are pregnant with diabetes, with type 1, with juvenile diabetes, I try and see them or have a detailed contact with them every few weeks, every two to four weeks at least, just to make sure their blood sugars are on target. For gestational diabetes, you know, they're probably seeing their obstetrician at least every month, if not more frequently, and contact with someone on the healthcare team to monitor their blood sugars and their diet and all those things.

Deborah Howell (Host): So if you are pregnant, my goodness, see and make those appointments for sure and keep them.

Rahil Bandukwala, MD: Right. Right. Yeah, it really ends up being a nice team approach. I mean, between either the primary or the endocrinologist, the obstetrician, there may be a high-risk perinatologist involved, pediatrician, all those practitioners can play a role that helps the pregnancy remain healthy for both the baby and the mom.

Deborah Howell (Host): Good, good, use your team, that's what they're there for. Now if diabetes is not properly managed during pregnancy, what side effects may the mother and the baby experience during and after birth?

Rahil Bandukwala, MD: So, you know, one of the key adverse effects is really abnormal weight gain. Especially for the baby, they can develop something called macrosomia, which is kind of a disproportionate growth of the head relative to the body, and it makes a vaginal delivery very difficult and very risky. And so you increase the rates of C-section. Also going into the pregnancy for a juvenile diabetic, if their blood sugars are poorly controlled that first trimester when the baby's forming, they can have more risk of birth defects. So that becomes a critical aspect of it as well. And, you know, for the mom we mentioned the eye and kidney health, that's very important. For the baby, they can get low blood sugar when they're born, they can have respiratory distress issues, premature delivery. All these things can take a toll on the health of the baby for the immediate birth term and also for the future of their health and their growth and development. And also their risk for diabetes.

Deborah Howell (Host): Okay. Well, another burning question then is does the diabetes go away after the pregnancy?

Rahil Bandukwala, MD: So yeah, for many, well, for type 1 diabetics, it doesn't. For juvenile, for them, it's still there. But it probably gets easier to control after they've delivered. That is a good thing. For gestational diabetics, very often the blood sugars do normalize, but they still have a risk, their lifetime risk of developing type 2 diabetes is up to 50 percent, which is very, very high compared to the average population. So it's very critical that those women remain in contact with their practitioners and get retested, you know, at their postpartum visits for hyperglycemia and diabetes, so that they have the testing. They don't necessarily have to check their blood sugar all the time, but just being aware of it, keeping those healthy habits of diet and lifestyle changes that they may have made during pregnancy are very important to prevent the diabetes from coming on. Now there are obviously some women that continue to require treatment with medication even after pregnancy, so that's a smaller percentage, but it does happen.

Deborah Howell (Host): And does the baby then also have to receive medication?

Rahil Bandukwala, MD: Usually not initially unless they have low blood sugar. If they have low blood sugar, that has to be managed obviously, but usually they don't require diabetes medication early on. But their risk for developing type 2 diabetes is higher again also than the average population because of what they were exposed to in utero, especially if the control wasn't good.

Deborah Howell (Host): Yeah, well, at least it's a blessing that they don't have to, you know, have the shots and… it’s hard enough already being a baby, right?

Rahil Bandukwala, MD: Right, right. I don't remember, but yeah, I guess so.

Deborah Howell (Host): Sure you do, come on. Alright, what are examples of some of these lifestyle modifications that, you know, it all seems to boil down to this. So much is it, you know, preventable.

Rahil Bandukwala, MD: Right, so a big focus is lifestyle modifications, diet. And probably one of the key concepts there is carbohydrate counting and managing where your carbohydrates are coming from. And for that, many people, you know, need a full education on. They don't understand that candies are, yes, one form of carbohydrate, but carbohydrates come from fruit, from bread, from pasta, from rice, from tortillas. You know, all these things contain carbohydrates that impact blood sugar. So managing the intake of that to, you know, 40 to 50 percent of your caloric intake for the day is one very important lifestyle modification. And then the other major one is activity. You know, I tell the patients that I counsel that one of the best things they can do is if they can take a short brisk walk after a meal, it really helps, especially for the gestational diabetics. It makes a huge difference in their blood sugars after meals. So...

Deborah Howell (Host): Is that because it affects metabolism?

Rahil Bandukwala, MD: Yeah, it helps reduce insulin resistance. You know, just really helps... it helps digestion.

Deborah Howell (Host): I think it helps mentally too.

Rahil Bandukwala, MD: Yeah, that too. Absolutely, you feel better. And all that does factor in. I mean, even just a little bit of stress reduction. If you walk and reduce stress, then your blood sugars will be better.

Deborah Howell (Host): It's pretty good for it. I love an after-dinner walk, it's my favorite thing to do.

Rahil Bandukwala, MD: Yep.

Deborah Howell (Host): Well, thanks so much for taking time out of your day to be on the show, Dr. Bandukwala. You've been absolutely a pleasure to have on the show.

Rahil Bandukwala, MD: Thank you. My pleasure.

Deborah Howell (Host): And for more information or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. Take care of yourself and your baby. I am Deborah Howell, and we will see you soon for another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have yourself a fantastic day.