Prior to the discovery of insulin (in 1922), the mortality rate of pregnant women with diabetes mellitis was 45%. It quicky dropped to 2% after the introduction of insulin. It became very clear that the pregnant woman with diabetes needed very special attention during her pregnancy. If you have insulin-dependent diabetes and are pregnant or planning to become pregnant, see your physician immediately…….the sooner; the better. This is not a time to take any chances with your management of your diabetes. The cornerstones of good, diabetic prenatal care are your nutrition, insulin therapy, and expert prenatal care by a medical doctor.
Diabetes mellitis is a disease characterized by high blood sugar. The body, and the blood vessels in particular, do not tolerate prolonged periods of high blood sugar. In a person without diabetes, foods are broken down in the intestinal tract and the components are dispersed throughout the body for use or disposal. The basic food component which provides fuel for your body’s cells is sugar, primarily, glucose. Glucose is converted into energy inside our cells. Insulin, produced in the pancreas, is the hormone responsible for taking glucose out of the blood, across the cells membrane and into the interior of the cell.
After a meal, blood sugar levels rise. As insulin is produced and circulated, glucose is removed from the blood and transported into the cells. As a result, blood sugar levels fall. This process is repeated over and over, again, each time a person eats something. Foods with high amounts of sugar and carbohydrate are absorbed quickly and have profound, immediate effects on blood sugar levels. Foods which are primarily protein and/or fat take longer to absorb and are broken down into glucose over much longer periods. As a result, proteins and fats have a more moderate effect over blood sugar levels and take a longer time to do so.
A person with diabetes has lost the ability to either produce insulin in the pancreas, or utilize insulin at the cell membrane. In either case, blood sugars collect and remain in the bloodstream and do not cross through the cell membrane and into cells, where it is needed for energy.
The effect of uncontrolled high blood sugars is profound. The problems associated with uncontrolled diabetes are primarily the result of problems with lipid (fats) metabolism and degeneration of small blood vessels. Because of these problems, diabetes can produce complications in the kidneys, heart, eyes and peripheral circulation (the circulation in the hands and feet). High blood pressure is also common. There is also a high rate of birth defects among the babies of women with diabetes.
In women, diabetes is generally placed in one of 3 categories:
- With Type I diabetes, insulin is needed to maintain normal blood sugars. Most of these women have Juvenile-onset diabetes and have a problem producing insulin in the pancreas. In most cases, the pancreas has been destroyed, probably by a virus or the body’s response to a virus.
- In Type II diabetes, sometimes called Adult-Onset-Diabetes-Mellitis, the effects are usually not seen until after about age 40, and most often in people who are overweight. It is believed that these people have become resistant to the actions of insulin. Many people with Type II diabetes can control their blood sugars with diet, exercise and weight loss.
- The third type of diabetes is Gestational Diabetes.
Women with Type I and Type II diabetes who become pregnant need specialized care. Their blood sugar levels should be in excellent control before conception to decrease the risk of birth defects and miscarriage. During pregnancy, good blood sugar control may help prevent blood pressure problems (including toxemia), urinary tract infections (including the kidneys), nephrosis, macrosomia, and stillbirth (need the Glossary?). The pregnant woman with diabetes is usually delivered between 36 and 38 weeks gestation to prevent stillbirth. With recent advancements in the control of blood sugars during pregnancy and improvements in the neonatal intensive care units, one of the biggest remaining problems is birth defects……..another reminder to women with insulin-dependent diabetes to seek care (and good blood sugar control) before pregnancy.