DIABETES AND PREGNANCY - Mednax

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DIABETES AND PREGNANCYOBSTETRIX OF THE MOUNTAIN STATES

DIABETES MANAGEMENT WITH MATERNAL FETAL MEDICINE (MFM)¡ Most visits will be done weekly by phone. Please make surethese visits are scheduled.¡ Ultrasounds and Non-Stress Tests will be determined by ourphysicians. We will let you know when you should come intothe office.

TYPES OF DIABETES¡ Gestational Diabetes (GDM):¡ This is a type of diabetes that occurs only during pregnancy. The placenta releases hormones thatcounteract your insulin which causes insulin resistance. Therefore, you have too much sugar in yourbloodstream causing an elevation in your blood sugar. Left untreated this can be dangerous for bothyou and your baby.¡ Our focus is to help you manage your blood sugars by diet and exercise. Sometimes, the use ofmedication such as Metformin or insulin may be required.¡ The majority of the time, diabetes will go away once the placenta is delivered. However, you willhave an increased risk of Type II in the future.

WHO'S AT RISK?¡ Who is at risk for gestational diabetes?¡ Women who are overweight¡ Women who have a family history of Type 2 Diabetes orGestational Diabetes¡ Gestational Diabetes in a prior pregnancy¡ Women who have delivered a 9lbs baby¡ Women of certain ethnicities

TYPES OF DIABETES¡ Type 1 and Type 2 Diabetes:¡ Patients with preexisting diabetes will benefit from frequent blood sugar reviews due to increasedinsulin resistance. With each trimester of pregnancy the needs for medication, whether oralmedications or insulin, will change.Possible Recommendations¡ A dilated eye exam to detect retinopathy with follow up indicated by findings and ophthalmologyrecommendations¡ A heart exam may be recommended (EKG or Echocardiogram)¡ Fetal Echocardiogram around 22 weeks

RISKS OF DIABETES IN PREGNANCY¡ Risks to Baby¡ Large baby¡ Polyhydramnios (increased fluid in amniotic sac)¡ Preterm baby¡ After birth¡ Hypoglycemia (low blood sugar), Jaundice, NICU admission¡ Stillbirth¡ Possible greater risk for obesity and increased risk for diabetes later in life¡ Risks to You¡ High blood pressure and pre-eclampsia¡ Frequent urinary tract infections, yeast, or vaginal infections¡ Difficult delivery and increased risk for need of c-section

HOW DO I MANAGE DIABETES?¡ Checking your Blood Sugar¡ Diet¡ Exercise¡ Medications

GLUCOSE METERS¡ A glucose meter will be called in, start testing you blood sugar as soon as possible. Let us know if you needfurther instructions with your meter. YouTube has instructions from the manufactures on the meters wefrequently prescribe. Click the link below for your meter.¡ Verio- https://www.youtube.com/watch?v kyoIVrpssOY¡ FreeStyle Lite- https://www.youtube.com/watch?v DixQXe9t-eE¡ True Metrix- https://www.youtube.com/watch?v eOjCUI6OXlM&t 9s¡ Accu-Chek Aviva- https://www.youtube.com/watch?v u3q6Mh6KlNAThis Photo by Unknown Author is licensedunder CC BY-NC-ND

METER TIPS AND INFORMATION¡ Never share your meter or testing supplies.¡ Use new lancets each time, wash hands or use alcohol.¡ Store used needles/syringes and lancets in a sharp's container; never throw sharps inthe garbage.¡ Don’t leave your sharps out and keep them away from children and pets.¡ Contact your local waste management when you are ready to throw your containeraway. They will give you instructions; different cities might have different rules.

BLOOD SUGAR GOALSCheck blood sugar when you wake upand 1hour after each meal. Documentyour numbers.Blood sugar goals Fasting- 70-95 1 hour after meals- less than 140-OR 2 hours after meal- less than 120 Middle of the night-70-120Type1&2 diabetes- A1C: 6-6.5% 7% if risk of garsExample04/01/208213811012972-notfeelingwell

HYPERGLYCEMIA (HIGH BLOOD SUGAR)¡ Blood sugar elevations can be caused by:¡ Consuming too many carbs¡ Lack of Sleep¡ Illness¡ Stress¡ Increased insulin resistance as pregnancyprogressesIf your blood sugars are consistently out of range,please call our office to schedule an appointment!

HYPOGLYCEMIA (LOW BLOOD SUGAR)¡ Low blood sugar can be caused from taking too muchmedicine, not eating enough, or exercise.1. If you feel shaky, sweaty, weak, confused or not well, check your sugar.2. If sugar is less than 70, have 15 grams of carbohydrate. (Example: fruitsnacks, 1/2 cup of juice or four glucose tablets)3. Recheck blood sugar in 15 min.4. Repeat until blood sugar is above 70 and eat a meal within one hour.5. Treat any low blood sugars and contact MFM or your providerif you are having blood sugars less than 70.

EXERCISE AND PREGNANCY¡ During this time of social distancing, find activities you can do safely in your home. Walking, cleaning, online videos,dancing, yoga. Do not lift heavy weights or do any activities that could cause you to loose balance. Contact yourOB if you are unsure if exercise is OK for you. You should not exercise if you are on restrictions or bedrest.¡ 2.5 hours a week of exercise is encouraged. You should exercise for 10 minutes after meals or 30 minutes eachday. Stop exercising if you are experiencing shortness of breath, chest pains, contractions, leakage of fluid, vaginalbleeding or any other concerns, and contact you doctor right away.¡ Always stay hydrated. If you are on medication for your diabetes, it’s best to exercise after a meal or snack. Donot exercise if your blood sugar is less than 100. Keep a snack and your meter close by for symptoms ofhypoglycemia.

RECOMMENDATIONS FOR DIABETES AND HEALTHY EATING¡ Protein – meat, eggs, fish, nuts, nut butter, Greek yogurt, cheese, cottage cheese at least 71 grams per dayand 50 additional grams if you are having twins.¡ Carbohydrates- fruits, vegetables, wheat bread, beans, wheat pasta, brown rice at least 175 carbs per day¡ Fiber- fruits, vegetables, beans, nuts 28 grams per day¡ Healthy Fats- nuts, olive & coconut oil, nut butter 6-8 teaspoons per daySome people find it helpful to use an app on their phone to track food.You can also use Google, Siri, Alexa and other internet platforms to find out the nutritionalcontent in the foods you are eating.

PROTEINS¡ Protein is very important to our body’s function. It slows down the rate we digest sugar and helps tomaintain a healthy blood sugar during digestion. Protein is highly recommended at each mealand snack. Pregnant women should eat 71 grams of protein per day. If you are pregnantwith twins, you should have an additional 50 grams of protein daily.ProteinAmount3 oz. of Fish19-26 Grams of Protein4 oz. of Chicken30 Grams of Protein4 oz. of Beef33 Grams of Protein1 Cup Non-Starchy Vegetables(broccoli)2.5-5 Grams of Protein8 oz. of 1% Milk7 Grams of Protein1 TBS of Peanut Butter4 Grams of Protein

EATING CARBOHYDRATES¡ DO NOT STOP EATING CARBS¡ Choose healthy carbs such as: fruits, vegetables, beans, whole grains and whole wheat.¡ Try to avoid processed foods and white products such as white rice and white bread.¡ Try not to eat more than a ½ cup- 1cup of pasta or rice in any meal, or more than a ½ of a largepotato.¡Cereals, regardless if it’s “healthy” or not will typically cause elevations in blood sugar. This might be afood you want to avoid during pregnancy.¡ Try to avoid fruit juices, sugary drinks, candy, cakes, cookies, added sugar and processed sugary snacks.

HOW TO CARB COUNT¡ Start counting your carbohydrates.¡ It is recommended to eat:¡45 grams of carbs at EACH meal.¡ 15-30 grams of carbs at EACH snack.¡ A pregnant woman should be eating no less than 175grams of carbs each day, with 3 meals per day and 2 to3 snacks per day.¡ Every meal and snack should include a carbohydrateand a protein.

HOW TO READ A FOOD LABEL¡ Important things to lookfor on a food label:¡ Serving Size¡ Carbohydrate¡ Protein

CARB COUNTINGThis Photo by Unknown Author is licensed under CC BY

EXAMPLES OF 45 CARBOHYDRATE MEALS WITH A PROTEINThis Photo by Unknown Author islicensed under CC BY-NC-NDThis Photo by Unknown Author islicensed under CC BY-NC-NDThis Photo by Unknown Author is licensed under CC BY-NC-NDThis Photo by Unknown Author is licensed underCC BY-SAThis Photo by Unknown Author islicensed under CC BY-SA-NC

DIETARY SNACK IDEAS¡ Eating 6 times a day can be challenging. Here are some simple ideas you can keep on hand for snacks between regularmealtimes. *Not all types of snacks are equal. Check the nutrition label on the box to determine the serving amount.¡ These are mix and match examples. 1-2 carb options and one protein!1 English Muffin with Peanut Butter1 Large Apple with Peanut Butter1 Large Peach with 1 String Cheese2 Cups of Melon and ¼ Cup of Cottage Cheese2 Graham Crackers and 1 Cup of Milk12 Crackers, ½ Cup of Cottage Cheese, andTomatoesGranola Bar and 1 Cup of Milk12 Crackers, 2 Cheese Slices2 Cups of Chicken Noodle Soup3 cups of popcorn with ¼ Cup of Nuts1 Cup of Greek Yogurt with ¼ Cup of Nuts & berries1 Pita with Hummus and NutsEgg Salad Sandwich or Peanut Butter Sandwich1 Protein Bar and 1 Cup of Milk

ARTIFICIAL SWEETENERS¡ Artificial Sweeteners: Sugar substitutes arefound in sugar free foods. They are anartificial sweetener added to foods that donot elevate blood sugars. Below are examplesof sweeteners that have been approved inmoderation during pregnancy.¡ Examples: Splenda, Equal, Stevia, Sunett,NutraSweet, Newtame

WHEN CAN I EAT? HOW OFTEN?¡ To keep blood sugar steady throughout the day, it isbest to eat every 2-3 hours.¡ Eating 3 meals a day with a snack in between can helpprevent your blood sugar from dropping too low orbecoming too high.¡ A bedtime snack is important to make sure you haveenough food to last while you are sleeping.¡ Routine is important. Eating roughly the same timeeach day will help regulate your blood sugar and helpyou to remember if you have eaten enough in the day.

DAILY FETAL KICK COUNTS¡ Do fetal kick counts daily starting at 28 weeks gestation¡ Do a fetal kick count each day.¡ Pick a time each day around the same time to monitor movement.¡ Have a something to eat and drink before starting.¡ Look at the clock and starting counting movements.¡ Make sure you feel 10 kicks in one hour. You can stop counting after 10 kicks are felt.¡ If you DO NOT feel 10 kicks in the hour contact your doctor right away.

CALL YOUR DOCTOR OR SEEK EMERGENCY CARE¡ Fever greater than 99.4, cough, or signs of Covid-19 (CALL FIRST)¡ Go to the ER with any difficulty breathingCall your doctor for instructions on:¡Nausea, vomiting or diarrhea greater than four hours¡ Decreased fetal movement (start daily fetal kick counts at 28 weeks)¡ Vaginal bleeding or signs of labor such as leaking fluid or contractions¡ Headaches, swelling, visual changes, or right upper abdominal pain¡ Any other concernsGo to the hospital or L&D if immediate care is needed.¡ Contact MFM if your blood sugars are out of range.

FOLLOW UP CARE AFTER DELIVERY¡ Glucose Tolerance Test recommended 4-6 weeks after delivery for gestationaldiabetes. Then diabetes screening every 1-3 years after as directed by primarycare physician.¡ Patients with Type I diabetes should resume care with endocrinologist within oneweek of delivery. Patients with Type II diabetes should have follow-up care withendocrinologist or primary care within 2-4 weeks, or sooner if concerns.¡Diabetes Prevention Program for anyone at risk for Type IIdiabetes. https://livingwell.utah.gov/ndpp/index.php

With each trimester of pregnancy the needs for medication, whether oral . ¡2.5 hours a week of exercise is encouraged. You should exercise for 10 minutes after meals or 30 minutes each day. Stop exercising if you are experiencing shortness of breath, chest pains, contractions, leakage of fluid, vaginal .

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TABLE 57-3. Proposed Classification System for Diabetes in Pregnancy Gestational diabetes: diabetes diagnosed during pregnancy that is not clearly overt (type 1 or type 2) diabetes Type 1 Diabetes: Diabetes resulting from β-cell destruction, usually leading to absolute insulin deficiency a. Without vascular complications b.

Gestational diabetes mellitus 2 What is gestational diabetes mellitus? Gestational diabetes mellitus (GDM) is a form of diabetes that occurs during pregnancy. The placenta produces hormones which are essential to keeping the pregnancy progressing and which steadily rise as the pregnancy progresses. These hormones also partly stop insulin working.

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