Diabetes and Pregnancy

Managing diabetes – type 1, type 2, gestational, or any other form – can be tricky by itself. When you add in the enormous changes that the female body goes through during pregnancy, diabetes management can seem downright impossible – but it is not, and I hope I can help put your mind at ease about what’s in store.

I am currently 20 weeks pregnant with my first child, and I’ve also been living with type 1 diabetes for over 26 years. Like so many others, I have concerns about the possible risks (and rewards!) associated with pregnancy and diabetes, but I also know that so many other women before me have experienced healthy pregnancies while managing their diabetes. Careful planning and the diligent care of a competent health team can help minimize the potential risks.

Having diabetes does not mean that a healthy pregnancy isn’t possible. And even though your pregnancy may be very healthy and uneventful, so to speak, pregnancies with pre-existing diabetes are considered “high risk”. Don’t let that label get you down – while you may be “high risk”, it also means that you will get lots of extra attention!

Your medical team will be very important to you throughout your pregnancy (and beyond), so if you are planning a pregnancy, you will want to start assembling your A-Team well before conception. Your team may include:

  • An endocrinologist who is familiar with pregnancy and diabetes, and is willing to help you manage the drastic changes in medication you may need, as well as monitor things like thyroid levels, blood pressure, cholesterol, and kidney function
  • An obstetrician familiar with managing high-risk pregnancies
  • A Maternal Fetal Medicine doctor (specializes in high-risk pregnancies) whom you may see for higher level ultrasounds and screenings
  • An ophthalmologist who can monitor your eyes for any changes that may occur during pregnancy

Pregnancy with diabetes will mean some (okay, a lot) of hard work on your part. It’s totally possible, though – you can do this! Some changes you can expect:

  • checking your blood glucose more often
  • aiming for numbers post-prandial and fasting glucose numbers that are lower than you are accustomed to
  • HbA1c goals of under 6.5% or 6.0% (your doctor will help set individual goals for you, which may differ from what I’ve listed here)
  • lower insulin needs in the first half of pregnancy, while the second half of pregnancy generally increases insulin resistance (and therefore increases insulin requirements by two, three, or even four times as much as you are used to taking)
  • changes to other medications, such as thyroid medication, vitamins, blood pressure medications or anti-depressants
  • all of the expectations for non-diabetic pregnant women: balanced diet, pre-natal vitamins along with increased folic acid, regular (but not strenuous) exercise, increased fluid intake, and plenty of sleep.

There are many women in the diabetes online community who have shared their personal stories of pregnancy while living with diabetes, and organizations who have put together resources specifically for people like us – be sure to check out the list of resources below.

 

Kim Vlasnik

Kim was Diagnosed with type 1 diabetes in 1986 at the age of six, Kim writes about and illustrates her life with diabetes. She authors the diabetes patient blog Texting My Pancreas and is the founder of the You Can Do This Project.

Resources: 

 

JDRF’s Pregnancy Toolkit:

From JDRF, “Take care! Pregnancy or planning a pregnancy with type 1 diabetes (T1D) requires special consideration to help ensure a healthy outcome for mother and child. This guide provides information for parents-to-be or future parents-to-be with T1D—explaining the disease management goals for pregnancy and reviewing how to obtain the best possible support from healthcare providers at every stage.”

http://jdrf.org/life-with-t1d/pregnancy/

 

Diabetes Forecast’s Guide to Pregnancy:
[online] http://forecast.diabetes.org/baby-oct2012

Kerri Sparling
[blog] Six Until Me: http://sixuntilme.com/blog2/diabetes_and_pregnancy/

Cheryl Alkon
[blog] Managing the Sweetness Within: http://www.thesweetnesswithin.blogspot.com/

[book] Balancing Pregnancy With Diabetes: Healthy Mom, Healthy Baby: http://www.amazon.com/Balancing-Pregnancy-Pre-existing-Diabetes-Healthy/dp/1932603328/ref=cm_cr_pr_product_top

Melissa Lee
[blog] Sweetly Voiced: http://www.sweetlyvoiced.com/2011/11/tell-me-sweet-little-lies.html, http://www.sweetlyvoiced.com/2012/02/this-time.html, http://www.sweetlyvoiced.com/2012/02/so-how-did-we-do.html

Guest posts on DiabetesMine
[blog] http://www.diabetesmine.com/2012/08/gina-capone-how-pregnancy-with-diabetes-saved-my-life.html, http://www.diabetesmine.com/2012/01/c-sections-vs-natural-birth-in-diabetic-moms.html

Jane Dickinson, RN, PhD, CDE
[blog] http://www.janekdickinson.com/diabetes-control/

Holly at “Arnold and Me”
[blog] http://arnoldandme.blogspot.com/search/label/Pregnancy

Jacquie Wojcik
[guest post] WhatToExpect.com: http://www.whattoexpect.com/wom/pregnancy/it-s-always-complicated.aspx
[blog] Typical Type 1: http://typicaltype1.com/tag/pregnancy/

Christel Marchand Aprigliano
[blog] theperfectd: http://theperfectd.com/2013/03/21/fall-down-seven-stand-up-eight/ 

Karen at “Blah Blah Bklyn”:
Sarah Kaye
Lisa Brady
Diabetic Mommy
Positive Diabetic Pregnancies
[Yahoo Group] http://health.groups.yahoo.com/group/positivediabeticpregnancies/
If you want the science, evidence, and clinical recommendations (not the warm-and-fuzzy”what to expect”: Cliincial standards of care, Pregnancy with Pre-Existing Diabetes (ADA): http://www.shopdiabetes.org/606-Managing-Preexisting-Diabetes-and-Pregnancy-ePub.aspx
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Parents of Children Newly Diagnosed with Type 1 Diabetes May Feel

Lost, Alone, Overwhelmed, Distraught, Confused, Helpless, Anxious, Guilty and a host of other Emotions.

 

Children With Diabetes
http://childrenwithdiabetes.com

Most new type 1 parents felt that way too. We did. We found connecting with peers “who get it”  helps. There is a community for that. we call it the diabetes online community or DOC for short. 

Here is a little welcome letter that community from Scott Benner, a diabetes dad. Below there links to more folks like him and a community that can be your new emotional lifeline.

Hi, I’m Scott.

Every person and situation is different, but there are only so many human responses for our bodies and minds to choose from when we experience an unexpected shift in our reality. When the doctors told me and my wife that our daughter Arden had type I diabetes, I broke down and sobbed uncontrollably. I found it impossible to look my wife Kelly in the face, I didn’t want her to see me so destroyed and I definitely couldn’t find it within myself to witness her heart breaking. The days, weeks and months that followed felt otherworldly, my head was ringing and I constantly felt like someone had reached down my throat and was strangling my heart. I struggled at times to look Arden in the eyes for fear that I would cry.

 

I began to slowly find my footing in our new world but the steps that I took were always uncertain and never in full stride.The only thing that kept me afloat as I searched for a way out from under the fog that type I blanketed or home with – hope. Eventually that hope blossomed into a desire to positively effect my daughter’s life with diabetes. I began to write online about my life with type I, and the connections that I made saved me.

 

I found places like the Children With Diabetes and their CWD forums, the Diabetes Online Community weekly #DSMA chat on Twitter and scores of other diabetes bloggers all doing what I was – trying to help someone else to feel a little less alone. Since then, I think that I’ve made a difference in others lives and I want very much for you to know the relief that comes with finding community and making real connections with other people just like you.

 

The first time that I was impacted by the DOC opened my eyes to the benefit of finding commonality and community as we live with type I diabetes. I wrote something on my blog that struck a cord with a reader in England. The woman wrote to me and thanked me for sharing, she told me that my transparency helped her. I never expected that my experiences shared, could relieve another’s anguish. The DOC provides support like this every day through the human connections that are made because of it. When I read her note further, I fell the rest of the way in love with this community. The woman offered me support. She wasn’t a victim, not a person adrift searching for hope online… she was a fellow combatant and she wanted me to know that she had my back. I’ve never once been alone since. You are all with me at two in the morning, in my car and when I struggle. I never feel like I can’t, because I know that somewhere you are living bravely despite the obstacles that we all face. You are my support on the days that I need it, and I am heartened to be yours when I can. We are a family. The DOC is home.

 

Welcome Home

 

Scott

 

Arden’s Day

http://www.ardensday.com

http://www.ardensday.com/diagnosis/

Other Parents Stories and Resources for Newly Diagnosed Families

Children With Diabetes
American Diabetes Association
http://www.diabetes.org/diabetes-basics/type-1/?loc=DropDownDB-type1
JDRF

Parents Blogging about Diagnosis

Voice of a D-Mom
d-mom
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Eating Disorders and Diabetes

Eating Disorders and Diabetes

 

Eating disorders are common, but despite the serious health consequences associated with them, people are reluctant to discuss them. It is no surprise that those with diabetes are more susceptible to developing eating disorders because managing diabetes requires patients to be vigilant about dietary management. Thankfully, efforts are being made to raise awareness, educate patients, and support those in need.

Diabetes Advocates is partnering with National Eating Disorders Association for National Eating Disorders Awareness Week, February 24th – March 2nd, promoting this year’s theme, Everybody Knows Somebody. Diabetes Advocates is proud to broaden and amplify the conversation on diabetes-related eating disorders by offering information and resources to the diabetes community, including those at risk and those in need of support, and encouraging participation in NEDAwareness Week through social media outlets.

How common are eating disorders with diabetes?

A report published in Diabetes Spectrum showed that having type 1 diabetes doubles the chance of developing an eating disorder1, and multiple studies have shown that eating disorders can lead to significantly higher rates of diabetic complications and mortality rates.2,3 Even more alarming is that one study indicated that 35% of 15–30 year olds manipulate or omit their insulin in order to lose weight, a practice known as diabulimia.4 For patients with type 2 diabetes, some research has suggested higher rates of binge eating disorder5, which is associated with poorer metabolic outcomes.6

Less severe, but still clinically significant, patients are at risk of developing disturbed eating behaviors, which are also associated with poorer metabolic outcomes, higher rates of diabetic complications and mortality.7 This is not surprising since behaviors that characterize eating disorders are often behaviors encouraged and praised by doctors with patients who have diabetes.Such behaviors include:8

  • Weighing, measuring and counting food portions
  • Keeping records of food consumed and exercise
  • Increased focus on body weight, weight management and BMI
  • Monitoring certain food components, i.e. carbohydrates, fiber and fat

National Eating Disorders Association is promoting dialogue and information sharing about eating disorders, and Diabetes Advocates is encouraging the Diabetes Online Community to engage in this important conversation. By highlighting the blog posts and projects of its members, Diabetes Advocates illustrates that disordered eating in the diabetes community affects people of all ages and genders. Michael Hoskins writes on Diabetes Mine about using emotional eating as a coping mechanism for feelings, and how it is not considered “manly” to struggle with such issues. Natalie Sera shares her story on Diabulimia Helpline about discovering she had a “young person’s” disease at the age of 64. Ginger Vieira has written a new book titled Emotional Eating with Diabetes that helps people with diabetes cope with the conflicted feelings about food that they often experience.

Lee Ann Thill, art therapist and founder of Diabetes Art Day, introduces VIAL Project: Voice-Insulin-Art-Life, a social network for people with type 1 diabetes and food and body issues to share creative expression and connect. VIAL project is a doctoral research project investigating the experience of living with diabetes and food and body issues, and participants’ experiences using creative expression and social networking. Erin Akers is CEO of Diabulimia Helpline, the only non-profit in the U.S. devoted solely to supporting diabetics with eating disorders, and their families. Diabulimia Helpline runs a support group on Facebook, where people with diabetes and eating disorders can share their struggles with recovery, and offers a 24-hour hotline to those in need.

The goal of National Eating Disorders Awareness Week is to promote public and media attention to the seriousness of eating disorders, their biological as well as environmental triggers, and to combat the pressures, attitudes and behaviors that can contribute to them. In a culture saturated with unrealistic body-image messages, most people know somebody struggling with an eating disorder. Education can lead to earlier detection, and intervention to help those who are struggling, ultimately improving the likelihood of full recovery.

Diabetes Advocates offers these suggestions to the Diabetes Online Community for participating in NEDAwareness Week:

  1. Bloggers can share their personal experience managing food and body issues
  2. Read, comment and share links to blog posts
  3. Share links to the projects and organizations listed in this post: Diabulimia Helpline, VIAL Project, Emotional Eating with Diabetes, and NEDA (Additional links are listed below)
  4. Participate in related discussions on diabetes social networking websites, Facebook and Twitter

By taking these actions during NEDAwareness Week, the Diabetes Online Community can raise awareness, educate others, and promote ongoing dialogue in support of those struggling and those at risk.

We can all help because Everybody Knows Somebody who needs it.

 

Erin, Lee Ann, Natalie

 

Notes
1. Daneman, D. Eating Disorders in Adolescent Girls and Young Women with Type I Diabetes. Diabetes Spectrum 2002; 15 : 83-105.
2. Steel JM, Young RJ, Lloyd GG, and Clarke BF. Clinically apparent eating disorders in young diabetic women: associations with painful neuropathy and other complications. British Medical Journal 1987; 294: 859-62.
3. Takii M, Uchigata Y, Tokunaga S, Amemiya N, Kinukawa N, Nozaki T, Iwamoto Y, and Kubo C. The duration of severe insulin omission is the factor most closely associated with the microvascular complications of Type 1 diabetic females with clinical eating disorders. The International Journal Of Eating Disorders, 2008 Apr; Vol. 41 (3), pp. 259-64.
4. *5 Goebel-Fabbri A. Insulin Restriction and Associated Morbidity and Mortality in Women with Type 1 Diabetes. Diabetes Care (2007).
5. Papelbaum M, Appolinário JC, Moreira Rde O, Ellinger VC, Kupfer R, and Coutinho WF. Prevalence of eating disorders and psychiatric comorbidity in a clinical sample of type 2 diabetes mellitus patients. Revista Brasileira De Psiquiatria (São Paulo, Brazil: 1999) [Rev Bras Psiquiatr] 2005 Jun; Vol. 27 (2), pp. 135-8.
6. Mannucci E, Tesi F, Ricca V, Pierazzuoli E, Barciulli E, Moretti S, Di Bernardo M, Travaglini R, Carrara S, Zucchi T, Placidi GF, and Rotella CM. Eating behavior in obese patients with and without type 2 diabetes mellitus. International Journal Of Obesity And Related Metabolic Disorders: Journal Of The International Association For The Study Of Obesity, 2002 Jun; Vol. 26 (6), pp. 848-53.
7. Goebel-Fabbri AE. Disturbed eating behaviors and eating disorders in type 1 diabetes: clinical significance and treatment recommendations. Current Diabetes Reports, 2009 Apr; Vol. 9 (2), pp. 133-9.
8 Affenito, SG, Adams CH. “Are eating disorders more prevalent in females with type 1 diabetes mellitus when the impact of insulin omission is considered?” Nutrition Reviews 2001; 59: 179-82.

About NEDAwareness Week

http://nedaw.myneda.org/about
http://nedaw.myneda.org/become-a-partner
http://nedaw.myneda.org/sites/default/files/resources/NEDAWOrgPartn…

Diabulimia Helpline
www.diabulimiahelpline.org
24-hour hotline (425) 385-3635

We Are Diabetes
http://www.wearediabetes.org/forum/thread.php?tid=142

The Butter Compartment - An Ounce of Prevention
http://www.thebuttercompartment.com/?p=6889 

Diabetes Mine
http://www.diabetesmine.com/2013/01/a-confession-and-a-new-book-about-emotional-eating.html

Natalie’s Story
http://diabulimiahelpline.org/in-our-own-words/our-stories/story-detail?id=13

Emotional Eating With Daibetes
http://emotionaleatingwithdiabetes.com

V.I.A.L project; Voice, Insulin, Art, Life.
VIAL project

SixUntilMe
Body Image- http://sixuntilme.com/blog2/2008/07/body_image.html
Articles Forbidden - http://sixuntilme.com/blog2/2013/02/articles_forbidden.html 

Your Diabetes May Vary
Food for the shrink – http://www.ydmv.net/2008/09/food-for-shrink.html
Cheating - http://www.ydmv.net/2013/02/eating-cheating-with-diabetes.html

MyGlu
•Blood Sugar Roller Coaster (over-treating low blood sugars)
https://myglu.org/articles/the_blood_sugar_roller_coaster
•Rules Around Food that Do More Harm Than Good
https://myglu.org/articles/rules_around_food_that_do_more_harm_than…

The Butter Compartment – Previous posts
Peace of Cake: http://www.thebuttercompartment.com/?p=6265
Overdue: http://www.thebuttercompartment.com/?p=5981
New Year’s Revelation: http://www.thebuttercompartment.com/?p=4763

The Odd Duck Out
Has a very poignant graphic of how diabulimia happens.
http://theoddduckout-natalie.blogspot.com/2013/02/initiating-eating-disorder.html 

Texting My Pancreas – Everybody Knows Someone
http://www.textingmypancreas.com/2013/02/everybody-knows-somebody.html

The Blue Heel Society – No Body is Perfect
http://blueheelsociety.blogspot.com/2013/02/everybody-knows-somebody-nedawarenes.html 

Diabetes Mine - Diabetes and Eating Disorders: Fellow PWD Shares Her Diabulimia Story
http://www.diabetesmine.com/2013/02/diabetes-and-eating-disorders-fellow-pwd-shares-her-diabulimia-story.html

DSMA Live
DSMA Live ‘Rents – Feb 18 – Lee Ann: http://www.blogtalkradio.com/diabetessocmed/2013/02/19/dsma-live-rents
DSMA en Vivo con – Feb 26 – Lizmari:
http://www.blogtalkradio.com/diabetessocmed/2013/02/27/dsm-en-vivo-con-lizmari 

The Angry Type 2 Diabetic
http://theangrytype2diabetic.blogspot.com/2013/02/finding-balance-in-unbalanced-world-of.html

Diabetes Forecast - Hope in the World of Eating Disorders and Diabetes
http://forecast.diabetes.org/disorders-mar2013

Me and D: You Know Me
http://www.meanddblog.com/2013/02/you-know-me.html

Diabetesaliciousness: #NEDAwareness Week: We All Know Someone~
http://diabetesaliciousness.blogspot.com/2013/02/nedawareness-week-we-all-know-someone.html

Bitter~Sweet: Disorders and Issues
http://www.bittersweetdiabetes.com/2013/02/disorders-and-issues.html 

Strangely Diabetic: I’m One of the Disorderly
http://strangelydiabetic.com/2013/02/28/national-eating-disorders-week-im-one-of-the-disorderly/

Encuentro Fortuito
http://nictetrujillo.wordpress.com/2013/03/03/nedawareness/

Jezebel.com
http://jezebel.com/5989924/diabulimia-eat-anything-you-want-lose-weight-and-seriously-put-your-health-at-risk

thePerfectD
http://theperfectd.com/2013/03/22/the-knickers-in-a-twist-club/

http://theperfectd.com/2013/03/29/for-want-of-a-nail/

My crazy life with my diabetic service dog
http://tarraandduchess.blogspot.com/2013/02/everbody-know-someone.html

 

 

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Spare a Rose, Save a Child


Dear DOC Friends,

Valentine’s Day is coming up, and we, as a community, have a chance to show some love for people with diabetes around the globe. A small group of us – Kelly Close, Manny Hernandez, Bennet Dunlap, Kerri Sparling, and Jeff Hitchcock – with the support of some folks at Johnson & Johnson, got together recently to see how the diabetes community could make the move to use social media for social good, and an idea was born out of that meeting that can impact the lives of children with diabetes across the globe.

Specifically, we’re looking to help the Life for a Child program, which is an International Diabetes Federation program aiming to take “contributions from donors [to] go to established diabetes centers enabling them to provide the ongoing clinical care and diabetes education these children need to stay alive.” Our idea was to take the typical “dozen roses,” so popular on Valentine’s Day, and save just one rose to spare the life of a child. “Spare a Rose, Save a Child” is simple: buy one less rose this Valentine’s Day and share the value of that flower with a child with diabetes in the developing world. Your loved one at home still gets flowers and you both show some love to someone across the world who needs it.

We’re hopeful that our friends in the DOC will help with this effort, if they’d like to pitch in.

Here’s what you can do to help:

The week of February 10 – 16th, please help raise awareness for the Life for a Child program by blogging, Tweeting, Facebooking (is that an official verb?), etc about the organization and the Spare a Rose, Save a Child effort.

If you’d like, you can download an image to use for your post, or host it on your site for the week of Feb 10 – 16th. Three banner sizes are available for you to use on your web site (click on the respective link below to access the file):
Download the 728W x 90H banner
Download the 160W x 600H banner
Download the 160W x 199H banner

Please use the URL: http://bit.ly/SpareRoseSaveChild to link to the IDF site. (This is a short URL we’ve created so we can see how much impact our social media campaign has generated.)

Also, please go to Kerri’s blog post on Spare a Rose, Save a Child and post a comment there with a link to your blog post so we can keep track of how many DOC sites are participating.

The hashtag for this effort is #sparearose

This Valentine’s Day, we can both share our care for loved ones at home and give a little help to those we have some much in common with around the world. We hope to connect our love for our families to helping other families keep their loved ones alive. It is a simple, caring, but life-changing message. And it shows that the diabetes online community takes care of one another, both online and off.

Thanks for reading all of this, and for everything you do as part of this community.

Kerri, Kelly, Manny, Jeff, Adam, Bennet 

 

Updated:  Here’s a link list of sites that are helping raise awareness.  If yours isn’t on here, please comment at SixUntilMe with a link or email  info@diabetesadvocates.org.

 

 


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