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Services
Each woman's care is special, different, and individually planned. You are the key player in the management of your diabetes and we are here to help.
A healthy balance of diet, activity, and insulin injections (when necessary) is essential for good diabetes control. We will help you to keep your blood sugar level in the target range before, during, and after your pregnancy.
Your first clinic appointmentWhen your doctor or midwife refers you to the clinic, you will be under the care of an endocrinologist (a diabetes specialist). During your first clinic appointment, you will have a two-hour session with the diabetes nurse educator and the dietitian. It is okay to eat before you come. You are always welcome to bring a support person with you.
The dietitian will ask you questions about your usual diet, and help you make a meal plan that will work for you. The dietitian will help you make the choices that you need for good blood sugar control, adequate nutrition, and healthy weight gain.
The nurse will talk with you about diabetes and pregnancy. The information that you get will depend on your type of diabetes and your own situation. Some of the things to discuss are:
- the diabetes team and your own role on the team
- what you need to know before you get pregnant if you have types 1 or 2 diabetes
- the effect of pregnancy on blood sugar control
- the risks to the baby from high blood sugars
- the care that you will receive from the clinic during your pregnancy, including the importance of diet, activity, insulin, and blood sugar monitoring
- what you need to know about diabetes after the baby is born
You will have a chance to ask questions, and will receive a book with printed information, so that you do not have to worry about remembering everything.
The nurse will talk to you about activity/exercise, because this is very important in controlling blood sugars. When you come for your follow-up visit, you will see the physiotherapist who will help you make an activity plan, and will tell you about preventing problems such as back pain and joint pain. Your activity plan will depend on several things, such as your likes and dislikes, and whether you have any pregnancy problems that limit your activity (such as high blood pressure). An activity/exercise plans works best when the same type of activity is done at the same time of day for the same amount of time. A common suggestion is a brisk 20 to 30 minute walk immediately after each meal.
You will need to test your blood sugars a few times a day in order to see if the diet and activity are working. Women who have type 1 or type 2 will already know how to do this, but the testing schedule may be different when they are pregnant. The target blood sugar levels are different for pregnancy, and the nurse will talk to you about what your levels should be. Women who have gestational diabetes mellitis (GDM) may be testing for the first time, and it may take a few days to get used to this. Most women find that once they get started, it is very easy to do (but it is a bit of a nuisance).
If you have GDM and cannot get good blood sugars by using diet and exercise, you will need to take insulin injections. They do not harm the baby. At BC Women's, a number of women with GDM need insulin as well as diet to keep their blood sugars normal. This is not like taking a new medication, it is just "topping up" your body’s insulin supply. We are unable to tell in advance who will need insulin and who will not. You need to do self-blood glucose monitoring to find this out. We will help you adjust your dose.
Women with type 1 diabetes are of course already taking insulin. As their insulin needs change, the dose will need to be adjusted, sometimes on a daily basis. This can be challenging, even for women who are very good at adjusting their own insulin dose. In our clinic, the nurses are experienced at insulin adjustment in pregnancy, and always have the help of the endocrinologist when needed.
Almost all women with type 2 will need insulin during their pregnancy. Many women who take oral hypoglycemic agents (pills) will discontinue these before pregnancy. There are studies going on right now to find out how safe and effective these drugs are for pregnancy. Although some centres are using metformin or glyburide during pregnancy, at BC Women's most women with type 2 are using only insulin for blood sugar control. Some women who are taking metformin may continue to take it through the first few weeks of pregnancy, and this is discussed on an individual basis. Women who do not need insulin before pregnancy will start taking it when diet and exercise are no longer enough to control their sugars. Again, the dose will require careful adjustment during the pregnancy.
At the end of your appointment, the nurse will make sure that you have a follow-up appointment within a few days. You are always welcome to call the clinic before your second appointment if you have questions.
Follow-up appointmentsWhen you return to the clinic, you will automatically see the endocrinologist, the nurse, the dietitian, and the physiotherapist. You may also ask to see the social worker if you wish. This appointment usually takes about an hour, or maybe a little longer.
Endocrinologist:
The endocrinologist is a doctor who has specialized training in taking care of people with diabetes. Endocrinologists are also expert at taking care of all of the complications that people with type 1 or type 2 diabetes might have, such as high blood pressure. The endocrinologist will ask you some questions about your general health, your diabetes and your pregnancy. They will check your blood pressure, and discuss any other exams or tests that you need. This will depend on your own situation. The doctor will also look at your blood sugar records and help you decide what to do next.
Dietitian:
You will see the dietitian, who will see how the meal plan is working for you, and whether you need to make changes that would help to keep your blood sugars normal. It is common to need some changes in the meal plan throughout the pregnancy.
Physiotherapist:
The physiotherapist will help you with an activity/exercise plan, and might suggest a follow up visit if she thinks it would be helpful.
Nurse:
The nurse will see how you are doing with the testing, and if you need to learn how to take insulin, will show you how to do this. Most women find that this is very easy to do, although many are nervous about it at first. The nurses will help you with adjusting your insulin dose until the baby is born.
The rest of the appointments tend to be a lot shorter than the first two. They may be two to four weeks apart, depending on your pregnancy (visits will occur more often at the end of your pregnancy). You will always have a chance to ask questions of any of the team members. If you are from out of town, we will make arrangements for follow-up, and will be in frequent contact by phone.
Most women do not need to be in the hospital during pregnancy for reasons related to diabetes.
Our team is here to help you have a healthy pregnancy. If you are worried or confused about any part of your care, we hope that you feel able to tell us so that we can help you.
Labour and DeliveryPlanning for labour and delivery is individual for all women, including those with diabetes in pregnancy.
If you have GDM, you may even go past your due date as you wait for labour to start, as long as you and the baby are healthy. If you have type 1 or type 2 diabetes, it is most likely that you will have your baby a week or two before your due date for the safety of the baby.
Some women may have an induction of labour if there is a concern about the health of the mother or baby. Other women may have a planned Caesarean birth, depending on their individual situation. You will always be involved in the decision-making, and have a chance to have your questions answered. The team will help you with advance planning as much as possible.
During labour, your blood sugar will be watched closely, and the nurses will keep in contact with the diabetes doctor as needed. Your care after delivery will depend on what type of diabetes you have.
PostpartumIf you have GDM, you will have a blood sugar test before breakfast the day after the baby’s birth to make sure that the diabetes has gone away. It is important to discuss diet, activity, infant feeding, future pregnancies, and the risk of type 2 diabetes with the team before you go home. A very small number of women still have high blood sugars after delivery and will need follow-up with the diabetes doctor.
If you have type 1 you may not need insulin for the first day or two after delivery, and will need it again when your blood sugars start to go up. If you have type 2 you may need some kind of diabetes medication. You and your doctor will make these decisions. The team will discuss diet, activity, infant feeding, future pregnancies, and future diabetes management with you.
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