Type 2 diabetes is a chronic disease in which blood sugar levels are higher than normal. It is most often caused by a weakened effect of the blood sugar-lowering hormone, insulin, in the body. This phenomenon is called insulin resistance. Due to insulin resistance, more insulin is needed than normal to keep blood sugar levels normal. A person with type 2 diabetes must-visits a maternity clinic throughout pregnancy and in this post, we have discussed type 2 diabetes and pregnancy.
What is Type 2 Diabetes
Type 2 diabetes is a persistent disease, In Type 2 diabetes, the pancreas is unable to produce enough insulin to meet the increased need, and as a result, blood sugar levels rise.
Type 2 diabetes occurs mainly in the adult population, but as childhood obesity increases, the disease is also found to increase in children. Both genetic and environmental factors (unhealthy diet and lack of exercise) play a clear role in the pathogenesis of the disease. If the father or mother has type 2 diabetes, the lifetime risk of getting offspring is about 40-50%.
There are an estimated 425 million diabetics worldwide, of whom about 80-90% have type 2 diabetes. It is estimated that the number of people with diabetes would increase to 649 million by 2045. In Finland, an estimated 500,000 people suffer from diabetes. About 80-90% of them have type 2 diabetes.
Symptoms Of Type 2 Diabetes in Pregnancy
Type 2 diabetes, or so-called adult-onset diabetes, is an insidious and serious disease because its symptoms develop slowly and a person adapts to them and does not necessarily pay attention to its symptoms. However, there are certain symptoms for which type 2 diabetes can be suspected specially in pregnant women:
- increased feeling of thirst
- increased urine output
- unexplained weight loss
- inflammatory susceptibility (especially yeast infections of the skin folds, dental infections)
- Insulin is not working effectively
- Usually goes away when the baby is born.
Type 2 diabetes is diagnosed or should be suspected if:
- blood sugar rises above the reference range
- symptoms of other conditions such as arterial stenosis, retinal disease and kidney or nervous system problems
- suffers from a heart attack or stroke
- wounds (especially in the legs) heal poorly or become more susceptible to inflammation
If you identify with yourself risk factors for diabetes, such as being overweight and have a family history of type 2 diabetes, you may want to take the Diabetes Association’s risk test to map your own diabetes risk .
What is the Causes of Type 2 Diabetes?
The disease is caused by insulin resistance (the body’s response to insulin). In sick people, insulin production continues, but it does not affect the body’s cells or speed up the absorption of glucose from the blood.
Doctors did not determine the detailed causes of the disease, but current studies suggest that type 2 diabetes may manifest in different cell counts or receptor sensitivity to insulin.
Risk factors for type 2 diabetes include:
- Irrational food: fresh presence of carbohydrates in foods (sweets, chocolate, candies, waffles, pastries, etc.) and very small fresh plant foods (vegetables, fruits, grains).
- Excess weight, especially in the viscera.
- Presence of diabetes in one or two close relatives.
- Sedentary lifestyle.
- High pressure.
The main factors that affect tissue resistance to insulin include the effects of growth hormones on puberty, race, gender (greater tendency to develop the disease is observed in women), obesity.
Type 2 Diabetes and Pregnancy
Pregnancy in type 2 diabetes is monitored by a maternity clinic.
A person with type 2 diabetes also visits a maternity clinic throughout pregnancy. In addition to diet and exercise, metformin tablets and insulin injections are used to treat blood sugar.
The treatment of type 2 diabetes during pregnancy follows the same principles as the treatment of type 1 diabetes. The goals for weight, blood sugar and blood pressure are the same.
Treatment of Blood Pressure During Pregnancy
People with diabetes should measure their own blood pressure at home. People with diabetes have a higher risk of developing high blood pressure during pregnancy.
The blood pressure target during pregnancy is less than 140/90 mmHg. The most important non-drug treatments for high blood pressure are the avoidance of salt (sodium) and high-salt foods and licorice, and peaceful exercise and rest. If the self-monitoring blood pressure rises above 150/100 mmHg in your own repeated measurements, you must contact the pregnancy monitoring site.
Patients with diabetes have an increased risk of high blood pressure and pre-eclampsia during pregnancy. Pre-eclampsia was formerly referred to as gestational poisoning or gestational toxaemia. It means a rapid increase in swelling, blood pressure and proteinuria associated with pregnancy. Pre-eclampsia requires rest and medication in the hospital ward. Childbirth usually has to be started prematurely.
The risk of pre-eclampsia is particularly high in women with diabetes who already have kidney problems before pregnancy.
The treatment and follow-up of a diabetic during pregnancy includes regular visits to the maternity clinic. The maternity outpatient clinic focuses on the treatment of diabetes and the monitoring of fetal growth and development. The goal of treatment is a good sugar balance throughout pregnancy and the normal development and growth of the fetus.
At the maternity clinic, a midwife-diabetes nurse, an internal medicine doctor and an obstetrician participate in pregnancy monitoring. If necessary, other experts, such as an ophthalmologist and a nutritionist, will also be involved in the follow-up.
In addition, the diabetic visits a maternity clinic. Among other things, the counseling center goes for a combined screening study and takes counseling peer samples. The counseling center also handles Kela matters.
Follow-up during pregnancy
The condition of both the baby and the diabetic mother is closely monitored during pregnancy.
The mother’s overall situation is monitored at the maternity clinic with various blood and urine tests. These aim to ensure the well-being of the mother and baby. Blood counts (such as hemoglobin) and sugar hemoglobin HbA1c are usually monitored every four weeks. The urine sample is monitored for the presence of protein and possible signs of urinary tract infection.
The baby’s growth and well-being are monitored in different ways during pregnancy. KTG (cardiotocography), or fetal cardiac monitoring, ultrasound and umbilical cord flow measurement, are ways to monitor fetal growth rate and well-being as well as placental function. If a baby is exposed to high blood sugar, its growth will also accelerate, which may jeopardize its well-being, but sometimes the baby’s growth may be inadequate.
In late pregnancy, the mother is instructed to count the baby’s movements regularly.
Infant water sample tests help assess a baby’s readiness to give birth if the birth should be accelerated prematurely. Cortisone injection is used to increase the baby’s ability to give birth, ie to mature the lungs. Cortisone greatly increases insulin requirements, in which case intravenous insulin therapy is usually associated with ward care.
If there is no obstacle in terms of maternal and infant health and baby size, childbirth can occur downstream. However, caesarean section is more common than in other mothers.
A person with diabetes can give birth in the calculated time downwards if the pregnancy has gone well, the baby is well and the baby is suitable for the entire subcutaneous delivery. In most cases, the uterus is planned to be started before the calculated time. Caesarean section is performed more often than others.
A childbirth in a person with diabetes is a special childbirth that should proceed without slowing down labor. If there are abnormalities in the baby’s cardiac tone monitoring (CTG) during childbirth, caesarean section is much more sensitive than usual. People with diabetes are 2 to 4 times more likely to have a caesarean section than mothers who usually give birth.
Insulin users ensure that their blood sugar level remains constant between 4 and 7 mmol / l during childbirth so that the baby’s blood sugar does not fall low after childbirth.
The use of an insulin pump is permitted depending on the maternity hospital. In this case, the mother determines the appropriate basal or basal insulin dose. In general, intravenous infusions of insulin and glucose into a vein are started at the start of labor.
The planned cesarean section will be done in the morning. It is advisable to reduce the dose of long-acting insulin from the previous evening by 2 to 4 units to avoid a drop in blood sugar at night. In the morning, long-acting insulin is injected after delivery. Blood glucose levels are controlled by insulin and glucose infusions.
After delivery, return to normal insulin dosing, possibly with slightly lower doses. Breast-feeding is recommended.
After delivery, the food received by the mother is switched to normal subcutaneous insulin administration. The required insulin doses are usually a few units lower than those used before pregnancy.
Breastfeeding is encouraged and its onset is supported. Breastfeeding consumes energy, and blood sugar can easily drop too low. During breast-feeding, pre-meal blood glucose levels may be between 6 and 8 mmol / l and hemoglobin HbA1c between 58 and 63 mmol / mol. Always before breastfeeding (including at night) the mother should eat, and it is necessary to keep food available during breastfeeding. Adequate fluid and calcium intake must also be provided.
If the mother has been taking antihypertensive medication in late pregnancy, it will be continued for 2 to 3 weeks until the blood pressure has returned to normal. Antihypertensive medication does not prevent breastfeeding.
The follow-up inspection normally takes place at the clinic. In addition, a review of diabetes and its treatment is performed at the maternity hospital by an internal medicine physician or endocrinologist.
It is important to take care of contraception even during breastfeeding.
Prevention of type 2 Diabetes After Childbirth
The best way to prevent type 2 diabetes is to make a permanent, healthy lifestyle change. A recommended diet and regular exercise are key, taking into account overall well-being. Children also get a model for their lifestyles from home.
Overweight mothers should strive to lose weight towards normal weight, but during breastfeeding, a large energy deficit is not recommended so that breastfeeding does not suffer. Breastfeeding has been shown to have a reducing effect on the risk of type 2 diabetes in both mother and baby, among others. For a baby, the best benefit is obtained if breastfeeding lasts for several weeks after the mother’s blood sugar balance has returned to normal.
Blood sugar balance is affected by many factors. Ingested food, insulin, and exercise are just some of them. Stress and the cortisol hormone secreted during it, among other things, raise blood sugar. Stress can include changes in life brought on by pregnancy, worries about type 2 diabetes, challenges to relationships in mood swings, night waking to the toilet or caring for a previous child, and excessively strenuous exercise or anxiety caused by pain.
Well-being is an entity where each component affects the other. People with sleep disorders have a higher risk of developing type 2 diabetes. It can bring on worries that are controlled at night, and poor night’s sleep impairs sugar balance and predisposes to additional problems. Symptoms of stress include a variety of physical symptoms such as headaches and upset stomachs, and mental symptoms such as depression, anxiety, and sleep problems. It also increases the risk of postpartum depression.
- Good nutrition, regular exercise, adequate sleep and relaxation will help you recover from stress. Mental health is a prerequisite for health and well-being. A professional, whether he or she is a physiotherapist, maternity clinic nurse, midwife, nutritionist, physician, mental health nurse, or even a trained masseur, can support a client’s mental health by speaking to the mental health as part of a visit and referring the necessary assistance.
2. The client’s lifestyle change can be supported, for example, by a motivational interview, which is intended to make the client an active part of his or her own health care and decision-making. Despite the clear health benefits of exercise, the client and his or her potential aversion to exercise or inability to exercise due to pain or contractions should be considered with respect and empowerment. Alternatively, it can be emphasized, for example, that simply increasing daily activity and taking a break from sitting can have a beneficial effect on blood sugar balance.
3. The major factors in regular physical activity during pregnancy are pre-pregnancy physical activity, part-time work, higher education, and a physically active spouse. In addition to the spouse, movement is encouraged by the child, other family members and the weather. Fatigue, nausea, perceived health status (e.g., overweight or pain), work, and lack of time are perceived as barriers to regular exercise.
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