Heatherly Simmons, PA-C, CDE, discusses what women need to know about managing diabetes during pregnancy, who is at risk for developing gestational diabetes, and what women can do prior to getting pregnant to mitigate the risk.
Transcription:
Bill Klaproth: Diabetes in pregnancy is a serious concern as it can pose several risks to you and your baby. So let's find out more with Heatherly Simmons, a Physician Assistant and Certified Diabetes Educator at WakeMed Maternal Fetal Medicine. This is WakeMed Voices, a podcast from WakeMed Health and Hospitals. I'm Bill Klaproth. Heatherly, thanks so much for your time. So let's start here. Can you first explain what is diabetes and then type one versus type two versus gestational diabetes?
Heatherly Simmons: Sure. The two main types of diabetes, type two far more common, about 90% of diabetics have type two it's genetically linked, runs in families, and it is caused by the pancreas either not making enough insulin or cellular resistance to the insulin that's being made. Type one is less common, about 10% of diabetics have type one. It's usually doesn't run in families and it is caused by the autoimmune destruction of the pancreatic beta cells, and that leads to total insulin deficiency. So these people don't make insulin and must take insulin daily in order to stay alive. When you have diabetes in pregnancy that is specifically gestational diabetes and also caused by insulin resistance as well.
Host: So Heatherly gestational diabetes, is this something a healthy woman can develop over the course of her pregnancy and then after delivery and birth, the diabetes goes away? Is that how this happens?
Heatherly Simmons: Yes. So most of the time a mother that has diabetes in pregnancy, the blood sugars will resolve as soon as she delivers the baby and the placenta comes out. A large part of this disease is caused by the placental produced hormones and as they increase towards the end of pregnancy, that insulin resistance increases.
Host: So I know for type two diabetes, it doesn't come with a big list of symptoms. Most people find out they have it through other tests. They didn't even know they had it. So how does that work for pregnant women? Does every pregnant woman get tested for diabetes?
Heatherly Simmons: Yes. Every pregnant woman will get screened in some way. If they are low risk, then they'll get screened with a one hour glucose tolerance test or challenge test somewhere between 26 and 30 weeks. If they have increased risk factors, then we'll screen them earlier in pregnancy.
Host: So how does this glucose tolerance test work? Can you give us a little more detail on that?
Heatherly Simmons: So it's a little different than normal type one or type two diabetes that's just usually diagnosed with elevated fasting blood sugars or hemoglobin A1C that's elevated. In pregnancy, this load of sugar is given to patient and then their blood sugar is monitored at specific intervals after that load is given.
Host: Okay, got it. So as we learn about diabetes, we hear the term insulin a lot. Can you explain what insulin is and why it's so important?
Heatherly Simmons: Yes. So insulin is a really important hormone that helps glucose or sugar enter the body cells where it can be used for energy and there's a normal amount of sugar that stays in the blood and that amount is about 80 to 120 milligrams per deciliter. And that number is important for people with diabetes to kind of keep track of. And the goal of all diabetes treatment is to keep that blood sugar in the normal range.
Host: So then insulin helps keep that blood sugar in the normal range, it knocks that high blood sugar level down into the normal range. That's what insulin is supposed to do.
Heatherly Simmons: Exactly.
Host: Who then is at risk for developing gestational diabetes?
Heatherly Simmons: So, patients that have a previous history of gestational diabetes or a history of impaired glucose tolerance where they've, you know, previously failed that test. If they're obese, if they're older, if they've had a previous child that was weighing greater than nine pounds at birth, or if they have a family history of diabetes, they're at increased risk.
Host: So then how are the blood sugar goals different in pregnancy versus non pregnancy? I would imagine they do differ.
Heatherly Simmons: Well, we just want to be very careful to keep the blood sugars meticulously controlled during pregnancy because of the risks of high blood sugars to both the mom and the baby. So those recommendations, according to the powers that be, the American Diabetes Association and The College of OB GYN recommend the fasting blood sugar to be less than 95, and then one hour after eating less than 140, and two hours less than 120.
Host: All right, so you just mentioned health risks to both the mother and baby. What are the risks of uncontrolled diabetes in pregnancy?
Heatherly Simmons: For the baby, the biggest risk probably is a baby being too large at birth. And then that increases the possibility of needing C-section or having difficulty with a vaginal delivery. There's also a risk of having preterm birth or earlier than normal birth or either the baby not growing large enough as well. For mothers that have preexisting diabetes or their blood sugars high in that first trimester when the organs are being developed, there's also a risk of birth defects including kidney, heart or central nervous system abnormalities. For the mother, there's an increased risk of high blood pressure, kidney disease, or if the mom had retinopathy or eye disease, then that could be worse in pregnancy.
Host: Wow. A lot of these risks really sound overwhelming. So if a woman is considering getting pregnant, do you have tips for her to minimize any of these risks?
Heatherly Simmons: I do. I think the biggest thing is to use your support group, your network of people, discuss what's going on with your medical provider, about your unique situation, work with them closely to maintain a healthy weight, exercise, eating a low carb diet, and then using medications or insulin to help keep your blood sugar normal is really, really important. Also, my position here in maternal fetal medicine is to help patients through this time, if they have either preexisting or gestational diabetes. So that's what I'm doing here is seeing patients in this situation.
Host: So that's really good advice. So maintain a healthy weight, make sure you're exercising and pay attention to a low carb diet and make sure you're using insulin or other medications as needed to keep your blood sugars normal. As Heatherly was saying, there certainly are fetal birth defect risks that you don't want to even think about. So pay attention to those things that Heatherly just mentioned. So, Heatherly, is there any other advice you would like to say to someone with diabetes or at risk of developing diabetes in pregnancy?
Heatherly Simmons: This topic is something that's not just my career but also something that's really personal to me. I've kind of done it myself. I do have type one diabetes or preexisting is what we're calling it, in the midst of pregnancy. And I've managed three pregnancies, so I understand how hard it can be and how you feel like you're, you know, constantly almost a slave to your blood sugars. But I also know that that doing that can result in a successful pregnancy and a healthy baby. So I would just say do your best to take care of yourself, and use the people around you that want to help you. And unfortunately sometimes I see women come in the clinic and they blame themselves for something they might have done wrong, but just do your best to take care of yourself. And if you do that, you can have a healthy baby and not worry about all the complications that I've mentioned.
Host: And that is what's most important. Well, thank you so much for opening up and sharing that story with us. That's really important to know that you've been through this and you paid attention and did what you needed to do, and I think you said it best there. The end result is a successful pregnancy and a healthy baby, right? That makes all of the work during pregnancy worth it. Is that right?
Heatherly Simmons: That is. That is exactly right.
Host: Wow. Heatherly thank you so much for sharing that story and talking with us today about gestational diabetes. You've educated us all. Thank you so much.
Heatherly Simmons: You're welcome.
Host: That's Heatherly Simmons. And to learn more about WakeMeds services and locations, please visit wakemed.org and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks for listening.
Bill Klaproth: Diabetes in pregnancy is a serious concern as it can pose several risks to you and your baby. So let's find out more with Heatherly Simmons, a Physician Assistant and Certified Diabetes Educator at WakeMed Maternal Fetal Medicine. This is WakeMed Voices, a podcast from WakeMed Health and Hospitals. I'm Bill Klaproth. Heatherly, thanks so much for your time. So let's start here. Can you first explain what is diabetes and then type one versus type two versus gestational diabetes?
Heatherly Simmons: Sure. The two main types of diabetes, type two far more common, about 90% of diabetics have type two it's genetically linked, runs in families, and it is caused by the pancreas either not making enough insulin or cellular resistance to the insulin that's being made. Type one is less common, about 10% of diabetics have type one. It's usually doesn't run in families and it is caused by the autoimmune destruction of the pancreatic beta cells, and that leads to total insulin deficiency. So these people don't make insulin and must take insulin daily in order to stay alive. When you have diabetes in pregnancy that is specifically gestational diabetes and also caused by insulin resistance as well.
Host: So Heatherly gestational diabetes, is this something a healthy woman can develop over the course of her pregnancy and then after delivery and birth, the diabetes goes away? Is that how this happens?
Heatherly Simmons: Yes. So most of the time a mother that has diabetes in pregnancy, the blood sugars will resolve as soon as she delivers the baby and the placenta comes out. A large part of this disease is caused by the placental produced hormones and as they increase towards the end of pregnancy, that insulin resistance increases.
Host: So I know for type two diabetes, it doesn't come with a big list of symptoms. Most people find out they have it through other tests. They didn't even know they had it. So how does that work for pregnant women? Does every pregnant woman get tested for diabetes?
Heatherly Simmons: Yes. Every pregnant woman will get screened in some way. If they are low risk, then they'll get screened with a one hour glucose tolerance test or challenge test somewhere between 26 and 30 weeks. If they have increased risk factors, then we'll screen them earlier in pregnancy.
Host: So how does this glucose tolerance test work? Can you give us a little more detail on that?
Heatherly Simmons: So it's a little different than normal type one or type two diabetes that's just usually diagnosed with elevated fasting blood sugars or hemoglobin A1C that's elevated. In pregnancy, this load of sugar is given to patient and then their blood sugar is monitored at specific intervals after that load is given.
Host: Okay, got it. So as we learn about diabetes, we hear the term insulin a lot. Can you explain what insulin is and why it's so important?
Heatherly Simmons: Yes. So insulin is a really important hormone that helps glucose or sugar enter the body cells where it can be used for energy and there's a normal amount of sugar that stays in the blood and that amount is about 80 to 120 milligrams per deciliter. And that number is important for people with diabetes to kind of keep track of. And the goal of all diabetes treatment is to keep that blood sugar in the normal range.
Host: So then insulin helps keep that blood sugar in the normal range, it knocks that high blood sugar level down into the normal range. That's what insulin is supposed to do.
Heatherly Simmons: Exactly.
Host: Who then is at risk for developing gestational diabetes?
Heatherly Simmons: So, patients that have a previous history of gestational diabetes or a history of impaired glucose tolerance where they've, you know, previously failed that test. If they're obese, if they're older, if they've had a previous child that was weighing greater than nine pounds at birth, or if they have a family history of diabetes, they're at increased risk.
Host: So then how are the blood sugar goals different in pregnancy versus non pregnancy? I would imagine they do differ.
Heatherly Simmons: Well, we just want to be very careful to keep the blood sugars meticulously controlled during pregnancy because of the risks of high blood sugars to both the mom and the baby. So those recommendations, according to the powers that be, the American Diabetes Association and The College of OB GYN recommend the fasting blood sugar to be less than 95, and then one hour after eating less than 140, and two hours less than 120.
Host: All right, so you just mentioned health risks to both the mother and baby. What are the risks of uncontrolled diabetes in pregnancy?
Heatherly Simmons: For the baby, the biggest risk probably is a baby being too large at birth. And then that increases the possibility of needing C-section or having difficulty with a vaginal delivery. There's also a risk of having preterm birth or earlier than normal birth or either the baby not growing large enough as well. For mothers that have preexisting diabetes or their blood sugars high in that first trimester when the organs are being developed, there's also a risk of birth defects including kidney, heart or central nervous system abnormalities. For the mother, there's an increased risk of high blood pressure, kidney disease, or if the mom had retinopathy or eye disease, then that could be worse in pregnancy.
Host: Wow. A lot of these risks really sound overwhelming. So if a woman is considering getting pregnant, do you have tips for her to minimize any of these risks?
Heatherly Simmons: I do. I think the biggest thing is to use your support group, your network of people, discuss what's going on with your medical provider, about your unique situation, work with them closely to maintain a healthy weight, exercise, eating a low carb diet, and then using medications or insulin to help keep your blood sugar normal is really, really important. Also, my position here in maternal fetal medicine is to help patients through this time, if they have either preexisting or gestational diabetes. So that's what I'm doing here is seeing patients in this situation.
Host: So that's really good advice. So maintain a healthy weight, make sure you're exercising and pay attention to a low carb diet and make sure you're using insulin or other medications as needed to keep your blood sugars normal. As Heatherly was saying, there certainly are fetal birth defect risks that you don't want to even think about. So pay attention to those things that Heatherly just mentioned. So, Heatherly, is there any other advice you would like to say to someone with diabetes or at risk of developing diabetes in pregnancy?
Heatherly Simmons: This topic is something that's not just my career but also something that's really personal to me. I've kind of done it myself. I do have type one diabetes or preexisting is what we're calling it, in the midst of pregnancy. And I've managed three pregnancies, so I understand how hard it can be and how you feel like you're, you know, constantly almost a slave to your blood sugars. But I also know that that doing that can result in a successful pregnancy and a healthy baby. So I would just say do your best to take care of yourself, and use the people around you that want to help you. And unfortunately sometimes I see women come in the clinic and they blame themselves for something they might have done wrong, but just do your best to take care of yourself. And if you do that, you can have a healthy baby and not worry about all the complications that I've mentioned.
Host: And that is what's most important. Well, thank you so much for opening up and sharing that story with us. That's really important to know that you've been through this and you paid attention and did what you needed to do, and I think you said it best there. The end result is a successful pregnancy and a healthy baby, right? That makes all of the work during pregnancy worth it. Is that right?
Heatherly Simmons: That is. That is exactly right.
Host: Wow. Heatherly thank you so much for sharing that story and talking with us today about gestational diabetes. You've educated us all. Thank you so much.
Heatherly Simmons: You're welcome.
Host: That's Heatherly Simmons. And to learn more about WakeMeds services and locations, please visit wakemed.org and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks for listening.
