Column: Dr Camille Powe On Diabetes & More
[Column written by Dr Camille E. Powe]
It’s Diabetes Awareness Month, which is particularly important on island given that the Bermuda Diabetes Association estimates that as many as 15-20 per cent of the population may suffer from Type 1 or Type 2 diabetes.
As an endocrinologist and co-director of the Diabetes and Pregnancy Program at Mass General Hospital, I’d like to shine a little light on an important form of diabetes today: gestational diabetes. Around 1 in 12 pregnancies will be affected by gestational diabetes and here’s what I’d like everyone to know:
What is gestational diabetes?
Gestational diabetes is high blood sugar first diagnosed during pregnancy. We use lower numbers to diagnose gestational diabetes than we do for other types of diabetes outside pregnancy because keeping blood sugar in a narrow range in pregnancy Is critical for mom and baby. Gestational diabetes doesn’t mean the person has done anything wrong, it’s simply the result of how pregnancy changes the body’s metabolism combined with each person’s individual risk factors. Two of the strongest risk factors for gestational diabetes are genetics [having a family member with diabetes] and weight [having a body mass index of 25 or over], but not everyone who gets gestational diabetes has these risk factors.
Why is it important to diagnose it?
Gestational diabetes can lead to complications for both mother and baby, but most of these risks can be reduced when blood sugars are kept within a healthy range. Some of the most common complications are having a big baby which can lead to problems at delivery, developing a high blood pressure disorder [such as preeclampsia], and the baby having a low blood sugar after birth. Management of high blood sugar is the key to supporting a healthy pregnancy and delivery.
What about women who already have diabetes before pregnancy?
For those with Type 1, Type 2, or a rare form of diabetes, preparation for pregnancy is especially important. Managing blood sugar before and during pregnancy greatly improves outcomes. Working closely with your healthcare team early, ideally before conception, can help ensure medication and glucose levels are in a healthy range from the start. With planning, monitoring and support, women with diabetes can have safe, healthy pregnancies.
What’s new in research and technology?
All gestational diabetes is not the same. We’re actively researching new ways to personalise the treatment of gestational diabetes based on an individual’s unique genetic and hormonal profile.
We’re also using technologies like continuous glucose monitors [CGMs] more frequently- devices that you wear on your body and connect to your phone using an app and that can tell you what your blood sugar is every few minutes. These tools improve pregnancy outcomes in people with type 1 diabetes in pregnancy, and we are testing them as a tool for gestational diabetes. We are also doing studies in pregnancy on insulin pumps that automatically dose insulin based on CGM readings.
While there’s a lot of interest in GLP-1 receptor agonist drugs, like Ozempic, Trulicity, Victoza, and Mounjaro, which can help with blood sugar and weight management in people with Type 2 diabetes, these are not recommended for pregnant people at this time. For those who are already on these kinds of medications and planning to conceive, it’s important to discuss your plans with a healthcare provider before becoming pregnant. We are currently studying pregnancy outcomes in people who took these medications before pregnancy or who took them in the first trimester before they knew they were pregnant.
How is gestational diabetes managed?
After diagnosis, usually in the second half of pregnancy, patients use a glucometer or continuous glucose monitor to check their blood sugar several times a day. The first treatment step is adjusting the diet. Everyone’s body responds differently to different foods, so I encourage a personalised nutrition plan that helps balance meals and manage glucose levels. It can also help to walk after meals to bring blood sugar down naturally.
If glucose levels remain above target, insulin or metformin can be used to help manage blood sugars. The goal is to keep blood sugar as close to normal as possible for the health of both mother and baby.
Gestational diabetes is manageable, and with the help of your doctors and healthcare team, you can have a healthy pregnancy and a healthy baby. The most important steps are to get tested, follow your care plan, and stay engaged with your health care team throughout your pregnancy.
- Dr Camille E. Powe, Endocrinologist and Co-Director, Diabetes in Pregnancy Program at Mass General Brigham
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