Because we know more about diabetes than ever before, there has never been a better time for you to plan a pregnancy. With the tools for checking your blood glucose level at home, you can work with your regular doctor and obstetrician to keep your diabetes under good control. For the best prenatal care, have a team that includes:

· a doctor, trained to care for people with diabetes, who has cared for pregnant women with diabetes

· an obstetrician who handles high-risk pregnancies and has cared for other pregnant women with diabetes

· a pediatrician (children’s doctor) or neonatologist (doctor for newborn babies) who knows and can treat special problems that can happen in babies of women with diabetes

· a registered dietitian who can change your meal plan as your needs change during and after pregnancy

· a diabetes educator who can help you manage your diabetes during pregnancy

Pregnancy is often a time of great highs and lows. It can be awesome and thrilling — when you hear the baby’s heartbeat or feel the first tiny kick. It can be frustrating, even scary. It is always a time of change. Your body is changing as the baby grows. Because you have diabetes, these changes will affect your blood glucose level. Pregnancy can also make symptoms of low blood sglucose hard to detect. During pregnancy, your diabetes control will require more work. The blood glucose checks you do at home are a key part of taking good care of yourself and your baby before, during and after pregnancy.

Insulin and Diabetes Pills

If you have type 1 diabetes, pregnancy will affect your insulin treatment plan. During the months of pregnancy, your body’s need for insulin will go up. This is especially true during the last three months of pregnancy. The need for more insulin is caused by hormones the placenta makes. The placenta makes hormones that help the baby grow. At the same time, these hormones block the action of the mother’s insulin. As a result, your insulin needs will increase.

If you have type 2 diabetes, you too need to plan ahead. If you are taking diabetes pills to control your blood glucose, you may not be able to take them when you are pregnant. Because the safety of using diabetes pills during pregnancy has not been established, your doctor will probably have you switch to insulin right away.

Checking Your Blood Glucose

Blood checks will help you keep your blood glucose on target.

Check your blood glucose levels at the times your diabetes team advises; this may be up to eight tests daily and will probably include after-meal checks.

· Write down your results

· Keep notes on your meal plan and exercise

· Make changes in your meal plan and insulin only with the advice of your diabetes team

Pregnancy and Food

During pregnancy you and your dietitian or doctor may need to change your meal plan to avoid problems with low and high blood glucose levels. This is the most important reason for keeping track of your blood glucose results.

If you start pregnancy weighing too much, you should not try to lose weight. Instead work with your dietitian or doctor to curb how much weight you gain during pregnancy.

Your dietitian will keep track of your weight gain. If you start pregnancy at a normal weight, expect to add between 25 to 35 pounds. Women who start pregnancy too thin need to gain more. If you are obese at the start of your pregnancy, work with your dietitian to limit your weight gain to about 15-25 pounds.

Pregnancy and Exercise

Exercise, especially for people with type 2 diabetes, is a key part of diabetes treatment. Just as you need to get your blood glucose under control before getting pregnant, it’s best to get fit before you get pregnant. Can you keep your current exercise program during pregnancy? Is it safe to start exercise after you are pregnant?

Discuss your exercise plans with your diabetes team. Ask for guidelines. Exercise can help you stay healthy during pregnancy. But if you have any of the following conditions (see the list below), then you will need to talk to your diabetes team about the risks of exercise during pregnancy.

· high blood pressure

· eye, kidney, or heart problems

· damage of the small or large blood vessels

· nerve damage

In general, it’s not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming or water aerobics.