For the needs of the "Program of Treatment with Personal Insulin Pumps for Pregnant Women with Diabetes" implemented by the WOŚP Foundation, rules were developed for the management of a diabetic patient during and during pregnancy preparation. Pregnancy in a diabetic woman is burdened with a high risk, therefore the expectant mother should be guaranteed specialist medical care.
If you suffer fromdiabetesandplanning a pregnancy , it is worth knowing that under the WOŚP programinsulin pumps are lent for freeto women with diabetestype 1 for preparation for pregnancy,pregnancyand childbirth. The program is implemented in 30 centers all over Poland. For the purposes of the GOCC program, since 2005, it has purchased 746 insulin pumps and 5500 sensors for continuous glucose monitoring.
- For the purposes of the GOCC program, we have developed the principles of care for women with diabetes at the stage of pregnancy planning and during it. The use of this treatment pathway enables proper pregnancy management and avoiding complications of the disease in the mother and the negative effects of diabetes in the child. We would like it to be a standard of care for pregnant diabetics in the future, applicable in all facilities in Poland - says prof. Jacek Sieradzki.
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Pregnancy planning and diabetes - care for a future mother
The patient should be looked after by a diabetology and obstetrics team consisting of: diabetologist, gynecologist, educator, nurse, nutritionist and pump trainer. Achieving normoglycemia is very important at the stage of pregnancy planning (3-6 months before), because maintaining the correct blood sugar level as early as possible will reduce congenital defects in the child and complications of diabetes in the mother. The diabetologist and the patient should treat diabetes in such a way that the blood glucose level is fully balanced. In achieving normoglycemia, the use of insulin pumps integrated with the continuous glucose monitoring system will be helpful. This system constantly informs the patient about the level of glucose in the blood, thanks to alarms it warns about dangerous drops and increases in blood glucose, so that the treatment can be corrected on an ongoing basis. Bywith such advanced technology and very strict glycemic control, it is extremely important to educate the patient both in the field of pump therapy and constant self-monitoring of glycaemia, glycemic goals and proper nutrition.
When a diabetic woman plans a pregnancy - important research
During the preparation period, check-ups are very important to determine diabetes complications: - ophthalmological tests (also of the fundus) - neurological tests - tests to determine kidney function - blood pressure and ECG tests - heart status tests - tests TSH
Pregnancy and diabetes - a he althy lifestyle is essential!
Another very important element is a he althy lifestyle - physical activity (walks are recommended, because physical activity reduces the need for insulin) and diet (he althy, balanced, with the amount of calories adjusted to the patient's he alth). The diet should be additionally enriched with vitamins and folic acid. At this stage, the patient should see a doctor every 4-5 weeks.
Diabetes during pregnancy
During pregnancy, a woman with diabetes requires monitoring of diabetic complications and control tests: ophthalmological examination - at least once a trimester, and other tests - urine, morphology, creatinine, body weight, pressure - every month. The patient must also control the appropriate weight gain and maintain normoglycemia, which is helped by an insulin pump. During pregnancy, the insulin requirement increases by as much as 100-200% of the pre-pregnancy state. The lifestyle recommendations are the same as in the preparation. The attending physician should train the patient about the caloric content of products, carbohydrate and protein-fat exchangers. The diet should be adjusted to take into account the increased caloric requirement and the increased insulin requirement as the fetus grows. During pregnancy, check-ups are recommended every 2-3 weeks, or more often if indicated by your doctor.
Childbirth and diabetes - what should you watch out for?
Childbirth of a pregnant woman with diabetes should take place in a specialist center, where diabetes and obstetrics care is provided. During delivery, the pregnant woman should be provided with: constant monitoring of glycaemia, protection in the form of intravenous insulin and glucose infusion, monitoring of water and electrolyte balance. It is very important to maintain normoglycemia during this time - it is of great importance for the he alth of the newborn. A woman who has previously used an insulin pump should also be attached to the device during labor. Visitfollow-up should take place about 4-6 weeks after giving birth.
WOŚP program for expectant mothers with diabetes
The program "Treatment of diabetic pregnant women with personal insulin pumps" is currently implemented by 30 centers. Women who come to hospitals will receive pumps while planning pregnancy, pregnancy and the puerperium. It is estimated that in Poland 0.3% of women of childbearing age suffer from diabetes. The program is held under the patronage of the Polish Diabetes Society, and the pumps are borrowed free of charge. Technical support is provided by Medtronic, a manufacturer of specialized medical devices, including insulin pumps. The program coordinator is prof. Jacek Sieradzki from the Department and Clinic of Metabolic Diseases in Krakow. Addresses of centers where pregnant diabetic women can rent insulin pumps can be found at www.cukrzycaiciaza.wosp.org.pl and www.cukrzycaiciaza.pl, where detailed information on planning and pregnancy of a diabetic woman is provided.
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