Nausea and vomiting in pregnancy (also known as morning sickness – although it can occur at any time of day) is very common in early pregnancy. It’s unpleasant, but it doesn’t put your baby at any increased risk, and usually clears up between weeks 12 and 14 of pregnancy. Unfortunately, for some women, it can have a significant adverse effect on their day-to-day activities and quality of life.
Managing your diabetes if you suffer from morning sickness may be especially difficult. You may find that making adjustments to your insulin doses – both in amount and timing – may help you with this.
Often you will need less insulin during this stage. However, it is very important that you discuss this first with your Diabetes Specialist Nurse or Midwife or other healthcare professional.
If you do suffer with morning sickness, your healthcare professional may also recommend that you try a number of changes to your diet and lifestyle to help you cope better.
These may include:
1.Getting plenty of rest because tiredness can make nausea worse.
2.If you feel sick first thing in the morning, give yourself time to get up slowly – if possible, eat something like dry toast or a plain biscuit before you get up.
3.Drinking plenty of fluids, such as water, and sipping them little and often rather than in large amounts, because this may help prevent vomiting.
4.Eating small, frequent meals that are high in carbohydrate (such as bread, rice and pasta) and low in fat – most women can manage savoury foods, such as toast, crackers and crispbread, better than sweet or spicy foods.
5.Avoiding foods or smells that make you feel sick.
6.Some women find that ginger biscuits or low sugar ginger ale can help reduce nausea.
7.Hopefully by this point your HbA1c is at the target level that you and your doctor agreed upon before conception.
This is important because very high blood sugar over time is associated with an increased risk of birth defects and miscarriage. (Though, on the more optimistic flip side, the closer your blood sugar is to normal, the lower the chance of problems.)
8.In order to come anywhere close to the super-human blood glucose targets of pregnancy (60-99 mg/dl fasting, a peak of 100-129 mg/dl after meals, an average daily blood glucose of 110 mg/dl, and an A1c of less than 6.0%, you need to be testing your blood glucose a lot.
As in, probably more than a dozen times a day.
Continuous Glucose Monitoring System (CGMS) can be enormously helpful in tracking your pregnancy blood sugars, since it gives you a nearly real-time graph of where your blood glucose has been and where it’s heading — and having advance warning of an impending low is also an important safety feature when you’re aiming for tight targets.
9.Insulin requirements increase dramatically during pregnancy, and the only way to stay on top of what those requirements are is to keep a log of what you’re eating, how much insulin you’re taking, and what your blood sugar is (you can throw in other factors, too, like exercise and sickness, but those are the basics).
Ideally, your endocrinologist or certified diabetes educator will be able to review these records weekly and help you tweak your doses as your pregnancy progresses.
10.Morning sickness sucks for everyone, but for women with pre-existing diabetes, it can be dangerous: if you eat food and take insulin – and then throw up the food you took the insulin to cover – you’re at risk of a serious low blood sugar. (And unfortunately, “morning sickness” can occur at any time during the day, contrary to its name.)
It’s a good idea to talk with your endocrinologist or diabetes health care provider (i.e. someone who’s familiar with you and your diabetes) about what to do to manage your morning sickness and diabetes at the same time.
If your morning sickness is severe, your doctor or caregiver may be able to prescribe anti-nausea medication to help you keep food down.
11. Morning sickness can put you at risk of serious lows. Be sure to carry a source of fast-acting carbs at all times (glucose tablets, juice box, etc).
It’s also a good idea to start carrying around glucagon in your purse and/or to stash a kit in your desk. (But remember: if your blood glucose is so low that you need glucagon, chances are you won’t be able to give it to yourself. Be sure to tell a colleague or friend where you store it, and teach them when and how to use it.)
12. Consider an insulin pump. An insulin pump can be a great management choice for pregnancy.
If you are having difficulty keeping food down, you can give yourself a lower temporary basal rate and lessen your chances of becoming hypoglycemic.
13.As is always true with diabetes, you can only do your best. While it’s important to work hard at achieving excellent control, remember that an occasional blood sugar that is higher that you like is not going to do long-term damage to your child.
And if you feel yourself getting frustrated and burnt out, try to keep in mind some of the long-term benefits of all the hard work you’re putting into your pregnancy: for many women, the intensified demands of managing a diabetic pregnancy can actually lead to improvements in their own health.
You’re likely to find yourself testing more often, exercising more frequently, eating more healthily, and seeing more doctors than you’d ever thought possible.
Sure, it’s hard and often annoying work, but the ultimate result is positive — for everyone involved.
For more great Health and Nutrition Tips refer to the website positivehealthwellness.com.
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