Planning for Your Healthy Baby: Pregnancy and Diabetes (Amarillo Diagnostic Clinic)

By Rachel Pessah Pollack, MD

Do you have diabetes? Are you thinking about getting pregnant?

If so, there are things you need to do for the health of you and your baby during pregnancy. Your blood sugar control is very important.

Diabetes during pregnancy is on the rise.

healthy pregnancy with diabetes

More and more people are getting diabetes. There are about 1.5 million new cases per year. As a result, many more women with type 2 diabetes are becoming pregnant.

Elevated blood sugar (glucose) levels during pregnancy are bad. They can cause a higher risk of birth defects, miscarriage, birth injury, preterm delivery and certain complications such as pre-eclampsia. By being careful with blood sugar levels before becoming pregnant and during the early weeks of pregnancy, these potential problems can be prevented.

Here is what you can do to optimize your care and ensure a successful outcome.

Tips for Diabetics During Pregnancy

  • Schedule your doctors’ visits.
    • Your doctor may send you to a specialist before you get pregnant to help you with your diabetes control.
    • Obstetrical [ob-steh-trih-kal] care – some patients with diabetes may see obstetricians [ob-steh-TRIH-shen] who specialize in high-risk pregnancies. Your doctor will help you make this decision based on how long you have had diabetes and how well your diabetes is controlled.
    • Eye disease – every woman with diabetes should see an eye doctor for an eye examination before getting pregnant. You may be counseled on the risk of getting diabetic eye disease (retinopathy [reh-tin-AH-pah-thee]). Eye exams are also recommended in the first trimester, during pregnancy, and after birth. Sometimes the eye disease may become worse with pregnancy; however, this risk can be prevented with laser surgery.
    • Kidney disease – all women with diabetes who want to get pregnant should be checked for diabetic kidney disease (nephropathy [neh-FRA-pah-thee]). A urine test is used for this test.
    • High blood pressure – your doctor will want to make sure that your blood pressure is under good control before you get pregnant. You may have to switch or add blood pressure medications.
    • Nerve disease – your doctor may suggest you see a foot specialist (podiatrist [poe-DYE-ah-trist]) to determine if you have diabetic nerve disease. This is also known as peripheral neuropathy [per-IH-fer-al noor-AH-puh-thee]. It is important to take good care of your feet before and during pregnancy and to check your feet each day to keep infections at bay.
  • Focus on healthy eating now
    • Before pregnancy, it is a good time to pay close attention to what you eat. Eating properly is important to achieve and maintain normal sugar levels throughout pregnancy. You are hopefully already following a healthy diabetes diet, including fruits, vegetables, and fiber. You can continue to eat the same foods as you plan for pregnancy. However, be aware that, during pregnancy, how many carbohydrates there are in each meal is the most important factor affecting your blood sugar control, both before and after your meals. It may be useful to meet with a registered dietician or diabetes educator before you get pregnant. This will help you learn how to count calories and choose healthy foods. In addition to watching your diet, all women who want to become pregnant should take a daily prenatal multivitamin containing at least 400 micrograms of folic acid. Folic acid prevents neural tube defects, such as spina bifida [spine-a BIH-fid-a] in babies.
  • Target normal blood sugar levels
    • Studies have shown that poor blood sugar control during pregnancy can lead to poor pregnancy outcomes and risk for birth defects. During the first trimester, the baby’s organs are forming and normal sugar levels can decrease the risk of any problems during this period. For this reason, it is very important to wait to conceive until blood sugars are under excellent control.
    • Hemoglobin A1C, which is a measurement of your blood glucose control over the prior two to three months, should be checked before you get pregnant to help with your overall diabetes treatment plan. Talk with your health care provider about what your blood sugar range and A1C level should be both before pregnancy and during pregnancy to reach your goal of a normal blood sugar. Blood glucose self-monitoring is recommended by many different diabetes organizations (each has different target levels). During pregnancy you will be asked to check blood sugar levels one to two hours after the first bite of your meal. This is different from when you weren’t pregnant.
  • Review your medications for safety
    • Before you get pregnant, have your doctor review your medications and determine if you need to switch them to ones that are safe in pregnancy. Some examples are listed below:
      • Diabetes medications – Many of the diabetes pills that are taken when not pregnant cannot be taken when pregnant. Before you get pregnant discuss with your doctor whether you may need to start insulin before or during pregnancy. Or, you might find out that diet and carbohydrate monitoring are all you need. In general, if insulin is needed, you will likely need to use more insulin the further you get into your pregnancy, especially during the third trimester. Although there is some good data with certain pills for diabetes, it is not known how safe and effective they are, and insulin is often recommended to control blood sugar.
      • Blood pressure medications: ACE inhibitors and ARBs used for blood pressure control and kidney disease are not advised during pregnancy, since they are likely to harm the baby. Before you get pregnant, consult your health care team about changing your blood pressure medications.
      • High-cholesterol medications: “Statins,” a class of medication used for its cholesterol-lowering effects, should be stopped before you get pregnant.
  • Evaluate your pre-pregnancy weight
    • Women with diabetes who are overweight or obese have a higher chance of having problems during pregnancy. These problems include higher rates of cesarean section, high blood pressure, birth defects, and premature infants. The good news is that if you are overweight and are able to reduce or normalize your body weight before you get pregnant, you can prevent many of these poor outcomes from occurring. Losing just a few pounds can help you maintain better control of your sugars and lower your blood pressure.
  • Plan to exercise
    • Once your doctor has decided that you are healthy for physical activity, add exercise to your daily regimen. Choose activities that you enjoy and are most likely to continue with and have a goal of 30 minutes of aerobic exercise most days of the week. Keeping fit will help with both weight loss and control of your blood sugar. Check your sugar level before and after exercising because you may need to eat a snack to prevent low blood sugar during physical activity. Continue your exercise routine during pregnancy unless your doctor advises against it.
  • Avoid bad habits
    • It is very important to get counseling from your doctor before you become pregnant so that you have a healthy pregnancy. Women with diabetes should be screened for depression, tobacco and alcohol use, drug abuse, weight management, and exercise.
    • If you are a smoker or are still drinking alcohol, the perfect time to stop is before you get pregnant.
    • If you are abusing drugs (prescription/non-prescription), now is the time to stop and get help if necessary.
    • If you have missed doses of insulin or if you don’t take your medications as prescribed, focus on taking the best care of your body as you prepare for pregnancy and avoid missing doses.
  • Know when you need to wait
  • It is important for each woman with diabetes to know when a pregnancy is not safe. If your diabetes is not under good control, you should wait to become pregnant. By working with your health care team and making adjustments to your treatment, you can improve control of your blood sugar and ensure a healthy outcome for you and your baby.

There is a lot of planning to be done. However, you must remember that the patience and additional work is worth the end result: your healthy baby!

Dr. Rachel Pessah Pollack has a special interest in pregnancy-related endocrine disorders. She has published articles and given presentations on gestational diabetes, Cushing’s disease during pregnancy, and iodine deficiency during pregnancy.

Diabetes is Not a Death Sentence

Together with ADC, people can live normal lives even with diabetes.

Over 400 million people worldwide have diabetes, and the disease causes over 1 million deaths every year. The disease also damages the body, amplifying other health concerns and is a secondary cause for even more deaths. It also causes blindness and amputations – it’s a very serious disease which, as of yet, has no cure.

But, there is some good news.

When managed properly, people with diabetes can lead long and productive lives. The Endocrinology Department at ADC deals daily with people managing the disease. Today, let’s learn more about the disease and what is necessary to manage it.

How Diabetes Affects the Body


After eating, carbohydrates in food are broken down into sugars to be carried throughout the body via the bloodstream. The body uses those sugars as energy for regular, daily function. The condition of diabetes disrupts this cycle – creating severe, damaging imbalances in blood sugar levels. There are two ways this imbalance occurs.

In Type I Diabetes, the body’s immune system damages the pancreatic cells responsible for producing insulin. The body’s naturally-produced insulin can no longer aid in breaking down blood sugars. With the body is incapable of producing enough of its own insulin, Type I Diabetes is treated with injections of an insulin replacement.

The second type, Type II Diabetes, is a more common form and is also a progressive form of the disease. This form of diabetes causes insulin resistance over time. The body still produces insulin, but has difficulty utilizing it effectively. There are various medications in pill form to treat Type II Diabetes. As a result of the nature of Type II diabetes, however, the pancreas often wears out due to late detection of the disease or from years of medication. At that point, insulin replacement by injection is – again – necessary.

When caught early, diabetes can easily be treated. The longer someone lives undiagnosed, the worse their health outcome is likely to be. Patients should visit their doctor every three to six months so that the efficacy of their treatment can be re-evaluated.

Good glucose control is essential to prevent the onset of diabetic complications that can can lead to blindness, heart attack or stroke, dialysis, and amputation. But with proper self-care and medical expertise people with diabetes can avoid these complications.

4 Ways To Effectively Manage Diabetes Symptoms

1. Exercise


If diagnosed, one of the best things a person can do for themselves is to exercise on a regular basis. Guidelines recommend a daily exercise regimen for at least 45 minutes that is initiated slowly and built up gradually to avoid injury and to build stamina. Clearance from a physician is imperative for any patient before starting an exercise regimen.

Every person that is overweight significantly increases their chances of contracting diabetes. The Amarillo Diagnostic Clinic has a patient education specialist to assist you in the care and management of diabetes through diet and exercise.

2. Check Your Blood Sugar

People living with this disease check their blood sugar levels regularly with a home glucose monitor. A physician or diabetic educator will prescribe a routine and frequency that best suits a patient’s needs. Most recommend checks before breakfast and before supper.

Not only is checking levels necessary for day-to-day health but recording those numbers daily is another necessary step. At doctor visits, a physician will need those readings to understand the full scope of how the patient is managing their disease.

3. Periodic Checks


Glycohemoglobin: This is a test developed for information about average blood sugar level over the course of two or three months. These checks may occur two to four times a year – varying between patients. The American Diabetes Association recommends that the patient’s diabetic regimen achieves a glycohemoglobin level of less than 7%. Any contributing risk factor for vascular disease should be aggressively assessed and treated.

Cholesterol, triglycerides, low HDL, high blood pressure, and smoking would all be considered factors of risk.

Some medications used to treat elevated blood pressure also have a protective effect in preventing kidney complications of diabetes. Any medication prescribed by a physician should be taken only as directed. Before adding or deleting any medication – including over the counter medications. Patients should consult their doctor about any changes to their prescriptions.

Microalbumin: This urine test is performed yearly to evaluate the likelihood of diabetic kidney involvement.

Ophthalmologist: A visit should be scheduled annually as well. The doctor can evaluate any diabetic retinopathy, cataracts, or other conditions and plan treatment accordingly.

Finally, patients should have an annual comprehensive medical exam – including a treadmill exercise test. Underlying coronary artery disease is often more common in an individual with diabetes and needs early intervention.

4. Sick Days

Living with this disease means that some days are simply going to be worse than others. We refer to them at ADC as “sick days” and they require special consideration. Anything a body perceives as stress has the ability increase blood sugar levels. This stress can be physical or emotional in nature. If a person with diabetes is ill their blood glucose will likely rise – even if they cannot eat.

Sick Day Best Practices for Diabetics

  • Stick to meal plans if able to eat.
  • Continue diabetes medication unless a physician says otherwise.
  • Check with a doctor before taking any new medication.
  • Drink at least one large glass of liquid each hour. If eating, these liquids should be sugar-free.
  • Take a blood sugar test every 4 hours.
  • It is recommended to have someone check on the ill person every few hours, in case the illness progresses.

If in doubt, consult a physician. Early and effective management of these sick days will reduce chances of falling into a diabetic coma.

It Will Be Okay


Taking steps to prevent and control diabetes doesn’t mean life is over. It means eating a tasty, balanced diet, exercising and taking the necessary steps to stay healthy. With these tips, anyone can still take pleasure in life – with diabetes – without feeling deprived.

The Endocrinologists at Amarillo Diagnostic Clinic are thoroughly trained in the management of hormonal and metabolic disorders. Patient education services are available for patients in the care and management of these disorders. We also provide dietary counsel for lowering cholesterol and triglyceride levels.

We are here to help, please contact us if you have any questions or to schedule an appointment.

Having Trouble Sleeping? Hit the Gym!

Photo by bruce mars on Unsplash

Try adding exercise to your daily routine to enjoy better sleep.

Do you toss and turn? Do you wake up after a few hours and find it impossible to fall back asleep? First, the bad news: so are 60 million other Americans. 60 million Americans will experience some form of insomnia this year.

The Good News

Sleep disorders are treatable, and you can find help at Amarillo Diagnostic Clinic Sleep Disorders Center. The center specializes in the diagnoses and treatment of patients who have sleep difficulties.

There may be personal changes that can also help that don’t require a physician. Putting your smartphone away an hour before bedtime helps your mind and body “power down.” Caffeine stays in your body for 6 – 8 hours after drinking a cup of joe, and your liver needs an hour to break down alcohol. So try having your beverage of choice earlier in the day.

Researchers have found sleep quality improves with exercise.

If you’ve been tossing and turning for twenty minutes, you often become anxious about not falling asleep. Getting out of bed and distracting yourself for a few minutes can help – reading, watching a relaxing show, meditating. But one study shows “a bout of moderate-intensity aerobic exercise (e.g., walking) reduced the time it took to fall asleep and increased the length of sleep of people with chronic insomnia compared to a night in which they did not exercise.”

People who regularly hit the gym sleep better and feel more alert during the day than those who are not as active. An Oregon State University sleep study showed that participants who exercised 150 minutes a week slept better and felt less drowsy during the daytime.

Regular physical activity may help those suffering from insomnia without medication.

Why Does Exercise Help?

Oddly, not all exercise seems to assist in battling insomnia. Running, lifting weights and other vigorous aerobic exercise does not immediately improve sleep. After a period of daily exercise, (a few months) adults following vigorous workout routines reported better sleep quality. They reported falling asleep more quickly than they did before starting their exercise regimen, and also sleeping for longer periods of time.

Exercise causes the body to elevate its temperature. This increase in body temperature can last for up to four hours after your workout. The post-exercise drop in temperature promotes falling asleep, so get that workout in before dinner. After that, a little light yoga or an after-dinner stroll is helpful – but don’t take a late HIIT workout.

If you don’t have problems falling asleep, but you wake up after a few hours, a morning jog may be the most beneficial. Beginning the day with exercise will help the body remain in its rested state longer. Make sure that you stretch and warm up if you go this route – your body needs time to adjust from sleep to activity.

Exercise Helps in Other Ways

Insomnia is often linked to depression and anxiety, ranging from mild to severe cases. The release of endorphins as a result of exercise plays a large part in reducing those symptoms.

Circadian rhythm also plays a part in some types of insomnia, and exercise can help to “reset” that natural cycle. Adding exercise early in the day sets the body cycle naturally to rest after a period of time. If your body clock is broken, a quick exercise regimen may be just the thing you need to fix it.

Beyond Exercise

If you have difficulties falling asleep or staying asleep at night or excessive daytime sleepiness, we are here for you. If it seems like nothing works, don’t worry. We have you covered – read this, and learn more about our Sleep Disorders Center here.

Diabetes: Sugar vs. You

Sugar

Diabetes is a lifelong (chronic) disease in which there are high levels of sugar in the blood. The latest statistics released in 2011 show that 25.8 million children and adults in the United States—8.3% of the population—have diabetes. Yearly, diabetes contributes to over 200,000 deaths. These statistics are daunting, but diabetes can be kept under control. At the Amarillo Diagnostic Clinic, we know that by being active, eating healthy, and keeping your blood glucose, blood pressure, and cholesterol under control, you can prevent diabetes problems.  There are many publications and information out there regarding diabetes, but the general public can be confused on certain aspects of diabetes, specifically the largest culprit of diabetes problems, sugar.

Let’s pull back the curtain on the sugar myths and exaggerations and learn what you or someone you know suffering from diabetes can do to keep glucose levels in check.

From Men’s Health | by Mike Zimmerman

Sugar Doesn’t Cause Diabetes

Too much sugar does. Diabetes means your body can’t clear glucose from your blood. And when glucose isn’t processed quickly enough, it destroys tissue, Levitsky says. People with type 1 diabetes were born that way—sugar didn’t cause their diabetes. But weight gain in children and adults can cause metabolic syndrome, which leads to type 2 diabetes.

“That’s what diabetes is all about—being unable to eliminate glucose,” says Levitsky. “The negative effect of eating a lot of sugar is a rise in glucose. A normal pancreas and normal insulin receptors can handle it, clear it out, or store it in some packaged form, like fat.”

What matters: That “normal” pancreas. Overeating forces your pancreas to work overtime cranking out insulin to clear glucose. Eric Westman, M.D., an obesity researcher at the Duke University medical center, says that in today’s world, “it’s certainly possible that the unprecedented increase in sugar and starch consumption leads to pancreatic burnout.” But researchers can’t be sure; everyone’s body and diet are different, so generalization is iffy. One thing that is sure, Dr. Westman says, is that the rise in sugar consumption over the past 100 years is unprecedented.

Your job: Drop the pounds if you’re overweight, and watch your sugar intake. Research has shown for years that dropping 5 percent to 7 percent of your body weight can reduce your odds of developing diabetes.

Sugar and High-Fructose Corn Syrup

Simply Avoiding High-Fructose Corn Syrup Won’t Save You from Obesity
In the 1970s and 1980s, the average American’s body weight increased in tandem with the food industry’s use of high-fructose corn syrup (HFCS), a staple because it’s cheap. But it’s not a smoking gun. “This is a correlation, not a causation,” says Levitsky.

“Obesity is about consuming too many calories,” says Lillian Lien, M.D., the medical director of inpatient diabetes management at the Duke University medical center. “It just so happens that a lot of overweight people have been drinking HFCS in sodas and eating foods that are high on the glycemic index—sweet snacks, white bread, and so forth. The calorie totals are huge, and the source just happens to be sugar-based.”

Dr. Westman notes that the effect of a high-glycemic food can be lessened by adding fat and protein. Spreading peanut butter (protein and fat) on a bagel (starch, which becomes glucose in your body), for example, slows your body’s absorption of the sugar.

What matters: We can demonize food manufacturers because they produce crap with enough salt and sugar to make us eat more of it than we should—or even want to. But it comes down to how much we allow down our throats. “A practical guide for anyone is weight,” says Dr. Lien. “If your weight is under control, then your calorie intake across the board is reasonable. If your weight rises, it’s not. That’s more important than paying attention to any specific macronutrient.” Still, skinny isn’t always safe. (Keep reading.)

Sugar and Fat

Too Much Sugar Fills Your Blood with Fat

Click here to read the rest of the article.

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Amarillo Diagnostic Clinic treats a variety of adult illnesses ranging from acute colds and flu to more serious conditions such as hypertension, diabetes and cardiac diseases. Click here to see a list of medical specialties that Amarillo Diagnostic Clinic offers.