Top Questions and Answers About Diabetes

Have a question about diabetes? Get quick answers to the most frequently asked questions.

What Is Diabetes?

Diabetes is a condition in which the body is unable to properly utilize blood sugar. Carbohydrate foods create blood sugar and the body needs insulin in order to process the sugar into energy for the body to function properly.

Type I diabetes is a condition in which the body’s immune system damages the pancreatic cells responsible for producing insulin. This form of diabetes is treated with insulin replacement by injection since the body is no longer capable of producing enough of its own insulin.

Type II diabetes is a much more common form and is progressive in nature. This form of diabetes causes insulin resistance which means the body still produces insulin but had difficulty utilizing it. There are various medications in pill form to treat Type II diabetes, but because of the nature of Type II diabetes, sometimes the pancreas wears out and insulin replacement by injection is required.

Is There a Cure?

At this time there is no permanent cure for diabetes. Your physician will determine what medications you may need and should be carefully used daily. You should visit your doctor every three to six months so that the efficacy of treatment can be re-evaluated. Good glucose control is essential in order to prevent or retard the onset of diabetic complications. These include, but are not limited to damage to the small vessels of the eye, kidney damage, coronary artery disease, and peripheral nerve damage. These complications can lead to blindness, heart attack or stroke, dialysis, and amputation. The good news is that with proper self-care and medical expertise you can significantly reduce or avoid these complications altogether.

Am I At Risk?

Good news, you can check! Glycohemoglobin is a test developed to give information about your average blood sugar level during the past two or three months. It should be checked every three to six months. The American Diabetic Association recommends that the patient’s diabetic regimen be adjusted to achieve a glycohemoglobin 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 are all factors that need to be addressed. Your physician or educator can help you understand your results and your treatment options. Some medications typically used to treat elevated blood pressure also have a protective effect in preventing kidney complications of diabetes. Any medication prescribed by your physician should be taken only as directed. Consult your doctor before adding or deleting any medication including over the counter meds.

Microalbumin urine testing should be performed yearly to evaluate the likelihood of diabetic kidney involvement.

A visit to the Ophthalmologist should be scheduled at least yearly. He or she will evaluate any diabetic retinopathy, cataracts, or other conditions and plan treatment accordingly.

You should have a Comprehensive Medical Exam yearly that includes a treadmill exercise test. Underlying coronary artery disease is often more common in an individual with diabetes and needs early intervention.

Sick Days require special consideration. Anything your body perceives as stress can and will increase your blood sugar. This stress can be physical or emotional in nature. If you are ill your blood glucose will rise even if you cannot eat. Rules of thumb for sick days are as follows.

  • Stick to your meal plan if you can eat.
  • Take your diabetes medication unless your physician tells you to stop.
  • Check with your doctor before taking any other medication.
  • Drink at least one large glass of liquid each hour. If you are eating, these liquids should be sugar-free.
  • Test your blood sugar every 4 hours.
  • Ask someone to check in on you or have them call every few hours to make sure you are all right.
  • If in doubt, consult your physician. Early and effective management of sick days will reduce your chances of developing diabetic coma.

What Should my Target Blood Glucose Level be With Diabetes?

Keeping your blood sugar in target will lower your risk of developing complications of diabetes. Target levels will depend on the person and their situation. Your health-care team will help you determine your own targets for blood sugar levels.

Finally…

Whether you have been diagnosed with type 1 or type 2 diabetes, you can live a long and healthy life by eating healthy, being physically active, and taking medications (if prescribed) to keep your blood glucose (sugar) in your target range. Contact us if you have any questions or to schedule an appointment. 

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4 Important Steps to Managing Your Diabetes

The Endocrinologist at Amarillo Diagnostic Clinic is thoroughly trained in the management of hormonal and metabolic disorders.  With the aid of our experienced staff, our Endocrinology Department can assist in the management of your diabetes, complex metabolic bone disease, or disorders affecting the thyroid, pituitary and adrenal glands.   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.

Diabetes

Diabetes is a condition in which the body is unable to properly utilize blood sugar. Carbohydrate foods create blood sugar and the body needs insulin in order to process the sugar into energy for the body to function properly.

Type I diabetes is a condition in which the body’s immune system damages the pancreatic cells responsible for producing insulin. This form of diabetes is treated with insulin replacement by injection since the body is no longer capable of producing enough of it’s own insulin.

Type II diabetes is a much more common form and is progressive in nature. This form of diabetes causes insulin resistance which means the body still produces insulin, but had difficulty utilizing it. There are various medications in pill form to treat Type II diabetes, but because of the nature of Type II diabetes, sometimes the pancreas wears out and insulin replacement by injection is required.

At this time there is no permanent cure for diabetes. Your physician will determine what medications you may need and should be carefully used daily. You should visit your doctor every three to six months so that the efficacy of treatment can be re-evaluated. Good glucose control is essential in order to prevent or retard the onset of diabetic complications. These include, but are not limited to damage to the small vessels of the eye, kidney damage, coronary artery disease, and peripheral nerve damage. These complications can lead to blindness, heart attack or stroke, dialysis, and amputation. The good news is that with proper self-care and medical expertise you can significantly reduce or avoid these complications altogether.

Exercise

Weight control through diet and exercise is important. If you are overweight, your chances of diabetes increases significantly and you are putting yourself at risk. The Amarillo Diagnostic Clinic has a patient education specialist to assist you in the care and management of diabetes through diet and exercise.

You need to exercise on a regular basis, preferably every day for at least 45 minutes. An exercise program should be initiated slowly and built up gradually to avoid injury and build stamina. Go for the distance rather than intensity. Our patient education specialist can assist you in starting an exercise regimen that will work for you. Be sure and obtain clearance from your physician before starting any exercise regimen.

Check Your Blood Sugar

You can do this with a home glucose monitor regularly. Your physician or diabetic educator will prescribe a routine and frequency that best suits your needs, but many doctors ask that you monitor before breakfast and before supper. Please be sure to record your numbers and to bring your results along with your meter when seeing the doctor. He or she will want to discuss those readings with you.

Periodic Checks

  • Glycohemoglobin: This is a test developed to give information about your average blood sugar level during the past two or three months. It should be checked every three to six months. The American Diabetic Association recommends that the patients diabetic regimen be adjusted to achieve a glycohemoglobin 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 are all factors that need to be addressed. Your physician or educator can help you understand your results and your treatment options. Some medications typically used to treat elevated blood pressure also have a protective effect in preventing kidney complications of diabetes. Any medication prescribed by your physician should be taken only as directed. Consult your doctor before adding or deleting any medication including over the counter meds.
  • Microalbumin: urine testing should be performed yearly to evaluate the likelihood of diabetic kidney involvement.
  • Ophthalmologist: A visit should be scheduled at least yearly. He or she will evaluate any diabetic retinopathy, cataracts, or other conditions and plan treatment accordingly.

You should have a comprehensive medical exam yearly that includes a treadmill exercise test. Underlying coronary artery disease is often more common in an individual with diabetes and needs early intervention.

Sick Days

Sick days require special consideration. Anything your body perceives as stress can and will increase your blood sugar. This stress can be physical or emotional in nature. If you are ill your blood glucose will rise even if you cannot eat. Rules of thumb for sick days are as follows.

  • Stick to your meal plan if you can eat.
  • Take your diabetes medication unless your physician tells you to stop.
  • Check with your doctor before taking any other medication.
  • Drink at least one large glass of liquid each hour. If you are eating, these liquids should be sugar-free.
  • Test your blood sugar every 4 hours.
  • Ask someone to check in on you or have them call every few hours to make sure you are all right.
  • If in doubt, consult your physician. Early and effective management of sick days will reduce your chances of developing diabetic coma.

Finally…

Taking steps to prevent and control diabetes doesn’t mean living in deprivation; it means eating a tasty, balanced diet, exercising and taking the necessary steps to stay on top of your health. With these tips, you can still take pleasure from life with diabetes without feeling deprived.

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

Key Points Your Endocrinologist Wants You to Know About Diabetes

adc-controlling-your-diabetes

The Endocrinologist at Amarillo Diagnostic Clinic is thoroughly trained in the management of hormonal and metabolic disorders. With the aid of our experienced staff, our Endocrinology Department can assist in the management of your diabetes, complex metabolic bone disease, or disorders affecting the thyroid, pituitary, and adrenal glands. 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.

Diabetes

Diabetes is a condition in which the body is unable to properly utilize blood sugar. Carbohydrate foods create blood sugar and the body needs insulin in order to process the sugar into energy for the body to function properly.

Type I diabetes is a condition in which the body’s immune system damages the pancreatic cells responsible for producing insulin. This form of diabetes is treated with insulin replacement by injection since the body is no longer capable of producing enough of its own insulin.

Type II diabetes is a much more common form and is progressive in nature. This form of diabetes causes insulin resistance which means the body still produces insulin but had difficulty utilizing it. There are various medications in pill form to treat Type II diabetes, but because of the nature of Type II diabetes, sometimes the pancreas wears out and insulin replacement by injection is required.

At this time there is no permanent cure for diabetes. Your physician will determine what medications you may need and should be carefully used daily. You should visit your doctor every three to six months so that the efficacy of treatment can be re-evaluated. Good glucose control is essential in order to prevent or retard the onset of diabetic complications. These include, but are not limited to damage to the small vessels of the eye, kidney damage, coronary artery disease, and peripheral nerve damage. These complications can lead to blindness, heart attack or stroke, dialysis, and amputation.

The good news is that with proper self-care and medical expertise you can significantly reduce or avoid these complications altogether. The following will help:

Weight Control

Weight control through diet and exercise is important. If you are overweight, your chances of diabetes increase significantly and you are putting yourself at risk. The Amarillo Diagnostic Clinic has a patient education specialist to assist you in the care and management of diabetes through diet and exercise. You need to exercise on a regular basis, preferably every day for at least 45 minutes. An exercise program should be initiated slowly and built up gradually to avoid injury and build stamina. Go for the distance rather than intensity. Our patient education specialist can assist you in starting an exercise regimen that will work for you. Be sure and obtain clearance from your physician before starting any exercise regimen.

Check Your Blood Sugars

You can do this with a home glucose monitor regularly. Your physician or diabetic educator will prescribe a routine and frequency that best suits your needs, but many doctors ask that you monitor before breakfast and before supper. Please be sure to record your numbers and to bring your results along with your meter when seeing the doctor. He or she will want to discuss those readings with you.

Periodic Checks

Glychohemoglobin is a test developed to give information about your average blood sugar level during the past two or three months. It should be checked every three to six months. The American Diabetic Association recommends that the patients diabetic regimen be adjusted to achieve a glycol hemoglobin 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 are all factors that need to be addressed. Your physician or educator can help you understand your results and your treatment options. Some medications typically used to treat elevated blood pressure also have a protective effect in preventing kidney complications of diabetes. Any medication prescribed by your physician should be taken only as directed. Consult your doctor before adding or deleting any medication including over the counter meds.

  • Microalbumin: urine testing should be performed yearly to evaluate the likelihood of diabetic kidney involvement.
  • A visit to the Ophthalmologist should be scheduled at least yearly. He or she will evaluate any diabetic retinopathy, cataracts, or other conditions and plan treatment accordingly.
  • You should have a comprehensive medical examination yearly that includes a treadmill exercise test. Underlying coronary artery disease is often more common in an individual with diabetes and needs early intervention.

Sick Days

Sick days require special consideration. Anything your body perceives as stress can and will increase your blood sugar. This stress can be physical or emotional in nature. If you are ill your blood glucose will rise even if you cannot eat. Rules of thumb for sick days are as follows.

  • Stick to your meal plan if you can eat.
  • Take your diabetes medication unless your physician tells you to stop.
  • Check with your doctor before taking any other medication.
  • Drink at least one large glass of liquid each hour. If you are eating, these liquids should be sugar-free.
  • Test your blood sugar every 4 hours.
  • Ask someone to check in on you or have them call every few hours to make sure you are all right.
  • If in doubt, consult your physician. Early and effective management of sick days will reduce your chances of developing diabetic coma.

Finally…

An endocrinologist diagnoses and treats hormone problems by attempting to restore hormone balance within the body’s systems. It is a good idea to compile a list of any existing symptoms before the visit so that none are missed. We are here to help! Contact us if you have any questions or to schedule an appointment.

What Is Endocrinology?

The Study of Hormonal and Metabolic Disorders

What Is Endocrinology? - ADC Blog

Blausen.com staff. “Blausen gallery 2014”. Wikiversity Journal of Medicine

The Endocrinologist at Amarillo Diagnostic Clinic is thoroughly trained in the management of hormonal and metabolic disorders.  With the aid of our experienced staff, our Endocrinology Department can assist in the management of your diabetes, complex metabolic bone disease, or disorders affecting the thyroid, pituitary and adrenal glands.   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.

Call and schedule an appointment today with ADC Endocrinologist Susan Tanner Wingo, M.D.

Diabetes

Diabetes is a condition in which the body is unable to properly utilize blood sugar. Carbohydrate foods create blood sugar and the body needs insulin in order to process the sugar into energy for the body to function properly.

Type I diabetes is a condition in which the body’s immune system damages the pancreatic cells responsible for producing insulin. This form of diabetes is treated with insulin replacement by injection since the body is no longer capable of producing enough of it’s own insulin.

Type II diabetes is a much more common form and is progressive in nature. This form of diabetes causes insulin resistance which means the body still produces insulin, but had difficulty utilizing it. There are various medications in pill form to treat Type II diabetes, but because of the nature of Type II diabetes, sometimes the pancreas wears out and insulin replacement by injection is required.

At this time there is no permanent cure for diabetes. Your physician will determine what medications you may need and should be carefully used daily. You should visit your doctor every three to six months so that the efficacy of treatment can be re-evaluated. Good glucose control is essential in order to prevent or retard the onset of diabetic complications. These include, but are not limited to damage to the small vessels of the eye, kidney damage, coronary artery disease, and peripheral nerve damage. These complications can lead to blindness, heart attack or stroke, dialysis, and amputation. The good news is that with proper self-care and medical expertise you can significantly reduce or avoid these complications altogether.

Weight control through diet and exercise is important. If you are overweight, your chances of diabetes increases significantly and you are putting yourself at risk. The Amarillo Diagnostic Clinic has a patient education specialist to assist you in the care and management of diabetes through diet and exercise.

You need to EXERCISE on a regular basis, preferably every day for at least 45 minutes. An exercise program should be initiated slowly and built up gradually to avoid injury and build stamina. Go for the distance rather than intensity. Our patient education specialist can assist you in starting an exercise regimen that will work for you. Be sure and obtain clearance from your physician before starting any exercise regimen.

CHECK YOU BLOOD SUGARS with a home glucose monitor regularly. Your physician or diabetic educator will prescribe a routine and frequency that best suits your needs, but many doctors ask that you monitor before breakfast and before supper. Please be sure to record your numbers and to bring your results along with your meter when seeing the doctor. He or she will want to discuss those readings with you.

Periodic Checks

GLYCOHEMOGLOBIN is a test developed to give information about your average blood sugar level during the past two or three months. It should be checked every three to six months. The American Diabetic Association recommends that the patients diabetic regimen be adjusted to achieve a glycohemoglobin 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 are all factors that need to be addressed. Your physician or educator can help you understand your results and your treatment options. Some medications typically used to treat elevated blood pressure also have a protective effect in preventing kidney complications of diabetes. Any medication prescribed by your physician should be taken only as directed. Consult your doctor before adding or deleting any medication including over the counter meds.

MICROALBUMIN urine testing should be performed yearly to evaluate the likelihood of diabetic kidney involvement.

A visit to the OPTHALMOLOGIST should be scheduled at least yearly. He or she will evaluate any diabetic retinopathy, cataracts, or other conditions and plan treatment accordingly.

You should have a COMPREHENSIVE MEDICAL EXAMINATION yearly that includes a treadmill exercise test. Underlying coronary artery disease is often more common in an individual with diabetes and needs early intervention.

SICK DAYS require special consideration. Anything your body perceives as stress can and will increase your blood sugar. This stress can be physical or emotional in nature. If you are ill your blood glucose will rise even if you cannot eat. Rules of thumb for sick days are as follows.

  • Stick to your meal plan if you can eat.
  • Take your diabetes medication unless your physician tells you to stop.
  • Check with your doctor before taking any other medication.
  • Drink at least one large glass of liquid each hour. If you are eating, these liquids should be sugar free.
  • Test your blood sugar every 4 hours.
  • Ask someone to check in on you or have them call every few hours to make sure you are all right.
  • If in doubt, consult your physician. Early and effective management of sick days will reduce your chances of developing diabetic coma.

Doctor

Below is the list of Doctors specializing in Endocrinology:

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.

– – –

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.

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.

Amarillo Diagnostic Clinic Blog

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:

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 is a second year endocrine fellow at Mount Sinai Medical Center in New York City, where she also received her internal medicine training. She is the AACE Fellow-in-Training Representative and 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. This fall she will be joining a private endocrinology practice in New York.