Diabetes and Reproductive Health
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Diabetes and Reproductive Health
‘‘This is
more than
talk…
this is what you need
about taking care of
body, sex and having
to know
your changing
children…
…when
you have
diabetes.
‘‘
Denise Charron-Prochownik, PhD, RN, CPNP, FAAN Julie S. Downs, PhD
University of Pittsburgh Carnegie Mellon University
Diabetes and Reproductive Health
Your Body is Changing –
Are You Ready?
Since you have diabetes, you already know
‘‘
a lot more about your health than other
girls your age. And now that you are a Puberty, periods, sex and
Diabetes and Reproductive Health for Girls was adapted teenager, there are even more things that pregnancy with diabetes.
with permission from READY–Girls! Reproductive-health you need to know and do.
Education & Awareness of Diabetes in Youth for Girls It’s all about being
You need to know how diabetes can affect prepared and knowing
©2014 and 2016, University of Pittsburgh, Diabetes and Reproductive your changing body, your period, and even how to get ready. This
Health for Girls, an adaptation of READY–Girls! Reproductive-health having sex and having a baby. It sounds
Education & Awareness of Diabetes in Youth for Girls, ©2009, 2011.
Used and made with permission from University of Pittsburgh.
All Rights Reserved.
like a lot, but now is the time to start
getting ready for your future.
information is called
preconception counseling
and you can get it from
‘‘
Managing your diabetes and your health care provider.
Developed with support from knowing what to expect will
National Institutes of Health grant NICHD RO1 HD044097
help you meet the challenge
Denise Charron-Prochownik, PhD, RN, CPNP, FAAN of being prepared for all of
University of Pittsburgh the changes as you move
toward womanhood.
Julie S. Downs, PhD
Carnegie Mellon University
Get Ready to
Stay Healthy
Just like the rest of your
No part of this publication may be reproduced or transmitted in any body, your reproductive
form or by any means, electronic or mechanical, including duplication, system needs to have
recording, or any information storage and retrieval systems, without normal blood glucose
the prior written permission of the University of Pittsburgh. levels to keep it healthy
and working properly.
2 3
Diabetes and Reproductive Health
Keeping Your Blood Glucose hormones, emotions, and how you grow Control What You Can:
on Target and develop. Managing your diabetes
1. Take your diabetes medicine
means doing what you can to keep your
Medicine, either insulin from shots or a
Target Your Blood Glucose to Normal blood glucose as close to your target
pump or pills, helps blood glucose go down.
range as possible.
It’s hard work to keep your blood glucose Insulin helps glucose move out of your blood
(sugar) and A1C close to your target. You Adolescents with diabetes could have a and into the cells where your body can use it
probably already measure your blood target A1C of less than 7.5%. Work with as energy.
glucose several times a day to make sure your doctor or nurse to set your target
A1C. 2. Eat healthy foods
it doesn’t go too low or too high. As your After a meal or snack your blood glucose
body changes, you’ll find that it might be Hormone: A chemical in the body that will go up. Some foods make your blood
harder to keep your blood glucose within affects how a specific body part works (or glucose go up more than others. Balance
certain limits. functions) this with physical activity or insulin.
Some things that affect your blood 3. Be physically active
glucose are under your control like your Physical activity usually makes blood
diet, your medicine, and your activity. glucose go down. Sometimes if you exercise
Other things are out of your control like and take your insulin as prescribed, your
blood glucose can go too low. But, if you are
not in good control and you exercise hard,
your blood glucose can actually go up!
Q ‘‘
How to Get Ready for Physical Activity:
What is an HbA1c Because of hormones,
• Check your blood glucose before and after
or the A1C? you have to pay way more you are physically active
attention during puberty. • Adjust your insulin if your blood glucose
Not only are hormones levels are too high or too low
A
The HbA1c (or A1C for short) is a blood making your body change, • Have a snack as needed
test that tells what your average blood but now you might also • Be sure to drink plenty of water to stay
glucose has been over a few months.
An A1C of 7% means your estimated
‘‘
have to change your meal
plan, your exercise, or
hydrated
• Keep something with glucose with you at
average blood glucose is 154 mg/dl. your medicine. all times
• Wear your medical ID
4 5
Diabetes and Reproductive Health
Puberty and Diabetes Changes on the Outside Puberty Means Starting Your Periods
Are you growing taller and weighing When your body is ready, you will start to get a period.
more? Your body is getting ready to This is what happens in your body to make you have a period.
become an adult. Puberty is when your
body is turning into an adult body. You EGG
might notice that you are growing taller
and weighing more. You see changes on
the outside of your body like hair in your
armpits, your genitals and your breasts mature breasts
begin to develop. There are also changes broader hips
happening inside your body. All of these
changes happen in your reproductive pubic hair About once a month an If you become pregnant, If you don’t become
system that gets you ready to make egg leaves the ovary the uterus builds up a pregnant during that
babies in the future. and moves down the thick lining of blood to month, after a few days
fallopian tube to the help the egg grow into the blood and egg flow
uterus (or womb). an embryo. from the uterus and
vagina. This is called
Changes on the Inside your menses or period.
When you get your
What is the arrow pointing to? period, the blood flows
• Uterus Oviducts from the uterus out
‘‘
• Ovary through the cervix.
• Cervix
If your blood
• Vagina
glucose levels are Ovaries
not in good control, Uterus Definitions: Ovaries – Store and produce the eggs
your body may or may
Cervix Oviducts (fallopian tubes) – The path that the egg follows
not have the energy
needed to develop
properly. You may even
‘‘ Vagina
from the ovary to the uterus
Uterus – Womb. The lower part forms the cervical canal
start puberty late. Cervix – Surrounds the cervical canal
Did you choose uterus? Did you know that
a baby grows in the uterus? Vagina – A canal that stretches easily
6 7
Diabetes and Reproductive Health
Living with Your Hormones What Should You Do? What Can You Expect? Boys Go Through Puberty Too!
Your body uses special chemical You check your blood glucose and it is If your blood glucose is in While girls’ bodies are developing
messengers called hormones to help it over 200! Good Control, you can expect: into women’s bodies, boys’ bodies are
grow and function. During puberty these Too much glucose is in your blood and developing into men’s bodies. Boys’
hormones change. As an egg ripens each • normal puberty reproductive systems are on the outside of
can’t get into your cells to be used as • normal development
month and becomes ready to be released energy. Your body looks for other energy their bodies.
down the fallopian tube, your body makes and starts breaking down fat into ketones The testicles make many tiny cells called
more hormones. Having your period can If your blood glucose is in
and fatty acids. Ketones can cause Poor Control, you might expect: sperm. Sperm leave the testicles through
make diabetes harder to control. Hormones problems and make you sick. If your blood the sperm ducts to get to the penis.
change in the days before and during your glucose is above 240, check your ketones • late puberty (starting your Usually the penis is limp. However, when
period. After your period your hormones for a few days before and during your period later) a man gets sexually excited, blood rushes
go back to the way they were before an period to avoid problems. • irregular periods into the penis and it stiffens. This is called
egg was released. • a greater risk for urinary tract an erection.
Hormones can change the way that you infections (UTI)
think about your body and about sex. • vaginal dryness
These changes are called Premenstrual Riding the PMS Roller Coaster
Syndrome or PMS. PMS makes it harder to Pituitary
Does this sound familiar? Gland
control your blood glucose.
“I have been feeling a little jumpy and my
Facial
belly’s just yucky. And it’s like I always Hair
want to eat! And I can’t help it and my Underarm
Voice Hair
During your blood glucose is all whacked out!”
Q
Change Breast
period, controlling Growth
Underarm
diabetes can be This could be why… Hair Hip
Growth
1. easier You are probably getting or just starting Pubic
your period! These types of feelings Hair Ovaries
2. harder
are normal and related to the hormonal Pubic
3. no different Ejaculation
A
Hair
changes in your body. You will need to
Testicles Menstruation
Harder, because check your blood glucose more often. You
of changing also might need to adjust your insulin or
hormone levels change your meal plan.
8 9
Diabetes and Reproductive Health
Sex and Pregnancy If there is an egg coming down the
fallopian tube, the sperm and egg meet
What is Sex?
and the egg is fertilized. This is when
In this book, when we talk about sex, we conception occurs. If conception occurs,
mean sexual intercourse or vaginal sex. that means that the woman has become
This is when a man puts his penis into a pregnant.
woman’s vagina.
The fertilized egg travels down the
fallopian tube into the uterus. When it
How Do Women Get Pregnant? reaches the uterus it plants itself in the
During sexual intercourse, that is, when the lining of the uterus. The egg then starts
man’s penis is inserted into the woman’s dividing many times to form new living
vagina, and the man has an ejaculation, cells. This develops into an embryo and
sperm squirts into the woman’s vagina. The then into a fetus which is a developing
sperm swim up the cervix into the uterus. baby inside the woman’s uterus.
Q
An egg must be moving Conception occurs when a
Q
down the fallopian tube for sperm meets the egg in the
pregnancy to occur 1. Vagina
1. True 2. Uterus
2. False 3. Ovary
A
4. Fallopian tube
A
True: In each month cycle,
the ovary releases an egg Conception occurs when
and it moves down the sperm meets an egg in the
fallopian tube to the uterus fallopian tubes
10 11
Diabetes and Reproductive Health
How Fast Does an Embryo Develop? As you can see, the first two months of a Sex and Diabetes type of activity, you should be prepared
pregnancy are very important. During this to prevent low blood glucose before you
The importance of having tightly Just like with any other form of physical
time the basic organs and body parts are have sex.
controlled blood glucose levels before you activity, when you have sex your glucose
formed. High blood glucose levels can hurt
become pregnant is obvious when you level can drop and it can keep dropping
consider how fast a fetus develops during
the baby’s development. This is why it is Prevent Low Blood Glucose
afterwards. And just like with any other
essential to control your diabetes BEFORE
the first few weeks after conception. • Check your blood glucose before sex
you conceive.
The heart and brain may not form • Adjust insulin if needed
If you don’t want to get pregnant you • Eat a snack if taking insulin
correctly if a woman’s blood glucose levels
need to think about family planning before • Have a glucose source handy
are high during this time.
you have sex. • Tell your partner that you have diabetes
About 4 weeks after conception, the
developing baby is just the size of a pea but
already has a head with a brain forming;
little bumps that will be arms,
legs, and eyes; and a heart
beating and pumping blood.
Q
By about 8 weeks after conception, the Only 4 weeks after
conception, what has
Q
developing baby is the size of a walnut.
The eyes, ears, and nose have taken shape; already begun to develop? Did you know that sex
the arms and legs are formed; the hands 1. Heart can cause low blood
have fingers; and the feet have toes. 2. Brain glucose, also known as
3. Eyes hypoglycemia?
4. Arms
A
5. All of the above
During sex, you need
A
All of the above. The to be careful that your
heart, the brain, the eyes glucose level does not
the arms and even legs 1. rise too high
have begun to develop! In 2. drop too low
fact, a heart is beating and
pumping blood.
12 13
Diabetes and Reproductive Health
Sex and Diabetes There are other things you have to Having Sex With a Guy Can Lead
consider when having sex. Sex can lead to Pregnancy
What Can Happen?
‘‘
to bladder and yeast infections. You can
A woman can get pregnant and not even
As you grow and your body changes, you also catch a sexually transmitted infection
know it. Deciding whether or
might start thinking about sex. Although (STI). Sex can also change your feelings
your body is becoming an adult’s body, about other people and how you feel If you become pregnant before you are not to have sex is a
you are still a teenager with a lot more about yourself. You are in control. This ready, you will have some hard decisions really big deal. You
growing, and lots of teen activities to do. includes knowing where you stand in to make. can become pregnant
Teenagers may not yet be prepared for regards to having sex. You may think it and not even know
things like having responsible sex, getting is best to wait and not have sex yet and Getting pregnant as a teenager with it, and the results for
pregnant and raising a child. that’s okay. Women with diabetes need to diabetes means that you and the baby can
plan ahead. • you can have a bigger chance of serious be serious. There
problems with the pregnancy because are so many
of your diabetes and age, especially if things to
you have had problems controlling your think about
blood glucose. and things
• your baby has a bigger chance of having that can
health problems, even dying. happen.
Even more
so for girls
who have
diabetes. When
But in the future,
when you’re ready
you are READY to
get pregnant in the
‘‘
and plan ahead, you future, plan ahead.
can have a healthy
pregnancy and
healthy baby.
14 15
Diabetes and Reproductive Health
Methods of Birth Control
Prevent Unplanned The family planning method Women who smoke or Forms Advantages Disadvantages
Pregnancies that you choose will depend take medication or have 100% effective. That means NO pregnancy.
on your health, your religious medical problems, such
—————————————————————————————————————————————————————————————————————————
Best
In the future you may —- Abstinence 100% safe.
beliefs, and your needs. Your as high blood pressure, --
—————————————————————————————————————————————————————————————————————————
No sexually transmitted infections.
decide that you want a health care provider will help heart disease, or have —--
baby and are ready for the -- Requires office visit to insert and
you decide what method is damage to blood vessels
—--
Long Acting, Reversible Contraception
99% effective. That means less than 1 pregnancy in every 100 remove.
responsibility of becoming best for you. or nerves could have -- IUD women who use this method each year.
————————————————————————————————————————
Does NOT protect against sexually
a mom. You will need to —--
—————————————————————————————————————————————————————————————————————————
• Hormonal
higher risks for some side • Copper
Doesn’t require daily attention. transmitted infections.
--
————————————————————————————————————————————————————————————————————————— ————————————————————————————————————————
work with your health care Remember: If you have sex, effects of certain birth
——————————————————————————————————————————————
Lasts for years. Can cause spotting or irregular
—--
Subdermal implant
bleeding.
team to get tight blood there is always some chance control methods and need --
glucose control before you of getting pregnant. If you to talk to their health care —--
Hormonal Birth Control
become pregnant. You can plan to have sex, be sure to provider to decide the -- Combination hormones
—--
(estrogen + progesterone) 99% effective if always used as directed. Can worsen blood glucose control.
have a healthy baby if you protect yourself. That’s why best method for them. • The Pill ————————————————————————————————————————————————————————————————————————— ————————————————————————————————————————
-- • The Patch 91% effective the way most people use them. That means Does NOT protect against sexually
plan ahead. If you are not
—--
transmitted infections.
it is important to wait until • Nuva-Ring about 10 pregnancies in every 100 women who use this ————————————————————————————————————————
ready to have a baby and you’re 100% ready. Women --
——————————————————————————————————————————————
Progesterone Only
method each year. Often used incorrectly.
Effectiveness Scale
if you have sex, you could with diabetes need to plan —-- • Depo Shots
get pregnant accidentally. -- • Mini-Pill
ahead. —-- Dual Method Protection 99% effective if both are used as directed. That means less Can worsen blood glucose control.
-- than 1 pregnancy in every 100 women who use this method ————————————————————————————————————————
—--
This means using a Condom with
The Most Effective Spermicide AND Hormonal Birth
each year. They are often used incorrectly.
————————————————————————————————————————
--
—————————————————————————————————————————————————————————————————————————
Condoms sometimes break.
Birth Control? —--
Control Prevents sexually transmitted infections.
Abstinence! There is no -- 98% effective if always used as directed.
—————————————————————————————————————————————————————————————————————————
—--
Hormone-Free Options Condoms are often used
Q
85% effective the way most people use them. That means
sperm to fertilize the egg. In the future, who can help you figure -- Condom with spermicide about 15 pregnancies in every 100 women who use this incorrectly.
————————————————————————————————————————
—--
(a fluid that kills sperm) method each year. Condoms sometimes break.
• 100% safe out which family planning methods will
—————————————————————————————————————————————————————————————————————————
-- Prevents sexually transmitted infections.
• 100% effective work best for you? —--
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
Withdrawal (when a guy pulls out
• Added bonus: no sexually A. Family planning clinic -- before he ejaculates)
—--
——————————————————————————————————————————————
transmitted infections B. Primary care team Diaphragm
-- ——————————————————————————————————————————————
Often used incorrectly.
—--
Sponge 85% or less effective the way most people use them. That
‘‘
C. Your diabetes team ——————————————————————————————————————————————
means about 15 or more pregnancies in every 100 women who
————————————————————————————————————————
Does NOT protect against sexually
D. Your family/parents -- Cervical cap
Abstinence
‘‘ E. All of these options —--
--
——————————————————————————————————————————————
Fertility awareness (using a calendar or
body temperature to know when during
use these methods each year. transmitted infections.
A
—--
the month you are most likely to get
is 100% pregnant if you have sex)
--
Worst
guaranteed! All of the options!
Your health care professionals can —- No Birth Control
85% or less effective. That means about 15 or more
pregnancies in every 100 women each year.
advise you on your individual needs
16 17
Diabetes and Reproductive Health
Talking About It If you feel like this… Remember:
Talk with Your Parents “So, you hope that I wait to have a
partner until I get older.”
Talk to Your Health Sometimes it’s hard to talk with a parent
“It’s embarrassing • Members of your health care team about sex, and some parents feel nervous “You’re worried that kids are doing a
Care Professional and some of my are sensitive, used to hearing the
questions are hard to questions you are embarrassed talking with their children. These types of lot of things without thinking about the
“But it’s, you know, conversations tell the parents that their consequences.”
ask.” about, and should keep things
personal…” confidential. little girl is growing up. Sometimes parents “You think that my friends are starting to
For many teens, it’s hard • Ask your doctor or nurse if there don’t want to think that their little girl is
are limits on confidentiality.
have sex.”
to talk about topics like growing into a woman. But parents can be
• Talk to the person you feel the 6. Ask questions. Give your mom or dad the
sex and birth control with helpful in giving information and advice.
most comfortable with. chance to give you information. It is A
a health professional. Here Here are some tips to get started:
are some common reasons “One of my parents • You don’t need parents’ permission LOT easier than having them ask you all
1. Think about the parent that you feel of the questions!
why you might hesitate to will want to be there.” to ask these questions.
• Your sexual behavior should not be would be the easiest to start talking to.
“start the conversation”: 7. Ask your parents if they know how
discussed with your parent without 2. Choose a time when you both have some
your permission. diabetes will affect you as you grow up.
free time so you won’t be interrupted. Suggest that this would be a good topic
“I don’t want to talk • Choose the person you feel the Sometimes the best times to talk are to talk about with your health care team.
about sex with the most comfortable with. when you are doing ‘normal’ things like
doctor that I’ve had • You might want to talk without riding in the car or when you have just
since I was a little your parents present. Explain to watched a movie.
kid.” your parent that you need to talk
about personal things with the 3. Ask if you can have a “private”
doctor or nurse. conversation; this alerts your parent that
the topic will be important to you.
“I don’t even know • It’s always a good idea to practice
where to start. These beforehand. Sometimes it helps 4. Start by saying that you are curious.
are hard questions.” to jot down your questions. You Ask a general question such as, “I was
might want to hand your doctor or wondering what you think is important
nurse a note. Here are some ideas for me to know about sex.” This allows
to get started:
• “Doctor (nurse), I have some your mom or dad to tell you what they
questions that are pretty hard to feel is important.
ask.” 5. Briefly, repeat back to them what they
• “If I ask you some questions, can it
just be between us?” just said only in your own words. This
helps you both to understand each other.
18 19Diabetes and Reproductive Health
Talk with Your Partner Your partner may really want to have
If your partner says… Try this:
sex, and you need to speak up if you
You make choices every day. Choices have
don’t want to. Having sex can change “If you loved me, you’d “If you really
one thing in common—they mean that
a relationship and how you feel about have sex with me.” loved me,
you have to stop and think before you act. you wouldn’t
yourself. Having sex doesn’t prove that
Think about the risks that you are about to pressure me.”
you’re in love or that you are an adult.
take. Think about the results. Some results
have more serious consequences than Your partner should also know that you “Don’t you trust me?” “It has nothing
others. Making a decision about sex and have diabetes and what that means in to do with trust.
I just don’t feel
what you want and don’t want to do can terms of having sex and the potential
right about
be hard. Telling your partner about your consequences. having sex.”
decisions can be even harder. Are you thinking about having sex for any
of the following reasons?
• My partner will love me more if we have It’s Your Body, Your Future
sex. It can be hard to tell your partner if you
• My partner won’t wait forever while I don’t want to have sex.
make up my mind.
But you have the right to
• We’ve been together long enough;
making love is the next step. • say that you are not ready
• It’s not a big deal. • choose if and when you want to have
• Everybody is doing it. sex, without feeling pressured
• tell your partner to stop
Having sex is a huge decision. It’s possible
• protect yourself from getting a disease
your partner might want to break up
• protect yourself against getting
with you based on what you decide. How
pregnant
would you feel if you got an STI or became
• be abstinent
pregnant? How would you feel about the
consequences?
20 21Diabetes and Reproductive Health
Diabetes Affects You can be pregnant and problems? If your blood The Glucose Connection mother leading to problems with the baby
Pregnancy not know it until you have glucose is not in tight having low blood glucose or hypoglycemia.
High blood glucose levels in the first 8
missed a period. This control before and during
When you are ready to weeks of development are hard on the
means that a month has your pregnancy, your risks Mom’s Baby’s
plan a pregnancy, why is baby because its pancreas is not yet Blood = Blood
already gone by. During for diabetes-related health
it important to have tight developed. The baby can’t make its own Glucose Glucose
this month, the baby is problems go way up. High
blood glucose control? insulin so it depends on the mother’s
developing very quickly. blood glucose levels can hurt
blood glucose for its energy. Insulin from
High blood glucose can the mother and the baby.
the mother does not get to the baby,
Ketones Transfer to Baby Too!
cause birth defects in the High blood glucose levels What are Ketones?
only blood glucose does. After the baby’s
baby. The first two months in the first month of
Planning of pregnancy are critical
pancreas develops it begins making its Ketones are chemicals that in large amounts
development can cause own insulin. If blood glucose levels stay
for for having a healthy baby. the baby to have problems
are poisonous to the body.
high, the baby’s pancreas will continue
Success If you become pregnant with the heart, brain, spinal to make a lot of insulin as it grows in the Blood glucose is not the only thing that goes
Women with and do not have tight cord, or skeleton. High blood from the mother to the baby. If the mother
mother’s uterus. When the baby is born it
diabetes control, the chances of glucose after the first month has ketones in her blood, those ketones will
stops getting all of the glucose from the
can have having a baby with birth can make the baby grow too also get to the baby. If a lot of ketones get
a healthy defects increase. big or be born prematurely. to the baby, it can get very sick or even die.
pregnancy Did you know that It can be hard on the mom
and baby. having diabetes and and baby when it is time to
Blood glucose being pregnant can also give birth.
raise your risk of health
Q
levels need
to be under If you have a blood glucose level of 150,
tight control High Blood Glucose Can Harm... what is the baby’s blood glucose level?
for at least
A developing baby by: The mother, by causing: a. 100 b. 125 c. 150 d. 175
3-6 months
A
before trying • Miscarriage (baby dies) • DKA (ketones) The answer is 150. Did you know
to become • Born too soon • High blood pressure that your baby will have almost the
pregnant, at • Birth defects • Eye problems same blood glucose level as you?
conception – Heart (Retinopathy) This becomes even more complicated
and during the – Brain • Kidney problems because your insulin does not pass
pregnancy. – Other organs (Nephropathy) through the placenta to the baby.
• Born with low blood • Nerve problems
glucose (Neuropathy)
• Being oversized • Trauma from giving birth if
22 the baby grows too big 23Diabetes and Reproductive Health
It Works Both Ways: Because of the changes brought on by Pregnancy is Hard Work…
Pregnancy Affects Diabetes pregnancy, pregnant women may need but It’s Worth It
to change their treatment to keep blood
Not only will your diabetes affect your glucose in tight control to minimize the Managing a pregnancy is hard work for you
pregnancy, but the pregnancy also makes risk of problems to themselves and their and your diabetes care team. In addition to
it harder to control your diabetes. babies. keeping your blood glucose under control,
you can expect
Pregnancy Can Make Blood Glucose What is Tight Control? • more clinic visits
Harder to Control • more medical tests
• Keeping blood glucose between 60 and
There may be more blood glucose • changes in your diet
90 before meals
reactions in the first few weeks, and a • changes in exercise
• Keeping blood glucose between 100 and
mother might need less insulin. At the 129 after eating But in the end, you’ll have a healthy baby.
middle and end of a pregnancy, blood • Checking blood glucose a lot more often
glucose will go up and the mother might
‘‘
• Getting your A1C tested every 4-6 weeks
need double or triple the insulin! After • Changing your medicine (for example,
birth, the insulin need drops to the normal starting insulin if advised by your health When the time is right, you
levels before pregnancy. care professional) can do it! You can have a
Pregnancy Can Cause Fat to Break
Down into Ketones What is the target blood glucose range for
healthy pregnancy and baby
if you plan ahead and are
‘‘
prepared to work hard!
planning and during a pregnancy?
A healthy pregnancy requires a lot of
energy. If the mother does not eat enough Your own goal should be determined by
your health provider and you.
to keep up the energy needed, fat can
break down for the body to use as energy. Target range when you Between 60 and
This can result in a dangerous condition wake up, before meals, 90 mg/dl
called DKA, and the mother needs to get bedtime, and overnight
medical help right away.
Target range after Between 100 and
meals 129 mg/dl
Target A1C 6-6.5%
A1C of 6% =
126 mg/dl
24 25Diabetes and Reproductive Health
Getting Ready with Where would you put yourself Not Ready to Get Pregnant Getting Ready for a Pregnancy
Preconception Counseling on this scale? Preconception counseling should begin As a woman with diabetes, in the future if
The key to a healthy pregnancy is when you first get your period. Your and when you are thinking about getting
lllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllll health care team will be there for you as pregnant, there are some things that you
planning: Plan on maintaining tight
blood glucose control so that it is safe to Not ready Getting Being you grow from a girl into a woman. At will need to do to be ready.
to get ready for ready for a
become pregnant, and maintaining tight pregnant pregnancy pregnancy this stage, preconception counseling will In Preconception Counseling, you will
blood glucose control during pregnancy. involve general goals for your reproductive
health. • work with a health care team, that
You don’t have to do it alone! A special Regardless of where you fall on the
specializes in diabetes and pregnancy
team of doctors, nurses, and other health readiness scale, preconception counseling Preconception Counseling will help you to • ask your health care provider what your
professionals will help you. can help you. Remember if you’re not
• be aware of family planning target A1C should be (usually the A1C
Preconception counseling is an ongoing ready yet, and you are still sexually active,
• control your blood glucose levels should be 6-6.5% for 3-6 months)
conversation with your diabetes health it’s not safe to get pregnant.
• learn how diabetes affects you as you • get blood glucose levels within your
care team that starts at puberty and grow into a woman target range before getting pregnant
continues during your child-bearing years. • learn how diabetes affects a pregnancy • learn how high blood glucose levels can
It increases your chances of having a hurt an unborn baby
healthy pregnancy and a healthy baby by • use a family planning method until it’s
Q
teaching you how to get and keep normal safe to get pregnant
blood glucose levels and postpone a What’s my risk for problems • make changes to meal plans, medicine,
pregnancy until it’s safe and wanted. with me or my baby if I exercise and blood glucose monitoring if
become pregnant? needed
‘‘
I am a teenager • make changes in blood pressure
I have diabetes medicine if needed
You should start getting My blood glucose is out • start taking vitamins, calcium and folic
Definitions preconception counseling in of control. acid
Conception – When the egg and the your early teens. It will help I have not attended • get vaccines up to date
sperm meet and fertilization occurs. This is you learn about how to take preconception counseling • get genetic counseling, if you want to
• stop unhealthy behaviors (smoking,
A
the beginning of a pregnancy. care of your changing body,
Each “check” raises your drugs, alcohol)
puberty, and periods. It will help
Preconception – Before conception; starts
even before having sex; before the sperm
and the egg join together.
you plan your pregnancies to
have healthy babies. And it is
‘‘ risk higher. But, with careful
planning you can have a
healthy pregnancy.
important for your health, too!
26 27Diabetes and Reproductive Health
Being Ready for Pregnancy Become Confident about Your Future READY-Girls Will You Be Ready?
In the future, if and when you are actively “Are you sure that you could plan a Here are three promises you should make
Take the First Step to yourself:
planning to have a baby, you have done pregnancy in the future, when you’re
all the steps in “Getting Ready for a ready?” You may want to talk with different people • I’ll get Preconception Counseling.
Pregnancy.” The goals now become more about diabetes, sex, and pregnancy. • When I decide to plan a pregnancy, I will
focused since your unborn baby’s health is lllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllll Remember, the first time that you get get help from my health care team to
at stake, too. your period is the right time to start the keep my blood glucose close to normal
Not at Totally conversation about diabetes, sex and
In Preconception Counseling you will all sure sure (A1C less than 6.5%).
pregnancy. • I will only get pregnant if my average
• keep tight control of your blood glucose How sure are you that you If you have any questions about diabetes, blood glucose levels have been normal
• get medical exams more frequently sex, and pregnancy it’s important to ask. for at least 3 months.
• change your medicines, if needed • understand why it is important to plan a
• manage your diabetes closely (meal pregnancy? Ask someone you trust and feel
plan, medicine, exercise and blood • know how to plan a pregnancy? comfortable with…
‘‘
glucose monitoring) • can get and stay in tight blood glucose • Your health care team members will
• take vitamins, calcium and folic acid control for one year? give you the straight facts and help
• get up to date with vaccinations • will get preconception counseling? you make choices. They will keep your You have
• avoid unhealthy behaviors (smoking,
drugs, and alcohol)
• can plan a healthy pregnancy in the
future?
conversations confidential.
• Parents can help you make choices.
the power to
choose to be
‘‘
You and your health care team will decide • Friends can listen, give advice, and in control.
when it is safe to stop your family planning support your decisions.
method and try to get pregnant. • Your partner should know about your
diabetes and how you feel about
relationships, sex, birth control, and
abstinence.
To find resources near you, call the
American Diabetes Association:
1-800-DIABETES (342-2383)
or visit diabetes.org
28 29Diabetes and Reproductive Health
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