HOW DIABETES CAN BE MANAGED:

Improve Your Diet:

• One needs to be careful about their nutrition and the diet they take. Your diet should include fresh fruits, vegetables, whole grains, beans, lean meats, and low-fat dairy.
• Focus on eating fruits and non-starchy vegetables, like broccoli, carrots, and lettuce, and having smaller portions of starchy foods, meat, and dairy products.
• Don’t opt for food items that have a high glycemic index (GI), a system that ranks foods according to how they affect glucose levels. High-GI foods include white bread, white rice, and soda. Limit fast food, too.

Exercise Regularly:

• Even without losing a pound, exercise can help keep diabetes under control. When you do physical activity, such as walking, your muscle contractions push glucose out of your blood into your cells. Result is Better blood sugar levels. The more intense the exercise, the better it is.
• Women who walked quickly gained more protection from diabetes than those who walked at a more leisurely pace.

Opt for Regular Tests:

• It is important for diabetics to opt for regular medical tests. If you are diagnosed with diabetes, it’s best that you take a weekly blood sugar fasting test. Please note that your diabetes can be pregnancy induced also.

Take proper medication:

• It is important you follow the medical regime recommended by your doctor. Do not self-medicate and do not take any medication without consulting your doctor.

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High blood glucose, also called blood sugar, can harm your baby during the first weeks of pregnancy, even before you know you are pregnant. With the help of your healthcare team, you can work on management of diabetes and can have a healthy pregnancy.

EFFECTS OF DIABETES ON THE BABY:

• High blood glucose levels can be harmful during this early stage and can increase the chance that your baby will have birth defects, such as heart defects or defects of the brain or spine.
• High blood glucose levels during pregnancy can also increase the chance that your baby will be born too early, weigh too much, or have breathing problems or low blood glucose right after birth.
• High blood glucose level can increase the chances of miscarriage and there are greater chances of having a stillborn baby.

EFFECTS OF DIABETES ON PREGNANCY:

• Hormonal and other changes in your body during pregnancy affect your blood glucose levels, so you might need to change how you manage your diabetes. Even if you’ve had diabetes for years, you may need to change your meal plan, physical activity routine, and medicines.
• If you have been taking an oral diabetes medicine, you may need to switch to insulin. As you get closer to your due date, your management plan might change again.
• Pregnancy can worsen certain long-term diabetes problems, such as eye problems and kidney disease, especially if your blood glucose levels are too high.

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Symptoms of Maternal Pneumonia

Pneumonia starts as flu or cold, you might experience symptoms like body aches, sore throat, and headache. Maternal pneumonia symptoms may include:

• Excessive fatigue
• Breathing difficulties
• Loss of appetite
• Rapid breathing
• Vomiting
• Chills
• Chest pain
• Fever

Maternal pneumonia symptoms do not usually differ between your trimesters.

Causes of Pneumonia during Pregnancy:

Pregnancy can put you at risk of developing pneumonia. This is in part endorsed to natural immune inhibition during pregnancy. This usually happens as your body is working harder to support the growth of your baby. Pregnant women possibly will be more prone to the flu because this time of pregnancy you may have reduced lung capacity. So, this makes you more susceptible to pneumonia.

Pneumonia is caused by a bacterial infections or flu virus that spreads to lungs. Often referred to as “community-acquired pneumonia.” Bacterial culprits include:

• Haemophilus influenzae
• Mycoplasma pneumonia
• Streptococcus pneumoniae

Following viral infections and complications can lead to pneumonia:

• Influenza (flu)
• Varicella (chickenpox)
• Respiratory distress syndrome

Possible you may be at a higher risk of having pneumonia during pregnancy if you are:

• Anemic
• Frequently visiting nursing homes or hospital
• Having asthma
• Having a chronic illness
• Working with young children
• having a weakened immune system
• Smoking

If you are suffering from bacterial pneumonia, your doctor may prescribe you antibiotics. But, antibiotics do not treat viral infections. To relieve pain and fever doctor may prescribe you over the counter pain relievers. For a recovery drink plenty of fluids and sleep well. Also, do not take any extra medicine or supplements that are not prescribed by your doctor.

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Causes of Chest Infections during Pregnancy:

• Closeness with an infected person.
• Smoking can trigger bronchitis.
• Sharing personal stuff with the infected person.
• Sharing utensils and food with an infected person.
• Not practicing personal hygiene.

Symptoms associated with Chest Infections during Pregnancy:

• A cough with sputum, blocked nose, mild fever, breathlessness, tiredness.
• Dyspnea, Rapid heartbeat and wheezing.
• Chest tightness, muscles pain.
• Sometimes nausea and vomiting.
• In case of TB- a persistent cough that lasts for three weeks or more, fever, fatigue and weight loss.
• Loss of appetite and nausea.

Treatment associated with Chest Infections during Pregnancy:  

If you experience any difficulty in breathing, wheezing or coughing, it is recommended that you consult a specialist at the earliest. This is important so that all the necessary precautions can be taken to ensure that the disease doesn’t get transmitted to the baby also.

Some of the natural remedies that can treat chest infections during pregnancy are:

• Hot Compress: You can use a warm towel or a hot water bag to calm your chest. It can make your body warm providing you relief.
• Dietary Supplements: Opt for a diet that is high in fiber content. Drink natural juices and eat whole grains. This type of diet increases your immunity level and helps you keep the chest infections at bay.
• Garlic Syrup: Equal number of white onions and garlic cloves with some honey can be chopped and put into a container for overnight. Consume this syrup at regular intervals with some warm water to ease chest infection

Preventive Steps to avoid Chest Infections in Pregnancy:

• Practice good hygiene personal cleanliness.
• Wash your hands often.
• Avoid coming into contact with the infected person.
• Take plenty of fluids and healthy diet.
• Take proper rest and ample amount of sleep.
• Quit smoking.

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Hand wash is must at some points in our daily routine. We all must be aware of those situations and should also teach children regarding importance of proper hand wash in those situations. Most of us are aware of those but still to emphasise are following:

• Before preparing, eating and serving food
• After touching or feeding animal
• After coming back home from office or school or park
• After using toilet
• After touching garbage
• Whenever hands are visibly dirty

Hand should be washed with soap and cleaned in the running water. At places where we may not have access to soap and water there alcohol based sanitizers can be used to remove germs and dirt and it usually cleans upto 60 % of your hand. Wide variety of hand sanitizers are available in the market and you can choose and busy any of sanitizer by looking at its contents.

Steps for hand wash with soap and water

First you have to wet your hands in clean and running water and apply soap. Make good leather by rubbing hands together in following sequence

• Back of hands
• Rub your palms with fingers interlaced
• Base of thumb
• Back of fingers to opposing palms with fingers interlocked
• Finger nails
• Wrist

For atleast 20 seconds scrub your hands then keep your hands under clean and running water to rinse. Always dry your hands after washing.

Steps for hand wash with hand sanitizer

Take palmful of product, apply on both hands. Rest steps are same as hand wash with soap and water. Rub your palms with fingers interlaced, back of hands, base of thumb, back of fingers, finger nails, and wrist. In some situations alcohol based sanitizers can reduce germs on the hands but doesn’t work when the hands are very dirty. The best way to get rid of all the dirt, germs or any type of chemical is to wash your hands properly with water and soap.

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• Drink lots of water

It is the elixir of life and keeps you away from numerous diseases, helps lose weight, keeps you hydrated and skin beautiful. There are innumerable benefits of having adequate water i.e. 10-12 glasses per day.

• Sleep

Get enough sleep and on time. It recharges your brain and body.

• Exercise

This is one thing which cannot be replaced by anything, at any stage of your life and quite a lot of pages can be filled describing benefits of physical activity. In short, you should exercise for 30-40 minutes on most days of the week. Pick an activity of your liking, keep changing your activity often, both aerobics and weight training should be done, core strength is very important, join a sport. Yoga is a boon to humanity which can be done by anyone and is beneficial for old age and pregnancy as well. Stay active in general. Start with 10 minutes if you have not been exercising. Something is better than nothing.

• Eat fresh fruits and vegetables

They give you the various essential nutrients like vitamins and minerals. Add bright coloured veggies to boost up your antioxidants which reverse the free radical damage to cells and slows the aging process. They also give you the fiber required for proper digestion and stool formation.

• Macronutrients

They are carbohydrates (40%), proteins (30%), fats(30%) needed in this proportion for the proper functioning of various systems of the body. Do not follow any crash or fad diet which disturbs this ratio and can slump your energy levels, in the long run, can also give you serious illnesses. If this percentage is followed, even diabetes can be reversed.

• Cut down processed food

They contain saturated fats, salt, sugar, and preservatives in increased amounts leading to many diseases like diabetes, hypertension, cardiovascular disease and cancers. Colas are also very harmful to the body.

• Eating techniques

It’s not always what you eat but also how you eat that can affect your body. Stop emotional eating. Stop when you are satisfied not overfull. Chew your food properly. Take small portions. Snack healthy. Stop eating 2 hours before bedtime. Practice mindful eating. Change your equation with food. Find other productive things to distract you when you are bored.

• Reduce your screen time

Watching meaningless things on screen adds to your burden and wastes your precious time which could be used for other fruitful activities with your family and for your well being.

• Mental and spiritual well being

Develop a good hobby, have friends, meditate, deep breathe. Try to omit negativity from your life from any source and cultivate positivity. Spend time doing things which you love with people whom you love in surroundings that you love. Love yourself.

• Health checkups

This is very important to detect any defect in your body before it changes to a serious illness. It is just like servicing your body so that it keeps on functioning smoothly and you regularly mend your ways to keep it in good condition. Go for blood tests, PAP test, mammograms, dental checks, eye examination regularly.

These are a few tips that if followed regularly become a way of life and fall in your daily routine with ease saving you lots of trouble later on same as the saying “A stitch in time saves nine”.

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Signs and Symptoms associated with Pneumonia:

Watch out for few of these major manifestations that can mean you have pneumonia. Nonetheless, these indications can extend from moderate to severe depending upon the sort of germ causing the disease, age, and your general wellbeing. Manifestations of a persistent cough with sputum, Breathing inconvenience, High fever and chills, Chest pain, Loss of appetite, Nausea and regurgitating or vomits.

Pneumonia during pregnancy:

• The presence of maternal sicknesses like anemia and asthma builds the danger of developing pneumonia in pregnancy. These are indications of pneumonia in pregnancy.
• Along these lines, the newborn children who are born to such females have low birth weight and increased preterm birth.
• Serious complications can occur to the mother also in the form of respiratory failure. However, since the approach of antimicrobials, the maternal death rate has diminished much.
• Pregnancy appears to increase the risk of major complications associated with pregnancy. Pneumonia in pregnant females is related to noteworthy fetal morbidity.
• The babies born can have preterm labor, growth retardation, and untimely birth. In extreme cases, intrauterine and neonatal death likewise has been noted.
• Most instances of pneumonia during pregnancy are caused by organisms that don’t influence the fetus, with the exception of through their consequences for the maternal status.
• All females with pneumonia in pregnancy ought to mandatorily test for HIV. It is on account of the fetus might be in danger because of maternal conditions which cause pneumonia-like an HIV contamination.

Pneumonia can be prevented by ensuring certain safety measures like getting vaccinated, Give attention to personal hygiene, especially the hands, Avoid or limit contact with the sick person and most importantly eat well and sleep well and build strong immunity.

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Clinical Breast Exam and Mammogram – It is used as a screening tool to detect early breast cancer in women experiencing no symptoms. All women should have screening mammography every year for women, beginning at age 40.

Pap Smear– It is a quick and simple test used to screen women for cervical cancer. Pap smear screening is recommended starting around 21 years of age if you are sexually active and then every 3 years.

Blood Glucose Test – Women should get a blood glucose test done every three years to check for diabetes or prediabetes from 45 years of age.

Heart Health Check-

• Blood Pressure -You should have it checked at least once every two years, starting at age 20.
• Lipid Profile – Every 5 years starting after 20 years of age.
• Weight Check – If you are overweight, it is a significant risk factor for many health conditions, including cardiovascular disease and diabetes. You should have your body mass index (BMI) and waist measurement every two years.

Complete Blood Count-This simple blood test tells how healthy our immune system is working. It measures white blood cells (high levels mean an infection), hemoglobin (low levels indicate anemia), and platelets (low levels signify your blood may have trouble clotting) and should be done every year.

Thyroid Disorders– It measures whether the thyroid hormone levels are normal or not.  More than half of all these cases may remain undiagnosed. So one should get it tested from the age of 35 years every 5 years.

Vitamin D Levels– Vitamin D deficiency is very common. Most people don’t realize that they have the deficiency unless it has a significant negative effect on the quality of life.

Bone Mineral Density Test – Menopausal women are at great risk of osteoporosis which makes the bones weak. Women should start getting a bone density test for osteoporosis with at age 65. Those with risk factors like fractures or low body weight should start their screening earlier.

STI Screening – If you have been sexually active at a very young age or have had multiple sexual partners then you consult your doctor regarding sexually transmitted infections.

Preconception Counselling – General check-up before planning a pregnancy to discuss any health risks during pregnancy and modification of certain risk factors like alcohol consumption and smoking.

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Symptoms associated with hypoglycemia or low blood sugar:

 It is defined as a situation when the blood sugar level is below 70mg/dl.

Mild-

• Hunger
• Nausea
• Headache
• Sleepiness
• Weakness
• Dizziness, shakiness
• Sweating with chills
• Nervousness, anxiety, crying, moodiness
• Fast heartbeat, blurred vision
• Tingling sensation around mouth or on tongue

During sleep-

If it occurs during sleep, it can cause nightmares, sweat on clothes or body, feeling tired or irritable on waking, seizures during sleep.

Severe-

The patient is not able to control and assistance is needed. You may feel confusion, lack of coordination, seizures, panic, the feeling of doom, loss of consciousness, coma and even death can occur.

Pregnant women who are taking insulin or hypoglycemic drug ( glyburide) are at increased risk. Both high and low blood sugar are harmful to pregnant women.

Prevention of hypoglycemia or low blood sugar:

If you are diabetic, you should take precautions like

• Food- Eating small frequent meals according to the instructions of the dietician with a balanced meal plan on proper timings can help. Meals should not be skipped.
• Proper dose and timing of insulin
• Avoid alcohol
• Exercise should be done after meal or snack. Over exercise is to be avoided. If an activity is increased, then the amount of food can be adjusted accordingly.
• Always carry a snack
• Keep a glucometer and frequently check the blood sugar levels

Treatment of hypoglycemia or low blood sugar:

• Easily digested food can be taken such as fruit juice( ½ glass), 1 cup no fat milk, 1 tablespoon sugar, 3-4 glucose tablets. This is around 15 gms of carbohydrates. Usually, blood sugar becomes normal after 15 minutes but if still, it is low, repeat the 15 gms of carbohydrates or sugar.
• If the patient is unable to ear or drink, emergency medical attention is needed. Glucagon kit may be prescribed. The hypoglycemic episode may cause loss of consciousness leading to accidents, injuries coma, and even death. So stringent sugar control is needed just like walking a tightrope.
• Sugar control also needs to be checked during labor, delivery and after delivery of insulin, the requirement may decrease after birth making hypoglycemia more likely during the postpartum period also.

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High Blood Sugar level and its effect on Pregnancy:

High blood sugar levels have different effects in different trimesters of pregnancy.

They can cause birth defects in the baby like neural tube defect or heart defect in the first trimester. It can also cause miscarriage. Miscarriage is defined as loss of the pregnancy before 20 weeks of gestation. Other complications related to diabetes can also occur in the mother. Desirable levels of blood sugar are-

• Fasting- 70-100 mg/dl
• 2 hours postprandial- less than 120 mg/dl

How to manage blood sugar levels?

The right blood sugar levels can be achieved by a delicate balance between meals, exercise, and medication.  Babies born to diabetic mothers are bigger in size or macrosomic i.e. >4 kgs. This is because mother’s sugar is high leading to increased sugar supply to the baby via the placenta. This causes increased insulin secretion in baby and more sugar being supplied and converted to fat in the baby.

Complications due to High Blood Sugar Levels:

• Polyhydramnios: Can be described as an excess of amniotic fluid in the amniotic sac. It is usually seen in 1% of pregnancy cases.
• Hypertension: High blood pressure induced due to high blood sugar and pregnancy. This can lead to preeclampsia.
• Preterm delivery
• Growth retardation in baby
• Stillbirth- baby can die in the uterus after 20 weeks.

Babies of diabetic mothers are also monitored for falling blood sugar or hypoglycemia after birth. They are also watched for calcium and magnesium levels.

Tips for prevention of complications due to High Blood Sugar Levels or Diabetes:

• Plan Your Pregnancy– Lose weight, control sugars and take pre-conceptional supplements like folic acid for better results
• Consult your Doctor well – Visit your doctor early when you miss your periods and keep visiting regularly. Don’t miss your appointment
• Eat healthy– meet a qualified dietitian and follow the diet plan advised by the dietitian
• Exercise- is a must and cannot be skipped. Stay active in general. 30 minutes of moderate activity is advisable on most of the days, at least for five days a week
• Don’t miss your medication
• Keep a regular check on your blood sugar levels.

These are a few things we can follow and achieve a successful outcome with diabetic mothers as well. Miscarriage is a great mental trauma for the parents and should not be in any case taken lightly.

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