Dear Doctor,
I'm a 36-year-old expecting mother, but I've got diabetes. How can I control my blood sugar level better? Now I am injecting insulin, and my blood sugar level before breakfast about 3.5 to 5.7, but sometime after food, it goes up to 10.6. I'm quite worried.
Dear Kuan Yee,
Your after-meal blood sugars are high - the usual target is less than 6.7 mmol/l. If you are on insulin, then you need to balance the insulin requirement with your food content, in particular the amount of carbohydrates in that meal. Please discuss with your doctor on adjusting your insulin dosage and regimen in order to achieve the required target goals for your blood sugars.
Dear Doctor,
I would like to know the risk and preparation of getting pregnant for diabetes carrier. What are likly to be the outcome of the process during the pregnancy? I had a pre-mature baby of 24 weeks with 540gm birth weight. Is being a diabetes patient the cause of this prematurity?
Dear Joanne,
I take it that by 'diabetes carrier', you mean that the person has diabetes. It is always said that no woman with diabetes should enter into pregnancy without prior planning. We call this 'pre-conception planning' in medical terms. This would involve both you and your doctor (diabetes specialist) discussing and attaining good blood sugar control prior to conception. This might mean going on to insulin injections even before pregnancy if you were on oral tablets previously. You need also understand that the pregnancy blood sugar targets are much stricted that the pre-pregnancy targets. Only when you are ready and your doctor agrees, should you start trying for a baby
Unfortunately there is 'good' and 'bad' regarding having diabetes in pregnancy. On the one hand, poorly controlled diabetes can affect the baby's development in terms of miscarriages and congenital malformations. Poor blood sugar control leads to big babies which make for difficult delivery and poor maturation of the babies' lungs. On the bright side, good sugar control from pre-conception can reduce all these complications to that similar to non-diabetic pregnancies.
It is really difficult to say if diabetes was the main cause for your baby's premature delivery and this is best discussed with your own OBGYN
I hope that the above information motivates you to control your diabetes perfectly whilst planning for another baby !
Dear Doctor,
I am 31 and expecting my 2nd child soon in September. I am considering if I should deliver naturally as my first child was delivered by C-section as he had his umbilical cord around his neck. However, my gynecologist has kept the option open. I am inclined to consider caesarean surgery again, as I am concerned about the physical discomfort of natural birth. Are there truly more benefits with natural birth?
Dear Jennifer,
As the indication for your first C-section sounds like fetal distress, you can try to deliver vaginally the second time round if the post-operative period was uncomplicated. Most obstetricians would encourage vaginal delivery rather than C-sections if possible. This is because although the risk of C-section is very low, it is still four times higher than that of a vaginal delivery. Bleeding during operation or post delivery, infection, clotting of the deep leg veins just to name a few are more common after a C-section. Bonding is also hindered if the C-section is performed under a general anesthetic. Most women are able to ambulate earlier and recover faster with vaginal delivery. In your case, if this birth is by C-section, your next delivery will almost invariably be another C-section.
However, I have come across some women who had experienced both and preferred C-section to vaginal birth. Unless you are very lucky, you most likely need some stitches at the private part. To some women, this is worse than an abdominal scar. Elective Caesarean sections allow things to be planned better. If the operation is done before you go into labor, then you don't have to go through labor pain. However, nowadays you can also have painless labor if you have an epidural ( or happydural as I call it). A trial of your previous C-section scar on the uterus carries a very very small risk of it giving way. If you are unlucky and it happens, then it can be very serious problem. Sometimes you may lose your womb in order to control bleeding.
The bottom line is that you have to discuss this with your obstetrician. Sometimes another problem in your pregnancy combined with a previous uterine scar may make C-section necessary. Please discuss it with your doctor who knows you best.
Dear Doctor,
I am already into the 2nd trimester of my pregnancy but I am still experiencing nausea and vomiting. It is somewhat reduced from the first trimester but it is still bad. The only foods that do not turn me off are fries and deep fried meats. While I know that my diet is neither nutritious nor healthy, I cannot seem to stomach anything else. Is there anti-vomit medication I can take, or vitamins I should supplement to avoid being "malnourished"?
Dear Serene,
I fully empathize with what you are going through. Although it is rare to continue nausea and vomiting when you are into the second trimester, it can happen in some. If you have persistent weight loss and a slightly raised pulse rate, excessive thyroid function has to be excluded. Sometimes bladder infection and multiple pregnancies can also predispose to this. Nausea and vomiting also can be secondary to gastric problems. After excluding treatable causes, the management is really tender loving care from your loved ones, simple measures like adjusting your eating pattern and amount to make things better. Don't lie down immediately after eating as food and acid reflux back up the food pipe can trigger off heart burn and nausea. We have medication which may help by either making you sleepy so you don't think about the nausea or medication which work on the vomiting center in the brain. Vitamin B6 has been tried but not proven to be effective. I find that distracting yourself from thinking about nausea and the vomiting that may follow helps. Don't allow your brain to reinforce this horrible feeling.
If you cannot eat, try drinking electrolyte drinks and drinks containing glucose if you are not diabetic. Water is also an essential part of your diet. Generally most Singaporeans are well nourished and you won't be affected much by not eating well for short periods of time. Your fat store can be broken down and sustain you for quite a while. Studies during times of famine has not shown any significant reduction in the birth weight of babies. Don't feel guilty about not eating the most healthy food. Although eating fries and deep fried meat is not to be encouraged as a regular part of your diet, under your present condition, you may just have to eat what you fancy. See fries as a source of carbohydrate. See deep fried meat as a source of protein. Just eat what you can. There are of course lots of other ways to supplement such as those in tablet or liquid form. I am sure that if you think positively, your problem will go away soon.
Dear Doctor,
I am 35 years old and I gave birth to my fourth child a few months ago. With each of my past 3 pregnancies, I gained 15kg and only managed to lose weight a year after giving birth. This time round, my weight gain was also 15kg. Now, several months after giving birth, I seem to have gained more than I lost even though I had Malay massage for a week 3 days after delivery and am on total breastfeeding. After Malay massage, my tummy was smaller, but now it is fatter again. Why didn't I lose weight even though I am totally breastfeeding? I don't eat a lot each day and have even cut down on my rice intake.
How do I lose weight quickly and healthily?
Dear Angela,
Your weight change is a balance of intake and expenditure of calories. Everyone has a basic requirement of calories to sustain life, any excess to that, it is stored as fat. Most women will shed about 7kg of weight as soon as the baby is born. You need to work hard to shed the remaining excess from your postnatal weight. Total breastfeeding will help in weight loss because you use up calories in producing breast milk. However, a lot of breastfeeding mothers experience an increase in appetite and thirst. This may hinder your wish to reduce your daily intake of calories.
The bottom line is that you need to be very aware of the daily calorie intake. You also need to exercise regularly, at least 3 times per week if not everyday. This might be lacking now as you may be preoccupied with your newborn and your other 3 children. There is no way out though. Try to do short spells of exercises eg. walking, brisk walking or skipping. Ten minutes each time thrice daily would add up to 30 minutes of exercise daily. The rate of weight loss has to be realistic. Most people can only shed half to one kg per week.
If you have done the calorie restriction (but please do it sensibly as you need nutrition for breastfeeding) and have been exercising regularly and still have problems, you can try to seek medical help to exclude endocrine problems. There are medications available to suppress your appetite if you are not breastfeeding. However, they should be used as a last resort.
Good luck and don't give up.
Dear Doctor,
I am diabetic and currently 34 weeks pregnant. I would like to know if it is advisable for me to breastfeed my baby. Will breastfeeding increase her chances of becoming diabetic?
Dear Sally,
You can definitely go ahead with breastfeeding and your diabetes should not compromise that at all. However, your diabetes control remains very important even during this period of breastfeeding. If you are unable to keep to blood sugar targets without medication, you will need to continue with insulin, just as you did during pregnancy.
Her chances of getting diabetes are determined by your husband's genes and yours and also only later in life. Therefore her risks are higher if both you and your husband have diabetes. However, she can still help prevent its onset by leading a healthy lifestyle through keeping an ideal body weight (not being overweight) and regular exercise.
Dear Doctor,
I am in my 5th month of pregnancy and was recently diagnosed with gestational diabetes. This my first pregnancy and I am 32 years old. Please advise on what I can do to stabililse my blood sugar and prevent from becoming a diabetic after child birth.
Dear Sing Mei,
You should best discuss this with your OBGYN and if necessary see an endocrinologist or diabetes specialist. True, gestational diabetes comes on during the later part of pregnancy and disappears after that. However, it is difficult to tell if you had diabetes prior to pregnancy and only detected it through testing, during pregnancy. The only sure way is to check with an oral glucose tolerance test (OGTT) about 2 months after your baby's delivery. You can't do anything to prevent 'being diabetic' after childbirth. What you should concentrate on now, is to keep your blood sugars strictly within the stipulated targets to prevent complications to your pregnancy and baby. You do this through proper meal choices, exercise (within the limits prescribed by your doctor) and regular blood sugar checks, sometimes done up to 6 times daily!
If your diabetes 'disappears' after pregnancy, you are still at a higher risk of developing diabetes later in life or in future pregnancies. The key to preventing this is to keep to your ideal weight (adjusted for your height), through regular exercise (after pregnancy) and a balanced diet, with lots of vegetables, fruits and grains.
