Diabetes

The exact cause for diabetes is unknown. Type 2 diabetes is sometimes called adult onset diabetes. You may develop type 2 diabetes as a result of other factors such as, being overweight, a lack of exercise, eating and other lifestyle habits or some illnesses. It is more common in people who are overweight, this is because excess body fat doesn't allow the body to make proper use of insulin.

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high.

There are 2 main types of diabetes:

- Type 1 diabetes – where the body's immune system attacks and destroys the cells that produce insulin.

- Type 2 diabetes – where the body doesn't produce enough insulin, or the body's cells don't react to insulin

Type 2 diabetes is far more common than type 1. In the UK, around 90% of all adults with diabetes have type 2.

During pregnancy, some women have such high levels of blood glucose that their body is unable to produce enough insulin to absorb it all. This is known as gestational diabetes.

Can I have a baby?

Almost certainly, yes. Although the risks are still higher than for anyone without diabetes, with good antenatal care most diabetic women can have a healthy baby. There have been great changes: only 35 years ago, a quarter of babies born to diabetic mothers died before or shortly after birth.

Is it important to plan my family?

A baby is formed in early pregnancy, even before a pregnancy test is positive. More abnormalities at birth are found if the mother's diabetes is poorly controlled at this time. Diabetes should be as well controlled as possible before you become pregnant. This is the best investment a mother with diabetes can make on behalf of her unborn child. Discuss your pregnancy with diabetic clinic staff before you become pregnant. Obviously, this does not apply to women whose diabetes is diagnosed in pregnancy ('gestational diabetes').

Does good diabetic control matter all through the pregnancy as well?

Yes. It has proved beyond all doubt that the outcome is directly related to how well the diabetes is controlled. Poor control is associated with large babies, a variety of other complications and a high rate of cesarean section.

How good should my control be?

As good as possible. Aim for HbA1c below 6.5%.

How do I achieve this control?

As, control is balance between diet, activity and insulin. To achieve the best control you will need to test at a frequency that many people find unacceptable out of pregnancy. We often recommed 4 times a day, before meals and bed,everyday, with only one day off. This is the one time where diabetes really must become the most important thing in your life because another life depends on it too.

Will I have more clinic visits?

Yes. Pregnant women with diabetes are usually seen every one to two weeks - usually in a combined antenatal clinic with the obstetrician. Bring your results, antenatal records and a urine sample with you.

Will I need more insulin?

Possibly, yes. Insulin requirements rise in many women, reaching a maximum at 28 - 32 weeks (gestational diabetes is often diagnosed). After delivery, this falls to pre-pregnancy levels (and gestational diabetes disappears). The dose does not change in some.

What about hypos?

With very fine control of diabetes, the risk of hypos rises. The warning of these may also change slightly. They should be treated in the usual way. In fact, if you are never getting borderline to hypo, control may not be good enough

Will I have to be admitted to hospital?

Occasionally admissions to hospital is required during the pregnancy if, for example your diabetes is difficult to control. You may also be admitted a few days before delivery.

Will I have a normal delivery?

Labor is often induced at around 38 weeks, although there are no fixed rules. Many women then deliver normally, but there is a higher chance of a cesarean section (about 50%). Diabetes is controlled in labor with insulin given into a vein by a pump with an accompanying infusion of glucose, plus hourly measurements of blood glucose. This ensures the best start in life for your baby. A pediatrician is usually called to the delivery itself.

What happens after delivery?

Your baby may be routinely monitored in the Special Care Baby Unit for the first 24-48 hours as a safety measurement.

Will my baby have diabetes?

Almost certainly, no.

Can I breast feed my baby?

Yes. We would encourage you to do this. Your diet may need to be reviewed again.

Will gestational diabetes go?

Yes, until the next pregnancy. There is also a 50% risk of developing diabetes later in life especially if you're overweight.

Where can I find out more?

You can find out more information from :

- Diabetic and Antenatal clinic staff

Diabetes UK CareLine,

10 Parkway, London NW1 7AA,

Tel No: 0845 120 2960

- Health Promotion Authority for Wales

(www.hpw.wales.gov.uk)

- National Childbirth Trust

Alexandra House

Oldham Terrace

London W3 6NH

Enquiry Line: 0870 444 8702

(www.nctpregnancyandbabycare.com)

- Diabetes UK publish a comprehensive guide:

'Pregnancy and Diabetes', (ref. 6019), price £3,

(Tel. no: 0800 585 088).

Safer Surgery

Knowing your diabetes

The beginning of your surgical journey.

You and your GP may decide you need to see a surgeon to decide whether you need an operation.

It is important to have good control your blood glucose levels before a planned surgery.

Improving the control of your blood glucose levels before surgery can reduce the risk of complications.

If your blood glucose control is poor the surgery will not go ahead.

The waiting time for your GP referral to surgical treatment is 'Referral to Treatment Time'. This may take more than 26 weeks. This gives you time to your diabetic control.

How do I know if my diabetes is well controlled?

A blood test called HbA1c is a measure of how well controlled your diabetes is. This is taken at surgery at least once a year. For surgery to take place your HbA1c level should be below 69mmol/mol. It's useful to keep a record of it. Your planned operation may be postponed until you reach this target.

Your referral to the hospital

Your GP will send a letter to the surgeon requesting an appointment. This letter will contain certain information about your diabetes.

Knowing about your diabetes

It is also important that you know about your diabetes. Important things you should know:

- What type of diabetes you have

- When your diabetes was diagnosed

- Who manages your diabetes (GP & practice nurse or hospital team) and the date of your last review.

- If you check your blood glucose levels: how often do you do it and what readings you get

- Your treatment for diabetes (tablets, insulin and GLP injections)

- Any complications from your diabetes (involving your heart, kidneys and feet)

- Any other illnesses you may have

Other useful information to know before your surgery

You can ask you GP or practice nurse your:

- Weight, height, body mass index

- Blood pressure measurements

Before your hospital visits start

- Try to follow a healthy eating plan

- Reduce the amount of sugary and processed foods eaten

- If possible try to exercise 30 minutes a day, five days a weeks

- If you smoke, try to stop, your GP or nurse can help with this. A useful website is: stopsmokingwales.com

The first hospital visit

A surgeon or advanced nurse practitioner will decide whether surgery is needed then you will be put on a waiting list.

The pre-assessment visit

Once on the waiting list you will be seen in a pre-assessment clinic, to assess whether you are fit enough for surgery. In most instances a nurse will see you, however, sometimes you may be seen by a doctor (called an anesthetist). You may require further tests to ensure your surgery goes ahead as safely as possible.

What should I expect next?

If you pass the pre-assessment AND your diabetes is well controlled, the date for your surgery will be made.

How will my diabetes to managed during the surgery?

This will depend on your diabetes and type of surgery your are having. A plan will be agreed with you during your pre-assessment visits. We aim to cause minimal disruption to your diabetes management.

A copy of the plan will be given to you, this plan is made with you and should be taken with you to the hospital when you have your operation.

What now?

We recommend you refer to the Diabetes UK website (www.diabetes.org.uk) or the helpline (0345 123 2399 Money-Find 9am-7pm)for information. It may help you understand the importance of improving your diabetes before the surgery.

Thank you for reading and stay safe guys x