Diabetes is a condition where the pancreas- does not produce enough insulin, which is needed for the body to absorb sugar (glucose) into cells and process it.
It is one of those chronic conditions that has significant potential of wreaking havoc during a pregnancy.
Many diabetic women who become pregnant will be on insulin. Through the course of the pregnancy, the needs of the body for insulin will continually change and dosage adjustments are inevitable. This means that monitoring of the condition will need to be closer and almost always involves not only the obstetrician but a specialist physician (for diabetes) as well as the GP, midwife and probably a diabetic liaison nurse; a classic multidisciplinary approach.
This is not meant to cause anxiety to the mother but to provide a close and coordinated service to ensure the best possible outcome.
There is no doubt that if a pregnant diabetic woman has poor blood-sugar control, the chances of a poor outcome are high. Not only that, but there is the possibility of very serious diabetic complications which in extreme cases could be life-threatening to the mother herself.
There is a group of women who become diabetic for the first time in pregnancy and whose diabetes ends with their pregnancy. This condition is aptly called "gestational diabetes". This will also require special measures, which will differ from person to person. All this is explained in detail in response to specific questions in this chapter.
Diabetes is one of those conditions which can be quite effectively controlled, to the point where pregnancy seems uncomplicated.
This, however, entails a very interventionist approach, which many women may find unacceptable. The onus is on the health-care professionals, from the midwife and GP through to the hospital-based professionals, to ensure the mother understands why a particular management plan is required and why each specific measure needs to be taken.