"This is not a disaster": Two stories about pregnancy with diabetes

It is believed that the presence of chronic diseases in women puts pregnancy at risk. The risk of diabetes is in its complications, but with proper control can reduce the risk of their development. In an article prepared jointly with Accu-Chek, we asked two heroines with type 1 diabetes about the course of pregnancy, changes in lifestyle, everyday difficulties and what helps them along the way. Sugar diabetes is a disease in which glucose levels blood gets too high. Over time, this can lead to complications of the cardiovascular system, damage to the nervous system and dysfunction of various organ systems. The hormone insulin plays an important role in the process of utilization of glucose entering the body with food. In diabetes mellitus of the first type, the pancreatic cells producing it are destroyed (the exact reasons for this are not known), so people with this disease require constant insulin therapy. In the second type, insulin is released, but the cells lose sensitivity to it. Such diabetes mellitus is called lifestyle disease - it develops with age, and its risk is greatly increased with obesity, low physical activity and arterial hypertension. If diabetes mellitus of the second type can be adjusted for a long time with diet and lifestyle changes, and then with different medicines, without resorting to insulin, then people with the first type of the disease need insulin daily. Margarita Bykova, 32 years old, economistGeneral pregnancy - 20 weeks - Diagnosis of diabetes mellitus first Like "I was delivered in February 2018. The first reaction was shock and denial. The brain refused to accept the diagnosis, I thought it was just a temporary failure. There are, of course, many rumors and horror stories on the Internet - for example, that diabetes is infectious or that it can be transmitted to children. Fortunately, I was lucky with a specialist: she explained that this diagnosis is not a sentence and that I can live a long healthy life if I follow certain rules. My mother was very worried. The husband took the disease calmly, quickly learned to read the labels on products, look for low-carb goodies. The most difficult thing in relations with relatives is pity when you are perceived as sore and looked with tears in your eyes. And I am not sick, I just have a peculiarity - I manage my pancreas myself. The most difficult thing in relations with relatives is pity when you are perceived as sick and looking with tears in my eyes I wanted to get pregnant, and together with a specialist we developed a training plan. None of the doctors did not intimidate me, everyone just insisted that it was necessary to achieve a compensated state in advance and maintain it, that is, glucose indicators should be within normal limits. If they are not controlled, there may be problems with gestation, developmental defects in the fetus, complications in the mother. But even if sugar sometimes goes beyond the required limits, it is not a catastrophe - it is important to be in the required range most of the time. Besides standard observation in the antenatal clinic, every two weeks I visit an endocrinologist, and every trimester I regularly go to the examination at the Research Institute of Obstetrics and Gynecology and Reproductology behalf of D. O. Ott - a specialized center for planning and managing pregnancy in women with diabetes mellitus type one and type two. The rest of the pregnancy is no different from any other. I had to change my diet a lot: now I can’t put something in my mouth without thinking, every piece has to be taken into account, I can even come to visit with food weights. Organization is also very important, you need to control sugar all day and night, do not forget to carry everything you need with you: insulin, means for stopping hypoglycemia, at least some food, a blood glucose meter, test strips, a pump and a remote control, some consumables. I can travel, play sports and other favorite things, just many of my actions are now accompanied by the question of what sugar I have now. For flights it is best to have a certificate from an endocrinologist - so that there are no questions to the insulin pump. It is also important to carry with you a card with information in English about the disease and how you can help me in the event of something. In the first type of diabetes, insulin is not produced, so it needs to be administered from the outside. For the past couple of months, I have been using an insulin pump - this is the device by which insulin from the reservoir flows through the catheter under the skin. Attached to the pump control panel. Together with a specialist, coefficients are entered into the memory of the device to calculate doses, which can then be changed as needed. Irene Brana, 28 years old, photographer Daughter Juno, 1.5 months. I have a girlfriend with diabetes. Somehow we went for a walk, and I learned what hypoglycemia is - a sharp decrease in the level of sugar in the blood, because of which a person begins to behave strangely, confused in thoughts. If this happens, you need to eat something sweet. A friend then bought a chocolate bar and gave half to me. I walked and thought: “How good, when you can eat just for pleasure, and not because it is a matter of life and death.” Then, when I was twenty-two years old, I began to feel bad: I lost weight, I started to reduce my legs, twofold in the eyes. There was constant thirst - I still remember how I sat on a pair at the university and, seeing someone on the table had a bottle of water, could not tear my eyes away from it. With the help of that same friend, I measured the sugar level, he was much higher than normal. The next day I went to the clinic, where the endocrinologist referred me to the hospital for a thorough examination. There the diagnosis was confirmed: diabetes mellitus of the first type. It happens that people refuse to believe that it is forever, and if a child is sick, they try to take it to all sorts of shamans or grandmothers. Unfortunately, many institutions still believe that diabetes becomes pregnant it is impossible, but if you become pregnant, you only need to give birth by caesarean section. Previously, all the risks were really difficult to control, but times have changed, and now everything is not so scary, and women with diabetes are bearing and having babies almost equally with healthy ones. Of course, you need additional control: if usually a person with diabetes of the first type measures the level sugar eight times a day, then during pregnancy it should be done 15 times or more often. During pregnancy, I was done 12 times by ultrasound. I was pregnant at the D. O. Ott Research Institute of Obstetrics, Gynecology and Reproduction, a specialized center for women with diabetes, and gave birth to a daughter for 38 and a half weeks - quickly, without anesthesia and interventions . I tried, breathed correctly, my husband was next to me. The daughter was born perfectly healthy, but with a decent weight, 4.4 kilograms, although an ultrasound scan was calculated for a kilogram less. I was even delighted with this error - if it were known that it is large, then I would definitely be advised to have a cesarean. Since it is impossible to predict how the body will react to childbirth (by increasing or decreasing glucose), then an endocrinologist is constantly present. They also start examining the child immediately and measure sugar levels at short intervals. I would like more people to know about diabetes mellitus of the first type so that even those who have not personally experienced the disease have information. There are a lot of misconceptions: people think that I just ate a lot of sweets and that now I don’t have it, that I have the same diabetes mellitus as their grandparents, or that this disease is sexually transmitted. Sometimes people ask about the pump, whether it is a pager - you have to remind what year it is. Some people think that this is a sentence - for example, I had friends who cried and asked: "Why are you?" Others perceive calmly, support, joke. It happens that people refuse to believe that it is forever, and if a child is sick, they try to take it to all kinds of shamans or grandmothers. For a person with diabetes, discipline is important. Of course, anything happens: once on a trip, I accidentally pulled a needle from under my skin, but there was no spare. It was in Murmansk, I called the hot line and managed to get needles literally ten minutes before closing the duty pharmacy. If you go to hot countries, we must remember that when heated, insulin loses its properties. You go swimming - you need to turn off the pump and put a cap, and then do not forget to check the sugar level and connect everything back. But in general, it is very convenient to use the pump - besides, there is a wireless controller, and you can, if necessary, inject a dose of insulin even in public transport. The material has been prepared with the support of

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