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Re: [IPk] Pregnancy and diabetes: Woman's Hour tomorrow morning discusses la...

Hi Abi,

I know a few women who have sought Dr. Jovanovic's advice during their 
pregnancies in the past couple of years. These days she advocates testing at 
least every other hour while awake (5 times is definitely too few nowadays). 
She also advocates a 1 hr postprandial glucose level of no greater than 6.7 
mmol/L. Her goal for her pregnant patients' A1Cs is no greater than 5.0. It 
is HARD WORK to give carry a baby in practically nondiabetic conditions but 
with complete dedication and the technology that we have available today it 
is achievable for many people. [I know three women that have done it and one 
who is doing it now.] Jovanovic is a huge proponent of insulin pump use 
during pregnancy (and any other time, for that matter!) and she has been 
involved in a number of recent studies of continuous glucose monitoring. She 
has her pregnant patients on pumps (that is, most of her pregnant patients!) 
take a small injection of isophane before bed, combined with a 
lower-than-usual nighttime basal rate, so that *if* there is a problem with 
the pump overnight, the woman's glucose won't go too high before she can 
sort it out. Interesting strategy, I think.

Jovanovic does advocate a low-carb diet, but only for the purposes of 
minimising glycemic excursions. She does not advocate a diet that would put 
the foetus at risk of malnutrition, I think it is key to bear that in mind!! 
She sees a lot of Hispanic women with type 2 or gestational diabetes whom 
she puts on quiite strict diets because even if their calories are reduced a 
lot they will still be eating plenty of food. The type 1s she has to be more 
careful with, else there's a risk of foetal malnutrition.

Type 1 13 years; MiniMed pumper 7.5 years; Animas pumper 2.5 years

----Original Message Follows----
From: email @ redacted
Reply-To: email @ redacted
To: email @ redacted
Subject: Re: [IPk] Pregnancy and diabetes:  Woman's Hour tomorrow  morning 
discusses la...
Date: Tue, 27 Jun 2006 12:40:44 EDT
MIME-Version: 1.0

On the subject of pregnancy and other "womens stuff" and D , I think "The
Diabetic Women" by Lois Jovanovich Peterson, invaluable. It is about 10 
  out of date and therefore does not mention analogues -therefore much more 
  meal schedules etc. Dietary guidlines quite different from standard ones 
  diabetics eg minimising starches as well as sugar ( and as far as I am 
she  still advocates a lower carb diet than D UK,ADA etc) She is type 1
  herself and a pump user. She would advocate testing 5 to 10 times per day,
people accept  the fact that patients need to be supported in how to
  micromanage their own disease, and people understand that basing a diet on
foods that
raise blood  sugar may not be a good idea, we will still be in the dark  
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