Mitzi Perdue

Diabetes During and Past The Reproductive Years

ABNORMAL GLUCOSE IN PREGNANT WOMEN: A WINDOW INTO FUTURE RISKS

Pregnancy is an insulin-resistant state, so future problems with diabetes may show up during this time. Although a pregnant woman with abnormal glucose may see her glucose problems go away once she’s delivered, she is at risk for diabetes in the future. After delivery, her OB/GYN should be in touch with her internist about blood sugar issues. This is important because the internist needs to know that preventive measures are needed even in the absence of symptoms. The internist may want to recommend lifestyle changes, such as strength training and controlling her weight.

PREGNANCY WITH ABNORMAL GLUCOSE CAN MOTIVATE WOMEN TO CHANGE THEIR LIFESTYLES

If a woman has an abnormality in glucose metabolism, this is a perfect time to encourage her to establish habits that she can continue the rest of her life. She’ll usually be highly motivated to do almost anything for her baby. A pregnant woman is apt to be so motivated to protect her baby that she’d be willing to eat cardboard three times a day and stand on her head (figuratively speaking) if it helps her baby! Pregnancy is therefore a very good time to suggest changes that initially will benefit her baby and will lower her long-term risk of developing diabetes.

RESISTANCE TRAINING IS IMPORTANT FOR DIABETES PREVENTION

For everyone who wants to avoid diabetes, resistance training is important. A large number of the body’s glucose receptors are in the body’s muscle mass, and it’s these glucose receptors that pull glucose out of the blood stream for use in the muscles. Muscle mass therefore helps in achieving normal blood sugar. However, as we age, and particularly after menopause, we lose muscle mass, and this makes us increasingly vulnerable to diabetes. Although walking or Zumba or whatever exercise a patient enjoys has many benefits, what’s really important for improved glucose metabolism is resistance training. This means weight lifting or bands or other exercises that focus on strengthening muscles.

ACHIEVING NORMAL WEIGHT IS IMPORTANT, BUT NO SINGLE WEIGHT LOSS REGIMEN IS PERFECT FOR EVERYONE

I tell patients, “You know your body better than I do. You know what foods are your triggers and what works for you.” Portion control diets work well for many patients, but not all. Portion control is the kind of diet that says, “You can eat that donut, but you have to cut back on something else.” Patients need to pay attention to–and minimize–eating foods that are difficult to eat in moderation.
Some patients are able to lose weight by cutting out carbohydrates. My problem with this is, cutting out carbs is not sustainable long-term.

On the other hand, it may be easy for some folks to handle a low-carb diet. One approach that does seem to help many people is they find they are less likely to overeat if they choose unrefined carbohydrates. Complex carbs such as beans are more filling and a person is less likely to overeat when consuming them.

THE GOAL IS TO HELP WOMEN TAKE CONTROL OF THEIR OWN HEALTH

Women do a good job of going to the doctor and having the rights tests. However, they also need to empower themselves to take action. Let’s say a woman visits her doctor because she doesn’t feel well. During the visit, she learns that she’s at risk for diabetes or she already has it. What happens next? Sometimes her response is to feel guilty, defeated, and overwhelmed, with the result that she’ll try to comfort herself by eating more.
As health care providers, we can try to prevent this by giving her positive and realistic things she can do to take control and minimize her risks. Let her know that she doesn’t have to be perfect; instead, encourage her to work on what she can and will do. Maybe she can start lifting weights. Maybe she could buy a new cookbook that would help her change her diet. Make sure to give patients advice on how to make things better and not just focus on how things look at the time.