Diabetes and pregnancy: type 2 diabetes

1) Blood glucose levels

• Aim for your HbA1c to be less than 48mmol/mol before becoming pregnant
• It is helpful to measure your glucose levels more often.
• There are several useful times of day to check your blood glucose levels. It can be helpful to start with checking once or twice a day and then build up.
• Once you are pregnant, we will encourage you to monitor your blood glucose levels more often.
• These are some of the times that are more helpful to check:
  • Fasting/when you first wake up (within 10 to 15 minutes of waking)
  • Before every meal
  • At one hour after a meal (from the first bite that you eat).
  • You are aiming to keep your blood glucose between 3.5 and 10.0mmol/l. However, please do not worry if your glucose levels are not there yet, we will work with you to support you to bring them into the healthy range for pregnancy. Remember any improvement in glucose levels towards these targets will reduce risk

2) Start taking 5mg folic acid daily for at least three months before trying for a pregnancy. Folic acid is a B vitamin that helps with brain and spinal cord development, and it takes three months to build levels up for its full protective effect. This dose is only available on prescription from your GP. This can be taken alongside a ‘routine’ (pre) pregnancy multivitamin that also contains a small amount of folic acid (400mcg)

3) Medication review

4) Healthy weight - there is good evidence showing that being at a healthy weight before becoming pregnant improves the health and outcome of your pregnancy. Being overweight carries independent risks such as high blood pressure, risk for pre-eclampsia, difficulty giving birth and unhealthy weight gain in your baby. If you are overweight, any weight loss prior to your pregnancy will be of benefit. See page 10 for more information and ask at your clinic appointments if you would like more support with weight management.

5) Eye and kidney checks are really important, please ensure that your eye and kidney checks are up to date.

For extra information please visit the Tommy's website (opens in a new tab).

• The recommendation is to take 5mg folic acid daily from 3 months prior to the pregnancy and continue until the end of week 12. We recommend that you take 5mg folic acid until after your dating scan when your pregnancy dates have been confirmed.
• All pregnant women are recommended to take vitamin D (10 micrograms) through their whole pregnancy and during breastfeeding. This can be taken as a single supplement or as part of a pregnancy specific vitamin and mineral supplement. Vitamin D is essential for healthy bone formation in your baby, and it helps insulin to work more efficiently.
• If you are vegan, it is recommended that you take an iodine supplement of 150mcg daily.

Smoking - if you smoke, it is beneficial for you, your pregnancy, and the health of your unborn baby to stop smoking. The hospital midwives will refer you to your local smoking support service to help you with this.

Already pregnant? – please do not panic, start taking 5mg folic acid daily, if you have not already and contact the pregnancy team (contact details on page 18).

We have a team of doctors, nurses, dietitians, and midwives experienced in supporting women with diabetes during pregnancy.

We can see you regularly in clinic. We also encourage email contact in between appointments.

• Pre-pregnancy - in the Diabetes and Women’s Health Clinic we can see you every 2-3 months to support you preparing for pregnancy.
• Pregnant - in the Diabetes Antenatal Clinic we can see you as often as required; usually every 1-3 weeks. With email or telephone support between clinic appointments.
• Email support - Email the Cambridge diabetes service for any questions. We encourage you to share your glucose meter or sensor upload or written glucose diary with diabetes medication doses with us by email to support you with your glucose management.

Once pregnant you may notice quite early on that your diabetes and glucose management is different. This is normal.

• Up to 8 weeks you may notice your glucose running higher and/or being more variable.
• Between 8-16 weeks you may find that your blood glucose readings are a little easier to keep in the healthy range for pregnancy. This is helpful as this is a really important time for your baby’s growth and development.
• From 16-18 weeks you will start to become more insulin resistant, and your blood glucose readings might start to rise. If you are taking insulin, you might notice your insulin requirements start to rise. Insulin resistance is a normal development as your pregnancy progresses and is caused by the pregnancy hormones.
• By 24 weeks of pregnancy, it is recommended that your HbA1c measurement is below 43 mmol/mol. This has been shown to reduce the risk of your baby growing bigger than is healthy for them, needing an admission to neonatal intensive care unit (NICCU) and having a low blood glucose after birth.
• A key change to glucose levels in pregnancy is that they tend to swing up more after meals, especially after breakfast. Please see diet section for tips on how to minimise this (from page 4 onwards).
• If you are taking background insulin and at least one dose of insulin at mealtimes you are eligible for NHS funded glucose sensors for one year. We will get you started and trained with this as soon as possible.

The following guidance is to help you keep your glucose levels in a healthy range for pregnancy.

• On waking less than 5.3 mmol/l (please check within 10 to 15 minutes of waking)
• 1 hour after start of meals less than 7.8 mmol/l

If you are using a glucose sensor, your targets are:

• As much time as possible in the healthy range 3.5 – 7.8 mmol/l
• Less than 4% below 3.5 mmol
• Less than 1% below 3.0 mmol/l

If you are new to using a sensor you might find your time in range is less than recommended, we will work closely with you to steadily increase this time. As you change your diet you should see your glucose levels move into the healthy range for pregnancy.

Please see our Top Tips leaflet for using glucose sensors in pregnancy.

It is also important that you eat a healthy balanced diet, please look at the Start4life - healthy eating pregnancy website (opens in a new tab) as it is a useful source of information.

• Carbohydrate is an important part of a healthy balanced diet providing you with energy, essential vitamins, minerals, and fibre.
• It is important to eat enough carbohydrate to keep your diet nutritionally balanced but not too much to cause your glucose levels to sit above the healthy range.

Glucose levels are more likely to stay in target when carbohydrate is spread over three smaller meals with carbohydrate snacks mid-morning and in the afternoon.

The amount of carbohydrate that you tolerate is likely to change as your pregnancy progresses and we will review this with you at your clinic appointments.

You may find the carbohydrate amounts below a good place to start.

• Breakfast: 15-20g carbohydrate
• Mid-morning snack: 5-15g carbohydrate
• Lunch: 40-50g carbohydrate
• Mid-afternoon snack: 5-15g carbohydrate
• Evening meal: 40-50g carbohydrate
• Keep your evening snack carbohydrate free

We can discuss portion guidance to help you keep to the recommended quantities of carbohydrate with meals and snacks.

Other sources of information to help you regulate your carbohydrate intake are:

• Carbs and Cals book (Chris Cheyette and Yello Balolia, Publisher - Chello) is a useful supplement to regulating your carbohydrate intake.

• MyFitnessPal App
• Food Labels: use the “total carbohydrate” amount when working out how much carbohydrate is in the food.
• Restaurant websites: nutritional information.

• Glucose levels tend to swing up much more after breakfast and so you will need to be much more careful with both the type and amount of carbohydrate at this meal.
• Most women find 15-20g carbohydrate works well at this time of day.
• Breakfast cereal of any kind will cause glucose levels to rise above target and are best avoided during pregnancy.

• 1 slice whole-wheat toast with a topping e.g. poached or scrambled eggs/mushrooms/tomato/cheese/ham/bacon/another cold meat/avocado.
• Or 1 small pot yoghurt with 1 chopped fruit or cup of berries and optional topping of chopped nuts.
• Or 25g jumbo porridge oats mixed raw with crème fraiche and 1 cup berries and optional topping of chopped nuts.
• Or 40g jumbo porridge oats cooked with water and single cream added to taste and can flavour with cinnamon, cocoa powder, or an artificial sweetener.

• Getting up and being active for 15-20 minutes after eating can make your post-meal glucose level up to 2mmol/l lower and really help achieve the post meal glucose target.
• This can be going for a walk or being active around the house or workplace.
• Avoid being inactive immediately after eating.
• Think about how you can structure activity in your day to time with after meals e.g. timing a meal before walking to work, nursery, or school, eating breakfast earlier to allow time for activity after, getting support from family so you can be active after your evening meal.

• When pregnant the absorption of insulin slows down and so it becomes even more important to give your mealtime insulin before eating.
• In early pregnancy give insulin 15 minutes before eating.
• In mid-pregnancy it is helpful to aim for 20-30 minutes before eating.
• As your pregnancy progresses this time will need to gradually extend to 30-45 minutes.
• Think about how you can structure your day to help you achieve this. Maybe use the alarm function on your phone. For example, if you are timing your insulin 20 minutes before eating set the alarm to go off 20 minutes before you are due to eat or 20 minutes after you have injected.

Eating more protein foods such as lean meat, fish, chicken, cheese, eggs, tofu, Quorn, pulses and vegetables will fill you up more and stop you feeling hungry when eating smaller carbohydrate portions. These foods also help limit the rise in glucose after meals and so help you keep to below 7.8mmol/l.

• Snacking between meals can be helpful to avoid post meal lows, help manage hunger and optimise nutrition.
• Making snack choices healthy, high in fibre and avoiding refined forms of carbohydrate helps to keep glucose levels stable between meals.

Try to carry healthy snacks with you when away from home in case you get hungry.

Healthier snacks containing 10-15g carbohydrate:

• 1 fruit portion (a helpful measure is an amount that you can fit your hand around)
• 2 whole-wheat crispbreads or 2 oatcakes with low fat cream cheese
• 1 small yoghurt pot
• 1 slice of wholemeal bread with cheese/nut butter/egg/other non-carbohydrate choice

The following snacks contain minimal carbohydrate and can be eaten at any time without needing insulin:

• Natural nuts or mixed seeds
• Olives
• Vegetable pieces such as celery, carrots, cucumber eaten alone or with a dip such as humous, cream cheese or salsa
• A small bag of vegetable crisps
• Avocado
• Cherry, plum or salad tomatoes
• Cubes of cheese (try with cocktail onion or gherkin), mini mozzarella
• Cooked meats
• Sugar free jelly
• Small corn on the cob
• Boiled egg

• Overnight can be as much as a third of your day, so getting glucose levels at a healthy level before bed and overnight makes a difference.
• Eating your evening meal before 7.30pm makes a difference to overnight blood glucose readings and will help you to be in-target on waking.
• If you become hungry in the evening it is helpful to not go to bed hungry but to have a carbohydrate free snack (see list above for ideas).

Nausea or ‘morning sickness’ can be a problem in pregnancy and can affect you at any time of the day. The following suggestions may help but please mention this to us at your next appointment.

• You may struggle to follow the dietary guidelines for pregnancy whilst struggling with nausea. Make a list of foods you can manage and bring to clinic so we can discuss how best to include these and help keep your blood glucose readings in target.
• Avoid going long stretches of time without food.
• Eat carbohydrate foods regularly throughout the day. Dry carbohydrate foods such as plain digestive biscuits and crackers like oatcakes or Ryvita may ease the nausea.
• Try drinking fluids before or after meals and snacks, rather than with them.
• Some people find ginger teas or peppermint teas can help with nausea.
• Avoid strong food smells.
• If you are unable to eat or drink without vomiting, please call your diabetes educator, GP, or Clinic 23 (see contact numbers below) for help.
• If you take insulin and are concerned about giving insulin when you may vomit, you can take 1/2 - 1/3 (a half or a third) of your mealtime insulin before eating and the rest when you are sure you are not going to vomit.
• If you are experiencing frequent hypos (blood glucose levels below 4.0mmol/l) due to vomiting, please contact a member of the diabetes team for advice.

• It can be challenging to keep up with all the changes over the course of your pregnancy.
• Sharing your glucose data every week when not in clinic can help with this.
• Use the pregnancy email to stay in touch

• The body becomes more efficient at using energy from food during pregnancy and most women find they do not need to eat more than usual until the last three months of pregnancy.
• Your appetite and rate of weight gain are good guides as to whether you are getting enough energy from your diet.
• It is not helpful to gain too much weight as this increases insulin resistance making it more difficult to keep glucose in the healthy range for pregnancy.
• Gaining more weight than is healthy can increase other risks as mentioned earlier such as high blood pressure, pre-eclampsia, more difficult birth, poor wound healing, and unhealthy weight gain in baby.

The table below (sourced from the US Institute of Medicine due to lack of UK data) gives a guide for healthy pregnancy weight gain based on your pre-pregnancy body mass index. (BMI).

• If you take insulin, you may be at risk of hypoglycaemia – where the blood glucose level drops below 3.5 mmol/l.
• ‘Mild’ hypos, although not pleasant and inconvenient, are not considered harmful to you or your baby.
• Eating regularly and always including a slow released carbohydrate with each meal and as a snack will reduce your risk of hypoglycaemia.
• To reduce the risk of having a nighttime hypo, aim for your blood glucose levels to be around 6-7mmol/l before bed. If your blood glucose is less than 5.0mmol/l before bed it is helpful to have a small carbohydrate containing snack of about 5-10g carbohydrate.

You are more at risk of having a hypo in the first 16 weeks of pregnancy and will need to be more careful to avoid hypos during those early weeks.

If you use a glucose sensor, and your sensor is reading less than 3.5mmol/l and you have hypo symptoms:

• Please treat as a hypo (hypo treatment suggestions below).
• After taking hypo treatment, please check with a finger stick blood glucose at about 15 minutes after the hypo treatment, to show recovery from the hypo, as this is more accurate than your sensor at lower levels.

If you use a glucose sensor, and your sensor is reading less than 3.5mmol/l but you do not have any hypo symptoms:

• Please check your blood glucose with a finger stick reading and if your finger stick reading is less than 3.5mmol/l please treat the hypo (hypo treatment suggestions to follow).
• After taking hypo treatment, please use a finger stick blood glucose reading at about 15 minutes after taking the hypo treatment to show recovery from the hypo, as this is more accurate than your sensor at lower levels.
  • Carry hypo treating foods / drinks (such as glucose tablets, “Lift” ® glucose juice or 200ml carton smooth orange juice) on you when away from home; keep some in the car and by the bedside.
  • If you take insulin check glucose levels before driving and ensure your glucose levels are “above 5 to drive”. See information leaflet on driving.
  • Check glucose levels before having a daytime nap, especially in the afternoon, to ensure you are at a safe level as this is often when glucose levels drop low.
  • If your sensor is showing glucose below 6mmol/l with arrows down have a 5-10g carbohydrate snack and ensure your glucose is stable before you sleep.

Hypo Treatment

Take 10-15g quick-acting carbohydrate:

• 4-5 glucose tablets e.g. Dextrose ®, DextroEnergy ®
• Or 4 Lift ® glucose tablets
• Or 1 Lift ® glucose juice
• Or 200mls smooth orange juice

This should raise blood glucose levels quickly and symptoms should clear within 5 - 15 minutes, confirm glucose levels are back in normal range with a blood glucose finger prick check. Do not use the glucose sensor to confirm this because it has a delay, and you can end up over-treating a hypo if you were to rely on the sensor data.

Ketones

• Ketones are produced when we breakdown stored fat for energy.
• Pregnant women are more likely to produce ketones, as this can be part of the changes that normally occur in pregnancy.
• Showing small amounts of ketones at times, especially if you have gone a long stretch without eating e.g. overnight, with glucose levels in the normal range are not a cause for concern.
• However, if you are seeing ketones regularly and losing weight, these can be signs that you are not eating enough.

Illness

• If you are unwell your glucose levels are likely to run higher than usual, and you might need more insulin (if taken) to keep them in the healthy range for pregnancy.
• If feeling unwell:
  • Monitor blood glucose levels every 4 hours.
  • Stay in close contact with the diabetes and pregnancy team for support and guidance.
  • Drink plenty of sugar free fluids or water 100mls per hour (2.5L per day) to avoid dehydration.

If you are taking insulin, you are likely to need to take more insulin to keep your glucose levels in the healthy range:

• Please use the following table to guide you on giving additional insulin to ‘correct’ high glucose levels above target before meals and bed.
• You may also need to increase your background or overnight insulin temporarily, ask the diabetes and pregnancy team for guidance.

• Your eyes will be examined two or three times during your pregnancy. The National Eye Screening Programme will be informed of your pregnancy, and you should be contacted to be screened in the first trimester. Please let us know if you have not received an appointment.
• Any eye disease present may worsen during pregnancy. If you are concerned about this, please ask at your next appointment.
• If you attend the eye clinic you should inform them of your pregnancy as you may need to be seen more often.
• You should seek an urgent assessment if you experience blurred vision, flashes of light, new floaters, or a change in vision. This can be a sign of changes to your eyes or indicate pre-eclampsia is developing (high blood pressure in pregnancy). If this occurs after 24 weeks in pregnancy, please also contact The Rosie maternity assessment line on 01223 217217 for advice.

Your kidney function will be checked during your pregnancy by blood and urine tests, and we will discuss the results with you. Any kidney disease present may worsen during pregnancy. We will ask you to provide a urine sample when you are in clinic to monitor your kidney function and check for signs of an infection. If you are concerned about this, please ask us at your next appointment.

• This will be measured at every appointment to screen for pre-eclampsia (high blood pressure in pregnancy) and to monitor pre-existing blood pressure problems.
• Aspirin 150mg once daily is prescribed to reduce risk of preeclampsia.
• 150mg Aspirin is recommended for all from after their dating scan, until 36 weeks gestation, to reduce the risk of preeclampsia.

• This is a programme run by NHS England.
• This audit collects data about your pregnancy and baby to better inform how to provide the best care for women with diabetes in pregnancy.

• Pregnancy in women with diabetes is classed as ‘high risk.’
• Your pregnancy will be actively supported by the obstetric team, which includes the offer of additional scans and foetal monitoring for the growth and well-being of your baby.
• NHS Choices website has a link for specific advice about pregnancy.
• It is important to continue to see your community midwife throughout your pregnancy for routine antenatal care.

Early pregnancy - up to 12 weeks

Please contact your local midwife for a pregnancy “booking visit” as soon as your pregnancy is known. The midwife will complete a medical and pregnancy history, order pregnancy blood tests and notify the hospital for your scans to be booked. Or if you are in area then you can make a self-referral via the Rosie website.

A midwife from the diabetes in pregnancy team will contact you in the early weeks of your pregnancy to discuss the following care recommendations:

Scans offered:

• 7-9 weeks - early pregnancy scan
• 11-13 weeks - dating scan with option for nuchal screen

Antenatal Clinic (ANC) booking visit with the obstetric team, which is requested for a time after your dating scan.

It is recommended that along with your booking bloods that you would have blood tests to check your HbA1c, kidney function and thyroid function.

Aspirin: for most women we will recommend taking 150mg Aspirin daily from 12 to 36 weeks to reduce the risk of pre-eclampsia.

You will be offered appointments to see the diabetes team every 1-3 weeks depending on how much support is needed to optimise glucose levels. At these appointments we will request a urine sample and as necessary, we will order blood tests.

Mid pregnancy - 13-26 weeks

Scans offered:

• 20 weeks in the Foetal Medicine department (Clinic 22) to review the development and well-being of your baby.

Please remember to book your antenatal classes if this is your first pregnancy.

At 24 weeks gestation we ask you to have a HbA1c which we are aiming to be as close as possible to 42mmol/. This has been shown to reduce this risk of having a larger baby or the need for NICCU or your baby having a lower blood glucose level.

Late pregnancy - 27-39 weeks

Scans (growth) offered to assess the growth of your baby, the fluid around your baby (liquor volume) and blood flow through the cord:

• 28 weeks scan and routine bloods plus diabetes bloods; HbA1c, kidney function and thyroid if needed
• 32 weeks scan
• 34 weeks scan if HbA1c above 48mmol/l or some other clinical indicator
• 36 weeks scan

You will be offered appointments with the diabetes and / or obstetric teams after each scan. Your diabetes medication needs for the birth and after the birth of your baby will be discussed with you around 32 to 36 weeks and will be documented in your notes.

You will be invited to a video education session at around 34-35 weeks where we will discuss your care during and after the birth of your baby and give guidance on colostrum harvesting.

Research shows that the placenta can age a little earlier in pregnancy when you have diabetes.

Please look out for:

• Loss of, significant reduction or change in baby movements.
• Significant fall in insulin requirements, if taken
• Increased frequency of hypos

Please contact the Maternity Assessment line 01223 217217 (open 24 hours a day) the same day you notice the change.

At 32-36 weeks we will make a plan for your diabetes management during and after the birth of your baby.

• Depending on what medication you took to manage your diabetes before pregnancy you may stop all diabetes medications once your baby is born.
• If you plan to breastfeed you may need to continue metformin and / or insulin, as most diabetes medications are not safe for use when breastfeeding.
• Your insulin requirements will return to pre-pregnancy levels within 24-48 hours after the birth.

The obstetrics team will be able to talk to you about your birth plan. National pregnancy guidance recommends that your baby is born between 38 and 40 weeks gestation due to the small increased risk of unpredictable stillbirth after 40 weeks and for many this may mean we recommend an induction of your labour. We are happy to talk through your birth options in clinic, so please ask.

It is recommended that your baby is born on the Delivery Unit where the full maternity care team (including obstetricians, midwives, and anaesthetists) can provide the recommended monitoring and support for you and your baby.

If you take insulin, your insulin requirements during labour are likely to remain similar to what they were at the end of your pregnancy. You are aiming to keep your blood glucose levels between 5 and 8 mmols/l throughout labour to support healthy glucose levels in your baby when born.

If for any reason you need support with your glucose levels during labour or your glucose levels are running outside the range 4 to 8 mmols/l you can be changed to a ‘variable rate intravenous insulin infusion’ (insulin through a vein) to maintain optimal glucose levels.

• It is helpful to offer your baby a feed within an hour of being born as this can reduce the risk of them having a lower blood glucose.
• Keeping ‘skin to skin’ contact with your baby in the first few hours, or as long as you want will help to encourage regular feeding and keep your baby warm and calm which has been shown to help keep their glucose in a healthy range.
• You can learn to hand express colostrum from 36 weeks and store it in the freezer so that if your baby has a low blood glucose level or needs extra feeds you have your own milk to give them. This will be demonstrated at the Teams meeting when you are about 34-35 weeks (or we can demonstrate it to you at your 36 weeks clinic visit).
• Your baby will have regular blood glucose monitoring during the first 24 hours after birth. Some babies require support to help stabilise their blood glucose levels after birth. At your 36 weeks appointment you will be given the leaflet ‘Information for parents whose baby is at increased risk of low blood sugars after birth’ which explains the treatment advice.

If continuing with insulin - do not give any quick acting insulin with your first food after the birth of your baby.

When you come into hospital it may be useful to have a checklist for things you will need for your diabetes.

Remember to bring:

• Blood glucose meter with plenty of test strips and lancets, small sharps bin if you have one and your glucose diary, if used.
• Spare glucose sensor, if used.
• Spare batteries for glucometer and sensor reader, if used.
• All insulins and metformin, if taking.
• Snack foods.
• Hypo treating foods.
• Sugar free drinks.

Your breastmilk is made exactly right for your baby, and it constantly changes to meet their needs as they grow.

Breastmilk also contains helpful things that no other milk can, including:

• Special factors that promote growth
• Antibodies that provide protection for your baby against infection

Breastfed babies are less likely to develop; type 1 diabetes, allergies, become obese (with associated risks for heart disease and type 2 diabetes).

If you choose to feed your baby formula milk it is helpful to feed them regularly, responding to their feeding cues, to help support their glucose levels in a healthy range. Keeping your baby close with ‘skin to skin’ time will help with this. If you would like to give your baby colostrum, or to give the first feed as a breastfeed, this has many health benefits. Please speak to a midwife in the Diabetes Team if you are interested in this

Things to consider for yourself:

If you take insulin, requirements are lower when breastfeeding. This will have been considered when working out your post-birth diabetes medications.

• You will need to eat extra carbohydrate to meet the demands of milk production, typically 30-60g carbohydrate (an extra 200-500 kcals) each day. Most women find their appetite during breastfeeding meets their increased needs, but if you are unsure of your diet, please discuss this with your diabetes dietitian.
• As breastfeeding stimulates milk production a small carbohydrate snack (10-15g) such as a glass of milk to keep your glucose levels stable and in a healthy range when breastfeeding will help.
• Monitoring your glucose levels using finger stick measurements or your sensor data around feeding times can help you to learn how breastfeeding affects your glucose levels, and the best ways to support optimal glucose levels.
• Keep hypo-treating foods by the bed or chair where you plan to feed your baby, in case your glucose levels fall below the normal range.

• It can take some time for your glucose levels to settle down after your baby is born.
• Life with a new baby is unpredictable as your sleep patterns change and you meet your baby’s needs for responsive feeding.
• During the early months aim for your glucose to run between 6-10mmol/l over the day, and do not worry if you see the occasional rise to 12-15mmol/l after meals.
• As you become more settled in your new routines you can nudge your targets down to 4-10mmol/l.
• If you are breastfeeding and taking insulin:
  • It is helpful to check your blood glucose levels more often around feeding times to learn how the feeds are affecting your glucose levels.
  • Keep hypo treating foods in the unusual places that you would feed your baby.
  • Please do get in touch if you need any more support with your blood glucose management.
• You will be offered a follow up appointment in the diabetes clinic 4 weeks after the birth of your baby and then around 8-10 weeks, to review your diabetes care. If you do not receive this appointment by 2-3 weeks after your baby is born, please get in touch. After this you will be booked back into your usual diabetes clinics.
• We encourage you to keep in contact with the diabetes team for support during the early days and weeks of new motherhood.
• You should see your GP practice for your routine postnatal mother and baby checks. Please ensure you take the opportunity to discuss contraception at this visit. Breastfeeding alone is not a reliable form of contraception.

It is possible to get pregnant 3 weeks after giving birth even if you are breastfeeding and therefore it is helpful to think about the best form of contraception you.

For some, there is the possibility for a Depo injection, which provides 3 months of contraceptive cover, before you leave The Rosie Hospital. Please discuss this with the Diabetes in Pregnancy Team if this is something you are interested in.

There are many contraception options available, please see links for further support:

• Family Planning Association (opens in a new tab)
• icash (opens in a new tab)
• Where to get contraception (opens in a new tab)

Diabetes in pregnancy team contact details Monday to Friday

Email the Cambridge diabetes service (preferred contact)

Diabetes Specialist Midwife: 01223 586901 (answerphone)

Diabetes Specialist Nurse: 01223 348790 (answerphone)

Diabetes Specialist Dietitian: 01223 349471 (answerphone)

Appointments: 01223 217664

Scan department: 01223 217621

Clinic 24 –for pregnancies under 13 weeks: 01223 217636 or 01223 217637

Delivery unit/maternity assessment (clinic 23): 01223 217217

Other useful sources of information include (all correct April 2024)

• Stopping smoking (opens in a new tab)
• Diabetes UK (opens in a new tab)
• NHS website (opens in a new tab)
• Rosie website
• Tommy's website (opens in a new tab)

Healthy eating

You are encouraged to eat a healthy diet that is high in fibre, low in fat, low in added sugar, and low in refined carbohydrate and salt, and includes plenty of fruit and vegetables. There are many benefits to eating a healthy diet including:

• feeling well
• achieving and maintaining a healthy weight
• avoiding constipation
• reducing the risk of developing heart disease and some cancers

If you are overweight with type 2 diabetes, losing weight and being more physically active are both especially important parts of your diabetes management. To lose weight, you need to use up more energy (calories) than your body takes in from food and drink. Which is where increased activity will help. Research shows that losing 5-10% of your body weight can also lead to health benefits such as reducing your risk of heart disease and high blood pressure as well as improving blood glucose levels.

Being physically active

• Studies have shown that being physically active reduces insulin resistance which means you will need to take less insulin or produce less insulin to manage your blood glucose levels.
• The ideal duration of activity for weight loss is 60 minutes every day. However, with a new-born this may be difficult to achieve and/or maintain. Any increased activity will be helpful. Breaking the activity time up into smaller chunks may be more achievable and is just as effective. For example, three lots of 15-20 minutes. You will know you are exercising at the right level if you are breathing harder than normal but still able to have a conversation.
• If you are having more hypos with activity, please contact your diabetes nurse.

When can I start exercising?

• It is advised that you wait until after your six-week postnatal check before resuming regular exercise.
• If you had a caesarean section your recovery time may be longer.
• For more advice, please speak with your midwife or GP. After your postnatal check at six weeks, you could join a postnatal exercise class. It may help to be with other new mums.
• If you plan to go to an exercise class that is not specifically for post-natal mums, please tell the person running the class if you have had a baby in the last few months. It is important that you take care of your back and avoid exercises that could injure it.

Can I take my baby along?

• Many postnatal classes let you do the exercise class with your baby at the side of the room.
• Some exercise classes sometimes allow the baby and pram in as part of the workout.
• Ask your health visitor or ask at your local Children’s Centre if they know of appropriate classes in your area.

Other activities you could do

It is recommended that you start exercise gently and feel comfortable with what you are doing. You could try the following:

• Push your pram at a brisk pace, keeping your back straight. Walking is a good form of exercise, so walk as much as you can.
• Climb your stairs at a brisk pace. It is likely that you already go up and down many times a day, so think of it as good exercise.
• When your lochia (postnatal bleeding) has stopped, you can try swimming. If you take your baby with you, try to have someone else there too so that you get a chance to swim.
• Play energetic games with older children. You can exercise by running about with them. You may be able to find outdoor space if there is no space at home.
• Online exercises are available too, here is an example of one specifically for the postnatal period - Bodyfit by Amy (opens in a new tab) This way you can Exercise after pregnancy (opens in a new tab) do a workout at home. You could get a friend or your older children to join in.
• Exercise information (taken from NHS Choices Website) Exercise after pregnancy (opens in a new tab)

Practical Points

Minor changes to your diet and lifestyle will have a positive impact on you and your families’ health, both now and in the future. Rather than making drastic changes that leave you feeling overwhelmed or that are too hard to keep to, why not make small changes that can eventually become habit?

• Make your change realistic and achievable; you will feel more positive and “empowered” as you make the change.
  • For example, “I will start with a brisk 15-minute walk to the shops twice a week”. Then when you are able, build this up to a 20/30-minute walk and / or walk at a faster pace or increase the number of days you go for a walk.
  • This will be more achievable than “I am going to run for an hour a day every day” when you have never run before.
• Plan your meals ahead and prepare a shopping list for these meals. You will then only buy the food you need and be less likely to buy surplus or less suitable food.
• Avoid shopping when you are hungry, so you are less likely to make impulse buys.
• Cut down the quantity. It may sound simple, but just eating smaller portions will reduce calorie intake. Eating from a smaller plate which holds less food, and ordering small portions, are both ways that can help you to reduce the quantity you eat.

Other sources of support

There may be a range of different weight management services and groups available in your area. Your GP or practice nurse may be able to direct you to services accessible to you.

Examples of local services may include:

• A dietitian who can offer more specialist, individualised advice to manage your weight. To access a dietitian, you will need to be referred by your GP.
• An exercise referral scheme run by exercise specialists, usually within local leisure centres. To access this, you will need to be referred by your GP.
• Community-based schemes might be available in your area, ask your health visitor about the local support options for weight loss.
• Commercial weight loss groups such as Slimming World and Weight Watchers.

What about the rest of the family?

If you think that your children could also benefit from having a healthier diet and being more active, they may like to visit the following website:

• Better Health - Healthier families website (opens in a new tab), designed to help families eat better and move more.