Prenatal Care: When Diabetic Moms-to-Be Stop Oral Medications and Switch to Insulin

Pregnancy brings many changes. For diabetic mommies-to-be, these changes are likely to include stopping oral diabetes medications, which are not approved for use during pregnancy, and starting insulin injections. Understandably, the need to start taking insulin may stir up negative emotions, even fear. Mommies-to-be may have thoughts such as "I don't like having to inject myself with drugs," "What if my other meds stop working for me after taking insulin?," and "Will I ever get off this stuff?" To cope with these types of uneasy thoughts, here are three gentle ways to help yourself make the emotional transition to taking insulin during pregnancy.

First, the big picture

It's easy for new insulin regimens to seem to "take over the world" and mushroom into an oppressive focus on blood sugar levels. But here's the big picture of prenatal care issues for diabetic women:

Blood sugar control during pregnancy is highly important for both mother and baby. However, according to BioMed Central, a tunnel-vision focus on strict control of blood sugars may cause its own set of significant problems. Look at this list of some of the emotions felt by diabetic mommies-to-be whose prenatal care centered on very stringent blood glucose monitoring. According to Prenatal Care Issues for Diabetic Women, researchers found these women felt:

--- Near constant anxiety and severe pressure over their baby's health, including "significant self-blame" for the risks to their baby's health;

--- Enslaved to stringent , constant, omnipresent blood sugar monitoring procedures;

--- Invisible and unimportant as individuals, because health care professionals tended to focus solely on the baby's health, with little emphasis on how the mom-to-be was doing; (this was especially difficult as many of the women suffered multiple episodes of hypoglycemia in the effort to strictly control their blood sugars).

Add to this picture the need, set out by Eastern Virginia Medical School, for most pregnant diabetics to stop oral diabetes medications, which may have been very effective and acceptable, and start insulin. Prenatal care for diabetics often means insulin. Insulin means needles, different monitoring requirements, and sorting out short- and long-acting versions.

Most powerfully, insulin is a symbol, rightly or wrongly, of the extent to which one is sick with diabetes. Clearly, an active coping strategy, designed to mellow one's emotional reaction to starting insulin, may be helpful.

Get plenty of "sugar"

Choosing to view taking insulin as good prenatal care --- that is, doing something good and protective for your baby --- rather than simply controlling blood glucose levels, can be profoundly calming. Most parents are willing to make substantial sacrifices for their children. These acts just occur sooner for diabetic mommies.

Gabsmom2, a Type I diabetic, posting at Diabetic Mommy, writes: "I truly believe that we diabetic moms are some of the strongest moms out there. We have to endure so much for the love of our babies, before and after" they are born. She adds, "We do all of this for the welfare of our children."

One gentle way to change your mind's emotional reaction to the new, prenatal need to take insulin is to get plenty of "sugar." No, this isn't about glucose, sucrose or any other -ose! It's about that wonderful kind of sugar---"sugah"--- that is love, especially a mother's love, and which is expressed in lots of sweet talk and baby babbles and coos. Regularly talking sweet talk to your unborn baby, sharing comforting words, laughing --- all this may help keep the focus on how taking insulin is helping you do the best you can to keep your baby healthy and happy.

Count your blessings

Yes, the old adage to "count your blessings" is as wise as ever --- and now scientists are proving it! To turn this bit of wisdom into practical, mini cognitive-behavioral therapy sessions, try to set aside a few seconds after you check your BGL or take insulin. Clear your mind of everything related to diabetes. Then name five things, large or small, for which you are thankful or which made you happy that day. Think of it as sending yourself five positive mental tweets --- such as "I got a great parking spot at Sam's Club" and "The robin that had been pooping on my car didn't show up this a.m." --- several times a day.

Doesn't sound like much. But this mental exercise, cued by and tied to your diabetes regimen, can be a powerful mind-changer. It's also another gentle way to guard against the oppression of "Must Monitor Blood Glucose Level" tunnel-vision in prenatal care.

Watch your language

Years ago, after navigating in rough waters for quite a while, I was fortunate enough to be seen by a multidisciplinary pain management team. One of the team's doctors was a psychologist. He listened patiently to my narrative. He then said, "This is what I heard you say." I was shocked. Basically, in referring to my treatment, I had constantly used words of helplessness: "I have to take chemotherapy," "I have to go to the hospital," and so on. Have to, must, no choice.

Wrong.

The good doctor pointed out to me that I did, indeed, have a choice as to each and every thing, even if it meant living or dying. He urged me to free myself from my unwitting descent into the language of helplessness. He said if I was actually choosing to take chemotherapy because I thought it was best for me and my family, because, in fact, I wanted to live, then I should say so, rather than saying, "I have to take chemotherapy."

He was right. It was freeing. And that experience came to mind when thinking about being faced with the need to take insulin as prenatal care. Sure, in most cases, it's a Hobson's choice. But it still can be freeing to lose the "have to" language. If you've made up your mind to follow your doctor's recommendation to take insulin, watch your language! Root out and avoid words of helplessness.

Switching from oral diabetes medications to insulin

Pregnancy brings unique changes for diabetic mommies-to-be. Prenatal care usually means switching from oral diabetes medications to insulin. Gently changing your mind and your words can ease the emotional transition to taking insulin.

More B.A. Rogers: Don't Miss the Babies Eating Lemons Craze and Quiet! The Baby is Learning to Talk!

Sources:

"Good Prenatal Care," American Diabetes Association.

Marie Berg and Carina Sparud-Lundin, "Experiences of professional support during pregnancy and childbirth - a qualitative study of women with type 1 diabetes," BioMed Central.

Katherine Brind'Amour, "Prenatal Care Issues for Diabetic Pregnancies; Study Shows Women with Type 1 Diabetes Struggle with Health Concerns," Suite 101.

"Medications for Diabetes Used During Pregnancy," Division of Maternal-Fetal Medicine, Eastern Virginia Medical School.

Rui Coelho, M.D., Ph.D., et al., "Coping Styles and Quality of Life in Patients With Non-Insulin-Dependent Diabetes Mellitus," Psychosomatics, Psychiatry Online.

"Motivation & Advice Page (From Other Diabetic Mommies)," Diabetic Mommy Online Magazine.

B. A. Rogers, "Got Happiness? How to Increase Your Emotional Resiliency," Associated Content.