Managing Diabetes for 2

While diabetes that's not under control can pose serious health threats, having diabetes and being pregnant comes with additional risks of complications for both mom and baby.

Mary Blasi can speak to that. Twenty-six years after learning she had diabetes, she was pregnant and well aware that managing her blood sugar would become doubly important.

"I was diagnosed with Type 1 diabetes at the age of 7," Blasi says. "When it came time to wanting kids, I knew it would involve a lot more from my care team compared to the average pregnant mother due to my diabetes."

Her care team would include UConn Health's Diabetes Self-Management Education Program, which includes nurse practitioner Luriza Glynn.

"In the mother, pregestational diabetes can increase the risk of complications such as high blood pressure, pre-eclampsia and other hypertensive disorders, development or worsening of diabetic retinopathy, and increase in risk of diabetic ketoacidosis. It can also increase the risk of developing long-term complications such as heart disease, nerve damage, and kidney damage," says Glynn, the diabetes education program's coordinator. "In the fetus, pregestational diabetes can increase the risk of complications such as macrosomia (large size) of the fetus, which can make delivery more difficult and increase the risk of birth injuries, premature birth, stillbirth, and birth defects."

Pregestational diabetes refers to diabetes that's present before pregnancy. It includes type 1 diabetes (also know as juvenile diabetes) and type 2 diabetes (also known as adult onset diabetes). Women who are not diabetic can get gestational diabetes, which is temporary during pregnancy and usually resolves after the baby is born. However, women who've had gestational diabetes do have a higher risk of developing type 2 diabetes later in life.

While it's always important for people with any kind of diabetes to manage their blood sugar levels, it's especially crucial during pregnancy - and in pregestational diabetes cases, before the pregnancy.

"Preconception counseling is extremely important to have the best maternal and fetal outcomes," says. Dr. Pooja Luthra, director of UConn Health's Diabetes Education Program and Blasi's endocrinologist. "It is best to keep the sugar control as normal as possible prior to planning pregnancy. This reduces the risk of large for gestation age babies, complications with delivery of the baby and also prevents low blood sugar in neonates after delivery."

Women with diabetes should plan for more frequent prenatal care visits and consultations with dietitians, Glynn says.

Achieving a healthy pregnancy as a diabetic mom is achievable even though it can feel very overwhelming. — Mary Blasi

Blasi, who lives in Plainville and is a nurse in UConn Health's operating room, was prepared to take the necessary steps, enlisting the diabetes education program, consulting with dietitians, and having more frequent prenatal care visits for both her pregnancies.

"The UConn Diabetes Education Program was very proactive in preparing for pregnancy and ensuring I was well prepared for the demanding daily tasks of carrying a baby as a diabetic mother," Blasi says. "The first big change was going from multiple daily injections to an insulin pump to help aid in tighter glucose control. After becoming pregnant I worked several times a week with UConn's diabetes team to make adjustments on my insulin pump, as the demand for insulin rapidly increases as you progress through your pregnancy."

UConn Health's Diabetes Education Program brings together physicians, nurses, dietitians and referring providers to offer personalized care and support and empower patients to take control of their diabetes through education, lifestyle, and the latest technologies.

"The biggest challenge was really the daily battle to ensure I was achieving the best glucose control I could," Blasi says. "The education program really informed me of all the complications that can affect the baby, so my blood sugars and blood pressures were constantly on my mind through the eight months I carried both my boys."

"Mary was willing to do anything to keep her sugars in control," Glynn says. "Mary manages her diabetes with an insulin pump and uses a continuous glucose monitor. As with most women with pregestational diabetes, Mary required an increase in insulin as pregnancy progressed, which resulted in an increase in steps involved related to day to day insulin pump use."

Blasi's first son, Mikey, was born in June 2020. Baby brother Bruno arrived December 2021. Both are graduates of the Connecticut Children's Neonatal Intensive Care Unit at UConn Health and are doing well.

"The first year with Bruno was a little crazy with two under 2 years old, but it has been so worth it! I am so blessed to have two beautiful and healthy boys," Blasi says.

She credits her OB-GYN, Dr. Christopher Morosky, plus Dr. Richard Wagner and Dr. Andrea Shields from maternal-fetal medicine, for collaborating with her diabetes care team "to help achieve the best pregnancy I could have." And she is thankful for the care, guidance and support from Luthra, Glynn, and nurse Amy Clark.

"I'm so grateful for having such an amazing team," Blasi says. "I spent much of my time with Luriza, who was absolutely amazing. She wanted to ensure I was fully aware of all the risks and challenges that I would face as a diabetic mother, and really instilled the importance of good glucose management."

And she has a message for those with diabetes who have dreams of motherhood:

"Achieving a healthy pregnancy as a diabetic mom is achievable even though it can feel very overwhelming," Blasi says. "It requires a large amount of self-discipline and lots of guidance from your care team. Don't give up when you have a bad day, and reach out to your team as much as you need to!"

Learn more about the UConn Health Diabetes Self-Management Education Program.