Shireen: In this episode, Sue Ellen Anderson, Haines dyes into the effects of preconception diabetes on getting pregnant and on pregnancy overall, she explores the connections between preconception diabetes and gestational diabetes, as well as the potential impacts on breasts. Tune in to learn more about how you can utilize a holistic approach to wellness and nutrition therapy to support your health and that of your baby.

Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish podcast. Yumlish is working to empower you, to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you.

Sue-Ellen is a mom, health writer and speaker, recipe developer, coauthor, wellness educator, and women's advocate with over 15 years of training in the health, wellness, and dietetics field. Welcome Sue Ellen. 

Sue-Ellen: Thank you for having me on line today. I appreciate it. Absolutely an absolute pleasure having you on.

Shireen: So then I want to dive right in and ask you, how did you become interested in nutritional and therapy and diabetes education, especially for pregnant women?

Sue-Ellen: Yeah. So I became interested in diabetes during my dietetic internship at Florida hospital. As an intern, I was impressed by the dietician I worked with and the way that she was able to lower her patient's blood sugar and thus the risk of chronic disease by specific strategies, namely medical nutrition therapy and also by teaching diabetes self-management skills. 

Additionally, in the inpatient setting, which is a hospital, I was able to observe and help manage symptoms of pregnant women who had hyperemesis or uncontrolled nausea and vomiting and blood sugar issues and other medical issues. So I saw both sides of the outpatient and the inpatient setting and my fascination grew. My fascination for women's health became more intense. When I became pregnant with my daughter, I became more hypervigilant. I mean, everything as it pertains to health and wellness, mother and baby. So that's kind of where my interests sparked.

Shireen: Interesting to help us understand how does type one diabetes preconception affect women's pregnancies?

Sue-Ellen: Yeah. So preconception education treatments can, uh, prevent complications for both mother and baby. And I'll talk a little bit about some of those complications, but type one diabetes basically means you don't have insulin. You're not producing enough insulin. And so insulin helps to lower your blood sugar after eating a meal, particularly a meal and carbohydrates. So without insulin, someone with type one cannot. Most women with type one because of this pregnancy or whether they're planning pregnancy in the pre-pregnancy stages, they need devices to help them better manage these narrow blood glucose ranges, such as a continuous glucose monitor or insulin pump. And so working with a registered dietician and the rest of the team, we help bring these ranges in better control and so lowering their risk of these complications. And I'll tell you a little story. Well, two stories, very short stories. 

So one patient that I worked with, um, struggled with team recommendations and, and the diabetes self-management skills that we were showing them. They kind of struggled to maintain those skills and to just to follow up accordingly and sadly, they had preterm birth, meaning that they delivered before 37 weeks. And one of the reasons we're due to the uncontrolled blood sugars, in addition to other complications that she was having. So on the flip side of this though, there are patients that I work with who do really well with following through with their self management skills and the nutrition therapy that we provide. And they have good support at home and they eventually have a healthy pregnancy and a healthy baby. And now this is with diabetes. So it is possible to, to, to maintain the recommendation and to seek out help before pregnancy and June pregnancy.

Shireen: Interesting. And both of these are type one diabetes? 

Sue-Ellen: Yeah. For type one, Correct. 

Shireen: So let's switch gears to type two diabetes. How are the effects similar or different?

Sue-Ellen: Yeah. So, pregnant women who have type one and type two diabetes, like I was saying earlier, they, well, what's similar. Let's start there. So the complications are similar. You can have congenital malformations for the fetus, which means that it can be born with heart problems or any kind of congenital issues can occur for the fetus and For the mom, there are other issues that can occur as well. Their hypertension can really get out of control there. Their eyes could be affected. their  kidneys. A lot of different organs that can be affected when blood sugars are not well controlled for type one or for type two. So again, the complications are similar for baby and mother. 

The difference for type two is that most women with type two diabetes have more insulin resistance because women with type two diabetes tend to be more obese than those with type one, according to research and according to the actual practice. We see that people with type one tend to be more overweight, including the woman. So it may be more difficult to manage blood sugars because of the strong insulin resistance factor. People with type two diabetes still produce some insulin, but initially may need to go on oral medication or pills. And diabetes over time  can become progressive meaning that you may need insulin if it's not well controlled. However, because one in four people with diabetes don't know they have diabetes by the time they actually get that diagnosed, the progression gets so rapid as you may have to be put on insulin right away. 

So what does this mean for pregnant women? Well, if you don't know, you have diabetes and you get pregnant, it puts you at risk for serious complications. And so another story would be like a patient that came to a clinic early in the pregnancy. And she was about seven or eight weeks. She came to our clinic early on and she wanted diabetes, prenatal, pregnancy care. However, her blood, her blood sugars were uncontrolled. She did know that she had diabetes versus other individuals that didn't know, but they were not well monitored. She wasn't following up with her diabetes over time. And then she found out she's pregnant. 

And when I saw her, we had a clinic visit and she seemed like she was going to follow through. And within a short few days, or maybe a week, she called the clinic that she had a miscarriage. So that is a complication similar to type one and two with uncontrolled blood sugars. You could have miscarriages or early abortion basically. So that's an example of things that are similar and things that are a little different with type two, but again, the complications are similar. 

Shireen: It's amazing the impact that it can have. And yet we have, you know, like you said, when it's undiagnosed, the person may not even know what is going on with them. 

Sue-Ellen: Yeah. And oftentimes we have women, they don't know they're pregnant and they don't know they have diabetes and they end up in the ER and you're like, well, do you know, you're pregnant? And do you know, you have diabetes, your A1C is like 10. And they're like, what? So, you know. Yeah. One in four, they don't know. And most of the diabetes in the United States is about 90% of it is type two. 

Shireen: What else do you think women with pre-diabetes or even diabetes preconceptions should know, even before pregnancy?

Sue-Ellen: So, what I think that women with diabetes should know, you know, before you, you mean before pregnancy, is that when you can increase your chance of having a healthy pregnancy because the people sometimes think that diabetes is a death sentence. It is not a death sentence. You can live very healthy with diabetes, you know, depending on you. And it is a self-management disease. So, you know, we give you the tools and you have to manage it with proper guidance. Right? So, the key message would be: you can increase your chance of a healthy pregnancy if you get prenatal care early, get it as early as possible.

As soon as you have the thoughts of becoming pregnant, go to your team, which is your registered dietician, which is your OB GYN, your endocrinologist, go to your team so that you can get proper counseling and we could set you up for a healthy pregnancy. The more planning you do, the better the outcome.

Shireen: Are type one and type two diabetes linked in any way to gestational diabetes. And if so, how? 

Sue-Ellen: Yeah. So type one is not linked to gestational diabetes. Type two is linked to gestational diabetes. So,  when you have gestational diabetes, about 50% of women go on to develop type two diabetes and about seven, seven to 10 years or so. And these numbers are even higher for a woman of color and it's alarming. And many people don't know that, you know, if you have gestational diabetes, you read also that, “oh yeah, it goes away after you deliver.” Yes, it can go away, but sometimes it can’t, it won't go away. 

I've seen it for women that, you know, I was told in class that, or I read somewhere that it's going to go away. And it was like, well, you know, there are some small exceptions and sometimes it doesn't go away depending on how intense your gestational diabetes was during the pregnancy. Right? When you take the oral glucose tolerance tests, your numbers could be so high that, you know, it's a concern that this may turn into type two later on, very sooner than those that are just missing the mark, because there is a glucose test that you take into the pregnancy at 24 to 28 weeks for gestational diabetes.

And if you fail these glucose tolerance tests, you're diagnosed with gestational diabetes. And what puts you at risk for gestational diabetes are a few things. And one of them is pre existing PORs or polycystic ovarian syndrome. Another could be, you have, you know, a history of overweight or obesity. And another surprise to many is a cultural background. That is a risk for having gestational diabetes. And what I mean by that is that if you are of African-American descent, Hispanic, Asian, Native American descent, your risks are higher for having gestational diabetes. 

And, just to kind of explain what gestational diabetes is, it's different from type one and type two, because this happens during the 24, 20 weeks where the hormones produced by the placenta kind of counteract the mother's ability to produce insulin efficiently. So there is insulin resistance, right? The placental hormone, it makes it hard for the woman again, to compensate for the amount of insulin they need. And so. It's difficult for mothers to keep their blood sugars in the  normal range after eating the meal, some women with gestational diabetes do need insulin in their pregnancy. Some do not. Some we help to manage with just nutrition. I would call it a diet and lifestyle activity and there they are fine. 

And usually those women that are able to maintain the pregnancy with this lifestyle approaches tend to possibly have gestational or type two diabetes later on in life. Those women that usually take insulin during their gestational diabetes – I haven't seen much studies, but in practice I've seen that they later on get type two diabetes, even sooner, especially if they don't go back to their pre-pregnancy weight within six months to a year. If they're not breastfeeding, I think we'll talk about that later. But gestational diabetes is very serious.

It puts you at risk for type two, which is the most prominent type of diabetes in the United States and across the world. 

Shireen:  So how can women with type one with type two diabetes utilize food and nutritional therapy before conception and during pregnancy to support their health and out of their child? 

Sue-Ellen: That's a good question. So kind of like a loaded question in essence, but so a combination of medical nutrition therapy and diabetes self management education given by a registered dietician may include, but it's not limited to your education on foods. Produce a slower rise in blood sugars. There are strategies like shopping, how to shop for foods., looking for reading labels, ingredient lists, meal planning, activity. A lot of these strategies are all individualized. So when you say, you know, how can women utilize these services? They need to actually go to the professional too. So we could show you how to support your diabetes in your pregnancy journey.

So seeking out a registered dietician who specializes in diabetes and pregnancy is extremely important.  That is a first step. Want to make sure you're doing that along with the rest of the pregnancy team, but nutritional therapy plays a vital role, because like I said before, in terms of gestational diabetes, you can manage gestational diabetes simply with just lifestyle, nutrition, therapy, and activity. Um, whereas type one and two, if they do, most type one need medication. They're all on insulin. Excuse me. You need medication management, but without nutrition, it's kind of like running through a wild goose chase, I would say without nutrition because that's part of the puzzle. 

You know, they all fit together and with type two, some women may be on an oral medication or we may have to switch them over to insulin because research doesn't really support taking particular oral medications during pregnancy, even though some providers do give that. So when you look at it either way, nutrition therapy for type one, type two. Or gestational diabetes lowers your risk of complications or mother and baby, and research does support that heavily. So again, the best way to utilize this is to seek out  a registered dietician in their pregnancy team or prenatal team. 

Shireen: So help me understand, does type one or type two diabetes influence breast milk? And if so, how?

Sue-Ellen: Yeah, this is a really good question too. It's not given notice. And some studies do show that restaurant production may lower or it may delay women who have diabetes delay their  restaurant production. And so why? You know, when blood sugars are uncontrolled, blood flow is compromised. Right? And similarly, if you think about healing, if someone with diabetes has a wound or a cut, we always say that you are at risk for poor wound healing because circulation is not adequate. The red blood cells are occupied with sugar molecules and they're not able to move freely through, through our blood, through our vessels. And so, as you think about breast milk production, blood flow is an important part of breast milk production. So I've read some articles and some studies that show that it's slower when breast milk comes out slower for those women that have diabetes. And for those who have diabetes and are not well controlled. So it can be a little depressing if you're trying to breastfeed. And you're like, you know, “I can't get enough milk” cause possible blood sugars are not where they need to be. But once they continue to breastfeed, lactation consultants do show that breast milk supply does continue to flow and flow more quickly. 

So again, it doesn't flow as quickly. It's much slower than those women that don't have diabetes, but it doesn't mean that they won't produce breast milk. So it does mean that you really want to hear from a lactation consultant. You want to make sure you have nutrition support from a dietician to help you with your meals and planning because without adequate intake meals fluid and all of that, your breast feeding production can be reduced.

So technique along with nutrition, along with support from family members and friends will continue to help women with diabetes breastfeed more efficiently because another study shows that if a woman with gestational diabetes and if they continue to breastfeed their chance for getting type two later in life decreases, and this is just gestational diabetes, right?

So diabetes overall breastfeed production is slower, but, like I said, the good thing is that if you continue to breastfeed for women with gestational diabetes, your risk for getting type two is lower overall. Any woman, whether diabetes or not, you, there are benefits for breastfeeding for the mom and for the baby that helps to shrink the uterus and helps with, you know, the good hormonal feelings citation that the woman gets from breastfeeding. And also it helps with the baby with, you know, Production decreases risk of developing asthma and different types of health issues, you know, and the good, the good, um, microbes that the baby needs for gut production and immune system is there. So we really encourage breastfeeding in the clinic, in my practice. We encourage it and we try to give support to those who, you know, may want to stop breastfeeding. Totally up to them. There are some contraindications, you know, medications that you may not be able to breastfeed with, But for those who can breastfeed, we support it a hundred percent.

Shireen: What is the importance of a holistic approach to wellness and adaptability to your body's needs as they change throughout your life cycle and pregnancy? Especially when you have a chronic condition like diabetes. 

Sue-Ellen: Addressing lifecycle needs using a holistic approach is something that Girls&Women360 specializes in. It's extremely important that you look at the whole person and meet them where they are in terms of their health goals and your life cycle needs. So the wellness recommendations that I may give to a teenager, for example, or a young adult, is totally different from an older woman. And now if you're pregnant and you have diabetes, my recommendations and supplementation is different.

So life cycle. Again, the approach is different. You can't give the same recommendations to everyone. And studies show that people with diabetes for example, have low magnesium. Right? So if I were not keen on this, I would kind of ignore this in the assessment, but  I make sure that I'm addressing their magnesium needs. look at their diets, asking specific  questions. And this is one particular example of nutrients that I zone into when doing a nutrition assessment with someone that has diabetes with a woman that has diabetes and their blood sugar goals again are different. And they have ranges that the relationships should be. And whereas a woman who does not have diabetes, that it's not more of a concern for us.

So holistic approach, meaning, you know, whole body, you know, addressing their mental health acts in for support, if they need it, making sure that, you know, they're also active and going over those types of techniques with them, if they need to refer them to an exercise physiologists, if need be are, you know, providing other recommendations.

Definitely just not focusing on one part of a particular person. You may miss out on answers. If you're just focusing on just one particular part and in patients, sometimes they give you clues as to, you know, other things that are affecting them that are challenging. And it is up to us as a provider to make sure that we are listening to what they're telling us, and also listen to what they're not telling us so that we can make the proper referrals, recommendations and treatment.

Shireen: In the last minute we have here, what if you had to give one tip related to nutrition therapy for women looking to incorporate nutrition therapy through their gestational diabetes. What is one tip that you would give them? 

Sue-Ellen: I would say that make sure that you are not skipping meals, not skipping out on carbohydrates. We see women with gestational diabetes. Also type one and type two diabetes, they avoid carbohydrates. They think that carbs are the enemy, but you actually need carbs as a main fuel for your brain and red blood cells and the main fuel for the fetus's brain and red blood cells. So whatever you do, don't eliminate your carbs. It's all about managing and choosing the right portions for you during your pregnancy. 

Shireen: Love that. And with that we're toward the end of the episode, unfortunately, how can our listeners connect with you and learn more about you? 

Sue-Ellen: Yeah. They can connect with me on my website 360girls&women.com. They can also follow us on Instagram and on Facebook our handle is @360girlsandwomen.com. And we use nutrition as the foundation, along with other innovative practices to help women journey, to complete health through the complete life cycle. So if you need more information, you'll figure it out.

Shireen:  Will do, I will link all of this in the show notes. Thank you so much to Ellen for your time today. This was very informational. Thank you for your time. 

Sue-Ellen: Yes. Thank you. 

Shireen: And to our listeners out there, head over to our social media on Facebook and tell us what's a pregnancy hack you think other women should know hetero origin resource, love media. Find our Facebook post on this podcast and comment on it. We will see you there.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

Shireen: We have an exciting announcement! Starting next week we will be dedicating our episodes to national childhood obesity month. For the entire month of September, we hope to increase awareness around childhood obesity and connect you with experts to help you better prevent child obesity and support related initiatives.

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