Posted on September 19, 2016

Ramya Munuswamy, a 35 year old type 2 diabetic gave birth to a healthy baby boy at Women’s Hospital, despite being told in her home country that she should terminate her pregnancy because of the increased risks associated with uncontrolled diabetes.

Not ready to give up on her pregnancy, Ramya went to a private clinic for a second option upon returning back to Qatar. Ramya said, “When the doctor in my home country told me I should terminate my pregnancy because of the risks to the baby and myself, I was shocked. Diabetes is hereditary in my family and as a result, I developed type 2 after giving birth to my first child. I never realized how much this illness could affect my baby should I fall pregnant.” Ramya was referred to Dr. Mohammed Bashir, an Endocrine Consultant at HMC who works with the multidisciplinary team at the diabetes clinic in Women’s Hospital. The team comprised of highly skilled doctors, nurses, nutritionists and dieticians, worked closely with Ramya to create a tailored program that would help regulate her diabetes and decrease any complications during her pregnancy and delivery.

Dr. Bashir said, “It is extremely important for women with diabetes to achieve normal blood glucose levels before they become pregnant. If women have poorly controlled diabetes going into a pregnancy, they are at much higher risk of having serious fetal complications in particular, congenital deficits, early loss of pregnancy, high blood pressure, large birth weight babies, resulting in more Cesarean deliveries. This also increases complications during delivery including, premature births and fetal death.’’ “Pregnant women who have diabetes should ideally plan their pregnancy and ensure their blood glucose are within targets prior to conception. Women, who require assistance with their planning, can visit our National Diabetes Centre services in Hamad General Hospital or Al Wakra Hospital.”

Post pregnancy women like Ramya, will be referred to the Women’s Hospital diabetes center. Here they will be able to work with Dr. Bashir and his team to get general counselling about the illness and understand the risks involved with not regulating their diabetes as soon as possible. They will also learn how to administer insulin injections, treat low and high blood sugar, how to use a glucometer, chart their blood sugar levels, follow home glucose monitoring and adapt their eating habits.

“It was not ideal that Ramya came to us well into her pregnancy, knowing she had type 2 diabetes. However, I was confident we could work with her to form a plan that would help get the diabetes under control thus helping her and her baby,” said Dr. Bashir. “During my initial visit, the clinic performed a routine blood checkup and prescribed a low dosage of insulin to start,” said Ramya. “I met with a dietician who revised my diet and helped reduce my carbohydrate intake. She also instructed me to eat smaller meals throughout the day, incorporate more fruits and vegetables into my diet. I was encouraged to walk daily and instructed to take my blood sugar readings 4 times a day either after each meal or in between to monitor my levels.”

“Every 2 weeks I would visit the team at Women’s Hospital to review my blood sugar levels and overall progress. The clinicians kept me closely monitored and gave me valuable advice about the complications associated with diabetes which motivated me to keep to the program we created. An obstetrician in the clinic followed my pregnancy monitoring the fetal growth of my baby to determine the safest way for delivery, vaginally or C-section. At the same time, the endocrinologist determined when I would deliver,” she added. “The team at Women’s Hospital was great at involving me in my care so that I understood everything every step of the way, I felt in control and knew if I had any questions or concerns, they were always just a phone call away,” she finished. Dr. Bashir added, “We spend most of our time teaching and guiding our patients to self-manage their blood glucose level. This education empowers our patients to take control of their diabetes during and after pregnancy.”

Type 2 diabetes is the most common form of diabetes, accounting for about 90% of diabetes cases in Qatar. Despite what is believed by the public, type 2 diabetes does not cause any symptoms of thirst or excessive urination in the vast majority of patients. This disease is mostly discovered during a routine blood screening and is often associated with older age, obesity, family history, previous history of gestational diabetes, physical inactivity, and it can be more prevalent in certain ethnic groups. Patients with any of these risk factors should be screened for diabetes regularly at their local Primary Health Care Center (PHCC).