Planning for Pregnancy With Diabetes: Hope, Support, and Smart Tools

From diatribe.org

Key takeaways:

• Most women with diabetes today can look forward to a healthy pregnancy, even though managing diabetes during this time takes extra effort and support.
• The right team, early planning, and diabetes technology can make pregnancy safer and more manageable, no matter what type of diabetes.
• Diabetes technology can ease some of the burden, but insurance gaps and limited access – especially for people with type 2 diabetes – remain a barrier.

Advances in diabetes care and technology have helped improve pregnancy outcomes for people with diabetes, even as managing diabetes during pregnancy introduces specific new challenges.

In a recent diaTribe online event, experts shared practical and personal insights into navigating pregnancy with diabetes today and highlighted the gaps that still remain.

The panel was moderated by Julie Keller Heverly, Vice President of the Time in Range Coalition and Patient Advocacy at diaTribe. Panelists included:

• Dr. Celeste Durnwald, professor of obstetrics and gynaecology at the University of Pennsylvania and director of the Perinatal Diabetes Program at Penn Medicine 
• Dr. Sarit Polsky, associate professor of medicine and paediatrics at the University of Colorado and director of the Pregnancy and Women's Health Clinic at the Barbara Davis Center for Diabetes
• Katie Larson, certified diabetes care and education specialist, who lives with type 1 diabetes and has two children under 2
• Jacquean Kosh, licensed clinical professional counsellor living with type 2 diabetes and mother of two children

To help people with diabetes navigate pregnancy, diaTribe brought together experts from six continents to develop a new consensus statement on the use of diabetes technology. The statement offers clear, up-to-date guidance to improve outcomes and ease the burden of managing diabetes during pregnancy.

“We were incredibly fortunate to have the support and endorsement of 25 organizations that we convened in this historic consensus effort," Heverly said. "It details 14 recommendations that our global  experts really felt would help people with diabetes."

Heverly also reflected on her own pregnancy and how long it took to find a healthcare team that supported her goals. 

“I finally found one that heard me and validated and stepped into the process to join me to achieve this goal,” she said. “And I sought a community of other people with diabetes, who were moms and who had navigated these waters before me, and it helped me visualize my journey.”

Dr. Durnwald acknowledged some of the specific challenges of pregnancy with diabetes, while at the same time navigating typical concerns like nausea and fatigue. There's added work, tighter glucose targets and closer monitoring, more appointments, additional ultrasounds – and she agreed it requires a collaborative team. But she emphasized how planning, communication, and technology have greatly improved outcomes.

"The vast majority of times we are very successful in helping guide patients through pregnancy and having a healthy mom and infant afterward," Durnwald said.

Managing different types of diabetes during pregnancy

Dr. Polsky explained that while monitoring glucose is key across all forms of diabetes, different types of diabetes have specific challenges. For people with gestational diabetes, it often means learning how to manage diabetes for the first time. For people with type 1 or type 2, pregnancy often requires changes to their existing care as the pregnancy progresses. And for some with type 2, that may mean starting insulin for the first time.  

Polsky stressed the importance of support from a care team that may include a diabetes provider, diabetes care and education specialist, registered dietitian, maternal-fetal medicine specialist, eye specialist, and, depending on the situation, neonatologist or kidney specialist.

“While there's a lot that's involved, you don't have to do these things alone," she said. "We are here to help you – and know that there are other people out there who have experienced what you're experiencing."

Personal takes: planning, pushback, and building the right team

Jacquean Kosh and Katie Larson shared two very different experiences with diabetes and pregnancy. At a pre-pregnancy check-up, Kosh was told not only that diabetes management would add complexity to the pregnancy, but that she should reconsider having a baby altogether. 

"I'm not the type of person who gets told she can't do something and handles it well," she said.  

Oral medications weren't sufficient to help her reach the tighter target ranges recommended during pregnancy, and she wondered why she wasn't being prescribed insulin. A referral to an endocrinologist led to a prescription for long-acting insulin, and the results surprised her.

"I got my A1C in a comfortable range where my endo said, ‘Go for it.’" 

Larson, a diabetes educator living with type 1, had a very different experience. She benefited from the expertise of the Barbara Davis Center for Diabetes, where she worked, but as she planned to conceive, she wanted a team close to home to guide her through the process. 

"I think sometimes, living with diabetes, I like to figure out things myself, but I knew this was a time to outsource that, because it truly is a second job – the number of appointments that you have and all the things that you have to do."

She asked providers how they worked with pregnant patients with diabetes, how many people they had helped through the process, and whether they would support her active lifestyle. She also readied herself for stigmatizing questions ("Aren't you going to have a big baby?") and misconceptions about pregnancy with diabetes.

"Mentally, it was a preparation as well, knowing some of this stuff was going to come my way," she said. "How do I protect my belief in myself – and this unit I'm about to create. And so I think that was a huge beginning step for me as well."

Tighter targets, but not perfection

Durnwald explained that tighter recommended glucose goals matter in pregnancy, for the development of the baby, and to reduce risks for the mother. That said, progress and rapid improvement matter too, especially if someone is already finding non-pregnancy target ranges challenging.

Durnwald highlighted goals for glucose management: 

• A1C goal of 6.5% or lower in the first trimester (7% or lower before conception and under 6% in the second and third trimesters is also recommended)
• CGM pregnancy time in range (TIRp) described as 63-140 mg/dL
• TIRp of 70% for type 1 diabetes
• TIRp of 80% for type 2 diabetes
• For gestational diabetes, aiming for 90% TIRp

“We know how challenging it is to achieve those targets," acknowledged Durnwald. "It can be very rough in that first trimester with nausea, highs, lows – so we try not to focus on that being a discouraging part. If you're not at those ranges, a 5% increase in time within the pregnancy range makes a big difference."

Trimester changes

Polsky offered an overview of changes to diabetes management that can be expected as the pregnancy progresses. 

In the first trimester, there's often more insulin sensitivity, which leads to dose reductions. Around 14 to 20 weeks, rising insulin resistance can lead to sharply increased insulin needs, she said, due to hormones that help ensure a steady supply of glucose as a form of energy to help the baby grow and develop. Those changes require close monitoring and may need week-by-week adjustments. She also illustrated how dramatic those changes can be. 

“Some people may require 20-30% less insulin in the first trimester compared to their pre-pregnancy doses if they were on it before pregnancy," she said. "And they may require 200-300% more insulin by the time that they deliver the baby. Everybody reacts differently.”

She also said overall health beyond glucose is important to monitor, including blood pressure and, in some cases, cholesterol. Polsky added that people should be prepared for significant fluctuations and reach out when needed so their healthcare team can offer treatment guidance and dose adjustments.

Tech for pregnancy: CGM, AID, and access 

The experts stressed the importance of using continuous glucose monitoring (CGM) in pregnancy. And while technology like automated insulin delivery (AID) and CGM can make glucose management less difficult, access can be uneven, especially for people with type 2.

“The use of the CGM increases the amount of time that the mom spends in that optimal pregnancy time in range," Polsky said. "And by doing that, it reduces the risk to the baby's health. It really can make a difference in helping people understand where their glucose is going and what adjustments need to be made.”

For those who want to explore diabetes technology to assist with their pregnancy, Polsky suggested starting a conversation with their provider. “The first thing is to just talk openly and honestly and say, ‘I've heard about this device, and I haven't been started on it – what do you think?’”

Larson used an AID system to manage blood sugar during her pregnancy and prepare for the tighter recommended goals (65-140 mg/dL). 

"I started on a hybrid closed loop system and CGM pre-emptively, knowing I was going to try to get pregnant," Larson said. "I really lived in that range. That helped me when I did get pregnant, because it wasn't this sudden switch.”

In contrast, Kosh said as a person with type 2 diabetes, she felt left out knowing helpful technology was available but wasn't prescribed for her (she now uses an AID system and CGM with a remote following app that her husband monitors). But during her pregnancy, she had a severe low blood sugar when her husband wasn't home and her son was sleeping. 

"Because of my label, I was not getting access to tools that I knew would work, and it would have saved me from a scary low," she said. "It just made me feel very vulnerable, feeling like I was denied that access solely because I'm type 2. That's not a great feeling.”

Durnwald made the point that some insurance plans don't cover CGM for all diabetes types. That said, Medicare, which influences coverage standards across private insurance, covers CGM systems for people with diabetes who use insulin, including people with type 2, as well as some people who have problems with low blood sugar. Medicare policy can also influence coverage standards across private insurance.

"These devices are costly. It's important for healthcare providers to advocate for better coverage. And for those living with diabetes, just keep pushing on the advocacy route. Everybody – if they choose and after discussions with their providers – should have the same equal access to diabetes technology," she said.

The need for pregnancy tech  

Heverly noted limited options for AID systems designed to handle menstruation and pregnancy, where automation could assist with changing insulin needs. Tandem’s Control-IQ+ AID system was just recently approved for use during pregnancy with type 1, making the t:slim X2 and Mobi the first FDA-cleared systems available for use in the U.S.

Polsky acknowledged the issue and said it requires the support of the research community, regulatory agencies, and manufacturers. But she said momentum is finally building, with randomized trials now published.

She discussed how the study of AID use in people who are pregnant and have diabetes is increasing, after more than a decade of gradual progress, which could help lead to devices that better meet their needs. 

"It takes all of our voices to push the field forward. I do feel like there's a little momentum now, and we as a community can step forward and push it toward the future even more," she said.

Looking forward

The panel offered practical tips for those who are pregnant with diabetes and those considering next steps. A common theme emerged: that while challenges are real, there is support and guidance available that can benefit people with diabetes in having a healthy pregnancy.

"We would love to talk with you ahead of time so that we can plan for a pregnancy together and start to develop our collaborative relationship,"  Durnwald said. "We acknowledge the hard work that it takes, but we are here to support you.”

Polsky offered this advice if the pregnancy isn't planned, since many are not: "Don't panic. Try to get into the healthcare system as soon as you can – and know that you're not alone. It's a vulnerable time, it's stressful, it's challenging, but it also can be a really special and beautiful time.”

If a healthcare provider isn't supportive, Kosh recommended pushing back. "It's the story of my entire health life," she said. "I've been told numerous times regarding what I can and cannot do for my health. I have two children, and I was told I couldn't. So you don't have to take that first no.”

The panellists also encouraged people with diabetes to give themselves a bit of grace. Larson, who now has two children, spoke about how the experience of her first pregnancy allowed space for her own mental health with her second.

"Living with type 1 diabetes, I was able to put so much less emphasis on it – and take that stress away. You are meant to do this, if you want to, and to enjoy it, because then there's this life after, which is so amazing,” she said.

https://diatribe.org/diabetes-management/planning-pregnancy-diabetes-hope-support-and-smart-tools 

Vitamin D May Help Lower the Risk of Developing Type 2 Diabetes

From prevention.com

It's a little complicated, though

• New research suggests some people with prediabetes may benefit from a vitamin D supplement.
• The supplement can lower the risk of developing type 2 diabetes.
• There are a few things to consider before trying this.

More than 115 million Americans have prediabetes, which is when your blood sugar levels are higher than what’s considered a healthy range, but not quite at the level of a type 2 diabetes diagnosis. If you’re one of them, the big challenge is to do what you can to lower the risk your condition will progress to type 2 diabetes.

While eating healthy and being more active can cut your risk of developing type 2 diabetes in half when you have prediabetes, new research suggests that taking a high-dose vitamin D supplement may also help—but only for certain people with prediabetes.

The study, which was published in JAMA Network Open, analysed data from the D2d study, which was a large clinical trial that looked at the impact of 4,000 units of vitamin D a day vs. a placebo in more than 2,000 American adults with prediabetes to see if it would impact their progression to type 2 diabetes. (That particular study didn’t find benefits to taking vitamin D to prevent type 2 diabetes.)

In the latest study, researchers dove into genetic data from 2,098 people who participated in the trial. The researchers specifically compared the response to vitamin D supplement in people who had different common variations in the vitamin D receptor gene.

After crunching the data, the researchers discovered that with prediabetes who also had certain common variations in the vitamin D receptor gene had a 19% lower risk of developing type 2 diabetes when they took a high daily dose of vitamin D. (Those variations were AC or CC variations of the ApaI vitamin D receptor gene, if you want to get technical.)

While the findings don’t suggest that everyone with prediabetes should put themselves on a vitamin D supplement, the researchers note that it suggests genetic testing may be helpful in the future in identifying people with prediabetes who might benefit from higher doses of vitamin D.

But why vitamin D? Here’s the deal, according to experts.

                                                                                                                               mrs//Getty Images

This isn’t the only study to suggest vitamin D may help prevent type 2 diabetes

One study that was published in the Journal of the Endocrine Society in 2025 analysed data from 10 clinical trials that included nearly 4,500 people with prediabetes. The researchers found that 18.5% of the study participants who took vitamin D reached blood sugar levels that were normal, compared to the 14% of participants who took a placebo.

Another scientific analysis that was published in the Annals of Internal Medicinein 2023 analysed data from three clinical trials on the impact of vitamin D supplementation on people with prediabetes. After three years of follow-up, the researchers found that that 22.7% of participants who took vitamin D developed type 2 diabetes, while 25% of those who took a placebo did the same.

So far, the differences between people who took vitamin D or a placebo haven’t been massive—but they have been noticeable. The latest findings suggest that diving a little deeper into genetics may drive that impact even more.

What’s behind this?

There are likely a few things happening here. “The vitamin D receptor is the ‘sensor’ that allows the body to use vitamin D,” says Anastassios Pittas, M.D.,the study’s senior author, a professor of medicine at Tufts University School of Medicine, and chief of endocrinology, diabetes, and metabolism at Tufts Medical Center. “In some individuals, this receptor works more efficiently, so higher vitamin D levels can better support processes such as insulin function, leading to better glucose control.”

But in others, the receptor doesn’t respond as well. “So, taking more vitamin D may not have the same benefit,” Dr. Pittas says.

Vitamin D doesn’t act on its own, points out Scott Keatley, R.D., co-owner of Keatley Medical Nutrition Therapy. It binds to the vitamin D receptor, which then sparks a reaction in tissues like the pancreas beta cells, he explains. “Those cells are responsible for insulin secretion,” Keatley says. (Insulin is what your body uses to escort blood sugar into your cells, where it’s used for energy.) “If the receptor is slightly different due to genetic variation, the same vitamin D level can produce a different biological response,” Keatley says.

How can you know if vitamin D will help you?

There’s no quick and easy way to know if you have these genetic variations, according to Keri Gans, R.D.N., author of The Small Change Diet. “Right now, most people would not know,” she says. “This is based on a specific genetic variation, and that is not routinely tested for in standard care.”

However, you may notice some clues, according to Jessica Cording, R.D., the author of The Little Book of Game-Changers.

Cording suggests knowing what your vitamin D status is at baseline. “Blood work is very important, and this is a really easy test,” she says. “That will give you some clues as to if you're deficient and should supplement, along with how high of a dose.”

But follow-up blood work is especially crucial, per Cording. “That will help you see how your body responds to vitamin D and will give you clues to see whether you should continue or stop, or if you need a higher dose,” she says.

What is a ‘high dose’ of vitamin D?

It depends. “Traditionally, a ‘high’ dose has been defined as intake above 4,000 IU per day, which was set as the Tolerable Upper Intake Level by the Institute of Medicine in 2011,” Dr. Pittas says. “That said, thinking has evolved.”

Now, he says that healthcare providers imply think about what may be appropriate for each person, noting that this is often show in blood work. “In studies on type 2 diabetes prevention, greater benefit has been observed among individuals who achieve and maintain higher blood levels of 25-hydroxyvitamin D—around or above 40 ng/mL,” Dr. Pittas says. “Reaching these levels requires doses higher than 4,000 IU/day in some individuals.”

Do you need a vitamin D supplement?

If you have prediabetes, a vitamin D supplement is unlikely to be the way to avoid progressing to type 2 diabetes, whether you have this special genetic variant or not. “Diet and exercise are still the main drivers,” Keatley says. “When people with prediabetes improve diet quality, lose some weight, and move more, the reduction in diabetes risk is typically much larger and more consistent than what we see from any single nutrient.”

That doesn’t mean vitamin D is worthless, though. “Vitamin D, if it plays a role here, would likely be a smaller, supportive effect,” Keatley says. “Think of it as something that might fine-tune risk in certain people, not something that replaces the basics.”

Ultimately, if you have prediabetes and want to lower your risk of developing type 2 diabetes, it’s important to have a conversation with your healthcare provider about your treatment options.

Dietary supplements are products intended to supplement the diet. They are not medicines and are not intended to treat, diagnose, mitigate, prevent, or cure diseases. Be cautious about taking dietary supplements if you are pregnant or nursing. Also, be careful about giving supplements to a child, unless recommended by their healthcare provider.

https://www.prevention.com/health/health-conditions/a71110342/vitamin-d-protect-from-diabetes/ 

What Happens to Your Blood Sugar With Daily Omega-3s, According to a Doctor

From verywellhealth.com

Key Takeaways

• There is insufficient scientific evidence that daily omega-3 supplementation lowers blood sugar (glucose) levels.
• An elevated blood sugar level is a hallmark feature of diabetes, a lifelong condition that is typically managed with a combination of medication, nutrition therapy, and physical activity.
• If you are considering taking an omega-3 supplement, speak with your healthcare provider first to avoid medication interactions.

Omega-3 supplements, also called fish oil supplements, contain a type of fat found in shellfish and cold-water fish like salmon, mackerel, and tuna. Research on whether taking a daily omega-3 supplement affects blood sugar (glucose) levels is mixed, with emerging evidence suggesting minimal to no effect.

                      Omega-3 supplements have not been proven to improve blood sugar control. Olga Pankova / Getty Images

Omega-3's Inconsistent Effect on Blood Sugar

Elevated blood sugar levels due to defects in insulin production or action are characteristic of diabetes. Without careful management, diabetes can lead to serious complications involving the eyes, kidneys, heart, and nerves.

Due to the seriousness and chronicity of diabetes, scientists have launched an extensive and ongoing investigation into the potential role of supplements, like omega-3 fatty acids, in both preventing diabetes and serving as an adjunct to traditional diabetes medications.

Despite substantial scientific investigation, results regarding the effect of omega-3 supplementation on blood sugar levels have been inconsistent.

Specifically, while some studies have found that omega-3 supplementation lowers blood sugar levels, others have reported little to no impact.

What Do the Scientific Studies Show?

One example of a study reporting conflicting results on the impact of omega-3 on blood sugar is a 2024 study in Current Nutrition Reports. 

Basics of the study include the following:

• This study reviewed 30 randomized controlled trials involving participants, primarily adults, with one of three forms of diabetes: type 2, type 1, or gestational.
• Participants received omega-3 supplements of varying types and doses for six weeks to 12 months.
• The trial found that some participants experienced a reduction in fasting blood glucose levels with omega-3 supplementation, whereas others showed no change.

Investigators noted that such differences in trial results could be attributable to factors like:

• Number of participants in each trial
• Trial duration
• Participants' age and, specifically, how long they have had diabetes
• Dosage of the omega-3 supplement

Other examples of studies addressing the uncertain role of daily omega-3 supplementation on blood sugar levels include:

• A 2022 study reviewed 30 randomized controlled trials involving participants with and without diabetes. Results revealed that omega-3 supplementation led to a significant reduction in fasting blood sugar levels.
• A 2020 study reviewed 12 randomized controlled trials involving just over 800 adults with type 2 diabetes. Results revealed that omega-3 supplementation did not affect blood sugar levels.
  
• A 2019 study reviewed 83 randomized controlled trials involving more than 120,000 individuals with and without diabetes. The average trial period lasted nearly three years. Results revealed that increasing omega-3 intake, whether through supplements or foods (fish or plants), had minimal to no effect on blood glucose levels.

Should I Take an Omega-3 Supplement?

Overall, there is insufficient evidence to support the claim that omega-3 supplements can improve blood glucose control.

The American Diabetes Association (ADA) does not universally recommend omega-3 supplementation for individuals with diabetes.

Omega-3 supplementation is also not formally recommended for individuals with prediabetes, a common health condition marked by high blood sugar levels that are not yet elevated enough to fulfil a diagnosis of diabetes.

All said, there is some evidence, albeit mixed, that omega-3 supplements may improve cardiovascular health in individuals with diabetes and risk factors for heart disease, like high cholesterol.

Given this potential link, your healthcare provider may recommend omega-3 supplements based on your personal heart disease risk factors.

Speak to Your Diabetes Healthcare Provider

Always consult your healthcare provider before starting an omega-3 supplement to ensure it's safe and appropriate for your care. Omega-3 supplements may interact with certain medications, like blood thinners.

If your provider recommends an omega-3 supplement, side effects are generally mild, with common ones being:

• Unpleasant supplement taste
• Bad breath
• Gastrointestinal disturbances (e.g., discomfort, nausea, diarrhoea, heartburn)

Using Diet to Improve Blood Sugar Control

For those with prediabetes or diabetes, the ADA recommends adopting a healthy eating pattern to optimize blood sugar control and prevent diabetes-related complications.

While no single diet suits everyone, the Mediterranean diet is a good fit for many. First, check in with your healthcare provider.

The Mediterranean diet is non-restrictive, offers tasty choices, and has been found to reduce blood sugar levels.

It consists of nutrient-dense foods like fruit, vegetables, and lean protein, as well as foods rich in omega-3s from both animal and plant sources, such as fatty fish, olive oil, and walnuts.

https://www.verywellhealth.com/omega-3-supplements-and-blood-sugar-11945435