Diabetes is a condition where sufficient amounts of insulin are either not produced or the body is unable to use the insulin that is produced. Insulin is the hormone that allows glucose to enter the cells of the body to provide fuel. When glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death.

There are three basic types of diabetes including:

• Type 1 Diabetes is an autoimmune disorder in which the body's immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin.

• Type 2 Diabetes - a metabolic disorder resulting from the body's inability to make enough, or to properly use, insulin.

• Gestational Diabetes - a condition in which the blood glucose level is elevated and other diabetic symptoms appear during pregnancy in a woman who has not previously been diagnosed with diabetes.

What happens with diabetes and pregnancy?

During pregnancy, the placenta supplies a growing fetus with nutrients and water, as well as produces a variety of hormones to maintain the pregnancy. In early pregnancy, hormones can cause increased insulin secretion and decreased glucose produced by the liver, which can lead to hypoglycemia (low blood glucose levels). In later pregnancy, some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin, a condition called insulin resistance.

As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results or there may be worsening of pre-existing diabetes.

Why is diabetes a concern in pregnancy?

Diabetes in pregnancy can have serious consequences for the mother and the growing fetus. The severity of problems often depends on the degree of the mother's diabetic disease, especially if she has vascular (blood vessel) complications and poor blood glucose control.

It is very important for a mother to maintain very close control of her diabetes during pregnancy. Generally, the poorer the control of blood glucose and the more severe the disease and complications, the greater the risks for the pregnancy.

Special fetal testing and monitoring may be needed for pregnant diabetics, especially those who are taking insulin (because of the increased risks for stillbirth). These tests can include the following:

• Fetal movement counting - counting the number of movements or kicks in a certain period of time, and watching for a change in activity.

• Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

• Non-stress testing - a measurement of the fetal heart rate in response to the fetus' movements.

• Biophysical profile - a test that uses the non-stress test and ultrasound to examine fetal movements, heart rate, and amniotic fluid amounts.

• Doppler flow studies - a type of ultrasound which uses sound waves to measure blood flow.