Diabetes mellitus

Diabetes mellitus, later just referred to as “diabetes”, is a condition where the body can’t convert sugars and carbohydrates from food into energy properly. This happens because the pancreas isn’t making enough of the hormone insulin (or any at all), or the body can’t use it well to get energy from food. As a result, levels of blood glucose, or blood sugar, are too high. 
There are several types of diabetes; the most common are type 1, type 2, and gestational diabetes. Diabetes influences health in many ways and can reduce fertility when not carefully managed.

This article has been verified by a medical professional

Impact on fertility

Diabetes can mess with the menstrual cycle and make it more difficult to conceive. It can cause oligomenorrhea (when there are 35 days or more between periods) and amenorrhea (absent periods for 6 months or more). Evidence shows that diabetes is linked to higher rates of primary ovarian insufficiency (when the egg reserve gets depleted before the age of 40 and menopause begins). In addition, diabetes is associated with obesity, being underweight, polycystic ovary syndrome (PCOS), endometrial cancer, diabetic complications, and autoimmune disorders, all of which can reduce fertility. 

During pregnancy, uncontrolled diabetes can raise the risk of miscarriage, birth defects, stillbirth, and premature birth. It can also increase the chance that your baby is born with breathing problems or low blood sugar levels. But with proper management and a healthy lifestyle, many women with diabetes can conceive and have a successful pregnancy.

Potential causes

Type 1 diabetes occurs when the body’s immune system mistakenly destroys pancreas cells producing insulin. Because of this, the body can’t make insulin. 

Type 2 diabetes happens when the body doesn’t produce enough insulin or use it well. Many factors can increase the risk of developing type 2 diabetes, including:

• Family history of diabetes
• Being overweight (body mass index over 25)
• Not exercising
• Polycystic ovary syndrome (PCOS)

Gestational diabetes refers to diabetes that appears during pregnancy and usually goes away after giving birth. Women who had gestational diabetes in the past have a higher chance of getting type 2 diabetes later in life. 

Symptoms

Common signs of diabetes include:

• Irregular or absent periods
• Thirst
• Frequent urination
• Weight loss
• Fatigue 
• Blurred vision
• Irritability
• Wounds that heal slowly
• Frequent infections (gum, skin, and vaginal)

Diagnosis

Doctors use a variety of tests to diagnose type 1 and type 2 diabetes and prediabetes. 

• The hemoglobin A1c test shows your average blood sugar level over the past 2 to 3 months by measuring the percentage of blood sugar that is attached to hemoglobin (a protein in red blood cells responsible for transporting oxygen around the body). Higher-than-average levels signal prediabetes, and elevated levels on 2 separate tests point to diabetes.
• The random blood sugar test involves taking a blood sample at a random time (regardless of when you last ate). Elevated blood sugar levels lead to a diagnosis of diabetes.
• The fasting blood sugar test measures the blood sugar level after not eating for 8 to 10 hours. Higher-than-average levels signal prediabetes, and elevated levels on 2 separate tests lead to a diagnosis of diabetes. 
• The oral glucose tolerance test, which is used to diagnose type 2 diabetes, measures the blood sugar level after fasting overnight. Then your blood sugar is tested again after you drink a sugary liquid. A blood sugar level that is above normal signifies prediabetes, and an elevated level means you have diabetes. 

If your doctor believes you to have type 1 diabetes, they may perform a urine test to look for ketones and check your immune system for autoantibodies.

Treatment to improve fertility

Experts find that diabetes treatment to control blood sugar levels can regulate the menstrual cycle and significantly improve fertility. With proper management, you can have almost equal chances of getting pregnant as women who don’t have diabetes.

Diabetes is treated with insulin, diabetes medications, or both, depending on the type of diabetes you have. Metformin is the most commonly prescribed medicine to treat type 2 diabetes. Careful monitoring of your blood sugar levels, healthy eating, and frequent exercise are key to diabetes treatment.   

You can work with a LEVY nutritionist to create a personalized meal plan to help you reach your health and reproductive goals. Eat plenty of nutritious foods rich in fiber and low in fat and calories, like fresh fruits and vegetables, lean proteins, and whole grains for a balanced diet.

Regular physical activity is vital for everyone, especially for people with type 2 diabetes. That’s because exercise lowers blood sugar levels and makes insulin more effective. A good rule of thumb is to get 30 minutes of movement on most days of the week. If you have type 1 diabetes, talk to your doctor about a safe exercise routine to manage blood sugar levels.

During pregnancy, you may need to work with your diabetes specialist to change your treatment plan and ensure that you meet your blood sugar goals because hormonal changes may change your glucose levels. You may need to alter your meal plan, exercise routine, or medication regimen. Additionally, not smoking and taking prenatal vitamins with folic acid can help keep you and your baby healthy.
By fully committing to your care plan and leading a healthy lifestyle, you can reduce your risk for diabetes-related severe health problems and significantly improve your chances of a successful pregnancy.

This article has been verified by a medical professional

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• Livshits A and Seidman DS: Fertility issues in women with diabetes. Women’s Health (Lond.) 2009;5(6):701-707. 
• Diabetes. Centers for Disease Control and Prevention. Accessed 07 November 2022. 
• Pregnancy if You Have Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases.  Accessed 07 November 2022.