NEWSNOTES CHILDREN’S DIABETES FOUNDATION — SPRING 2020 EXERCISE AND TYPE 1 DIABETES PAGE 6 THOMAS LENNON TYPE1LIFTING.COM NEWSNOTES Children’s Diabetes Foundation FEATURES Board Members EXECUTIVE BOARD: SCIENTIFIC ADVISORY BOARD: Mrs. Barbara Davis, Chairman Richard S. Abrams, M.D. Dana Davis, Executive Director Director, Colorado Preventive 5 HEART HEALTH Mr. Cameron van Orman, Vice Medicine, Rose Medical Center; Chairman Clinical Professor of Medicine UCD Richard S. Abrams, M.D., Treasurer Mark Atkinson, Ph.D. Mrs. Arlene Hirschfeld, Secretary Professor of Pathology & Pediatrics, Director, University of Florida 6 EXERCISE AND TYPE 1 DIABETES Stephen Daniels, M.D., Ph.D. Chairman of Pediatrics Diabetes Institute The Children’s Hospital, Denver Ezio Bonifacio, Ph.D. Mrs. Nancy Davis Rickel Professor for Preclinical Approaches to Stem Cell Therapy, 8 CONTROL IQ Steven Farber, Esq. Center for Regenerative Therapies, Daniel Feiten, M.D. Dresden, Germany Mr. Wayne Forman Robert Eckel, MD Mr. Robert Garelick Professor of Medicine, Physiology and 13 FINDING MY STRENGTH Mr. Shane Hendryson Biophysics, University of Colorado Mrs. Deidre Hunter School of Medicine Mr. Shawn Hunter Matthias Hebrok, Ph.D. Mr. Steve Lucas Professor in Residence and Director, 14 BDC STAFF SPOTLIGHT Diabetes Center, University of Mrs. Marcela de la Mar California, San Francisco Mrs. Tracy van Orman Steven Kahn, MB, Ch.B. Mr. Ken Rickel Professor of Medicine, Director of the 16 UPCOMING EVENTS John J. Reilly, Jr., M.D. Diabetes Research Center, University Vice Chancellor for Health Affairs of Washington & Dean, School of Medicine, University of Colorado Denver Rudolph Leibel, MD Mrs. Stacy Mendelson Robinson Professor of Pediatrics and Medicine, 23 COMMUNITY CORNER Co-Director, Naomi Berrie Diabetes Marian Rewers, M.D., Ph.D. Ex-Officio Member Center, Columbia University Alvin Powers, MD Mr. Joseph Smolen Professor of Medicine, Molecular Physiology/Biophysics, Division Director, Vanderbilt University William Tamborlane, MD Professor of Pediatrics, Yale University School of Medicine NewsNotes is published quarterly by the Children’s Diabetes Foundation. If you would like to submit an article or a letter to NewsNotes, send information to [email protected]. Zachary Reece, Graphic Designer Brent McDaniel & Dana Davis, Editors Facebook.com/ @CDFdiabetes @CDFdiabetes ChildrensDiabetesFoundation [email protected] 303-863-1200 • 4380 S. Syracuse St., Ste. 430 Denver, CO 80237 2 BARBARA DAVIS CENTER BARBARA DAVIS PREGNANCY AND DIABETES BY SARIT POLSKY, MD, MPH Originally published to DiabetesSisters.org October 2019 Pregnancy can be an exciting time for a woman and her family, but it can add extra layers of emotions and stress for women with diabetes. As pregnancies in women with pre-existing or new diabetes can be more complicated than pregnancies in women without diabetes, here are a few key messages: 1. In women who have 3. The risks to the mother diabetes already (pre- and baby can be higher existing diabetes) or in pregnant women with who are at high risk of diabetes compared to developing diabetes during those without diabetes. pregnancy (gestational These risks include diabetes), it is important to fetal loss (miscarriage, plan ahead. Women who stillbirth), abnormal fetal do not want to become pregnant and who are sexually active growth (babies born too should use accepted forms of contraception. Women should small or too large for get pre-conception counseling from the right specialists: a their gestational age), diabetes provider (one who cares for women in pregnancy) birth defects, high blood and an obstetrician. If a woman has an advanced pressure conditions complication of diabetes already (like eye, kidney, or heart for the mother (e.g., disease), then she should also get pre-conception counseling preeclampsia), pre-term from the specialist who cares for the complication. delivery (delivery before 37 weeks), cesarean delivery, Pre-conception counseling visits include testing for and for the baby to be born certain diseases (like rubella, syphilis, etc.), discussion with low blood sugars, about medications that may need to be changed prior to low oxygen, and trouble conceiving, and information in this article. Optimally, breathing. There are many women with diabetes should have a hemoglobin A1C level more possible risks as well. of 6.5% or less prior to conception, if they can achieve it Tighter glucose targets are without significant hypoglycemia (low blood sugars). recommended in order to reduce these risks. 2. After conception, it is critical to obtain and maintain 4. Women should near-normal to normal blood glucose levels. For women be monitoring for with pre-existing diabetes, we recommend having an A1C new development of of less than 6% as the pregnancy progresses. Women should and progression of establish care with providers quickly after a confirmed diabetes complications. positive pregnancy test. For women with pre-existing Pregnancy can put a diabetes, a high-risk obstetrician is recommended. strain on a woman’s eyes, kidneys, and heart. For women who were already using insulin or who will Therefore, these and need to start insulin during pregnancy, there are shifts in other organ systems insulin requirements over the course of the pregnancy. should be monitored Women tend to be sensitive to insulin in the 1st trimester, throughout the increasingly resistant to insulin in the 2nd and 3rd pregnancy. trimesters, then sensitive again right after delivery. For women with gestational diabetes, glucose-lowering therapy Pregnancies associated includes diet therapy, oral medications, and/or insulin. with diabetes require more monitoring and are Women with diabetes generally have more obstetric visits at higher risk than those than women who do not have diabetes. They have frequent without diabetes. It’s ultrasound examinations and fetal non-stress testing. Some important to plan ahead, women may also be started on aspirin therapy to lower work with experienced the risk of developing preeclampsia (a disorder with high providers, and pay closer blood pressure in pregnancy and damage to another organ, attention to managing like the kidneys or liver). It’s important to work with the glucose levels and obstetric and diabetes teams to ensure that all the proper watching out for possible screening and monitoring is performed. complications. 3 F O R V A L E N T I N E ' S D A Y T H I S Y E A R , C D F A D V O C A T E S D E C O R A T E D H E A R T S F O R E M P L O Y E E S A T T H E B A R B A R A D A V I S C E N T E R ! A D V O C A T E S P E R S O N A L I Z E D M O R E T H A N 2 5 0 V A L E N T I N E S , T H E N H U N G T H E M U P O V E R N I G H T A S A S U R P R I S E F O R T H E B D C S T A F F T O F I N D I N T H E M O R N I N G . W E C A N N O T T H A N K T H E B D C S T A F F E N O U G H F O R A L L T H E I R I N C R E D I B L E W O R K . H A P P Y V A L E N T I N E ' S D A Y ! 4 HEALTHY HEARTS ARE DIABETES NEWS HAPPY HEARTS According to a Harvard-led study published in the American Heart Association's journal Circulation, keeping type 1 diabetes under tight control through medication and monitoring may help prevent an immune reaction that attacks the heart. Dr. Myra Lipes, the study's senior author and an investigator at Harvard Medical School's Joslin Diabetes Center in Boston, and other researchers looked at data from a broad clinical trial involving type 1 diabetes patients who were randomly split into two groups. People in one group tightly controlled their blood sugar levels with intensive insulin treatment and frequent glucose monitoring, while those in the other were looser with their regulation and had higher blood sugars. At the start of the experiment, participants were free of heart disease and had regular blood pressure and cholesterol levels. The researchers found that people exposed to higher blood sugar levels were more likely to develop an autoimmune response to the heart proteins that was linked to later development of heart disease, including calcium buildup in heart arteries, heart attack, bypass surgery and death. The study points out that the difference for patients with type 1 diabetes may stem from the creation of antibodies "It wasn't something in the blood itself that triggered this that attack the heart, said endocrinologist Dr. Robert reaction," Lipes said. "It's that the high glucose levels injure H. Eckel, a professor of medicine at the University of the heart muscle tissue, and we postulate that the immune Colorado. system of people with type 1 diabetes overreacts to this heart injury." "They don't occur in everybody, but the control of the diabetes relates to the formation of these antibodies People with type 1 diabetes have a higher risk of against heart proteins," said Eckel, who was not involved developing heart disease than the general population, but in the study. "In type 2 diabetes, you just don't see these the reason why hasn't been clearly understood. In fact, antibodies being developed." The study stresses the people with both types of diabetes are known to be at importance for patients with type 1 diabetes to keep their higher risk for heart disease, just for different reasons.