As an academic health science centre, Sinai Health fosters a culture where everyone is a learner. We believe that the combination of energy, fresh thinking and knowledge transfer is a reciprocal relationship that benefits the hospital, the student – and ultimately our patients.
As an academic health science centre, Sinai Health fosters a culture where everyone is a learner. We believe that the combination of energy, fresh thinking and knowledge transfer is a reciprocal relationship that benefits the hospital, the student – and ultimately our patients.
One of the biggest lessons prenatal patient Joanna Nicholson learned while having diabetes in pregnancy is to be kind to herself when things don’t go perfectly and to accept that some days are harder than others. Photo credit: Liza Litvinovich.
Soon-to-be-mom Joanna Nicholson has been managing her glucose levels for as long as she can remember. It has impacted many aspects of her life – from how she approaches wellness to how she is navigating her second pregnancy.
“Diabetes has shaped my entire pregnancy journey in ways that are hard to put into words,” says Nicholson. “As a high-risk pregnancy due to my Type 1 diabetes, my age, and now being pregnant with my second child, it feels like every moment is magnified.”
Nicholson, who is a prenatal patient at Mount Sinai Hospital, is thankful that she is able to continue to use insulin pumps and continuous glucose monitors to help manage her blood sugar more effectively during pregnancy, rather than having to switch back to manual management. Under the watch of Dr. Denice Feig, Head of the Diabetes and Endocrinology in Pregnancy Program at Sinai Health and Senior Clinician Scientist at the Lunenfeld-Tanenbaum Research Institute, she continues to use a closed-loop system which automatically adjusts insulin delivery based on her glucose levels in real time.
As her insulin needs have been fluctuating throughout her pregnancy, the glucose control and precision of the automatic insulin modulation every five minutes from the hybrid closed loop insulin pump take away a lot of the guesswork, giving her peace of mind that her blood sugars are being kept in a safe range for both her and her baby.
Closed-loop systems continuously check and respond to glucose changes, preventing highs and lows more effectively than manual management. It offers consistent monitoring, particularly overnight, and reduces the daily effort needed for diabetes management, while also providing valuable data for long-term insights.
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Dr. Denice Feig has numerous peer-reviewed publications in the area of diabetes in pregnancy.
“Continuous glucose monitoring has revolutionized the care of pregnant women with diabetes,” says Dr. Feig. “These devices have improved quality of life for pregnant women and reduced rates of large babies, neonatal hypoglycemia and babies who end up in the NICU, but there is more to do.”
Dr. Feig says the current hybrid closed-loop systems have improved glucose levels and reduced patients’ burden of taking care of their diabetes, but most of these systems have only been tested on non-pregnant populations. Dr. Feig is currently involved in research that is evaluating the potential benefits of hybrid closed loop systems in pregnancy.
She is hoping that trials using the hybrid closed loop technology will show that patients can safely achieve blood sugars as low as is needed in pregnancy to improve pregnancy outcomes. Dr. Feig was the principal investigator of two international randomized trials in women with diabetes in pregnancy (the MiTy trial and the CONCEPTT trial) and is currently following up the babies of the mothers in the MiTy trial (MiTy Kids) and CONCEPTT trial (CONCEPTT Kids International). She hopes that the outcomes of these trials will help patients with diabetes in pregnancy have healthier babies.
Nicholson says Dr. Feig has been closely monitoring her use of these devices throughout her pregnancy, and Barbara Cleave, her diabetes nurse, has been making tweaks to her insulin intake and offering practical advice.
“I’ve been incredibly lucky to have Dr. Feig, Barbara and others by my side for both of my pregnancies,” says Nicholson. “Every visit feels like we’re working together to make sure both the baby and I are as healthy as possible. I honestly don’t know how I would have managed without their support—it’s kept me grounded during a time that can feel anything but stable.”
