What Is Gestational Diabetes
GD is when higher-than-normal blood sugar levels develop during pregnancy that can cause complications to the mother and developing baby, said Dahlia Gomez, MS, a spokesperson for the Association of Diabetes Care & Education Specialists .
What kind of complications? The mom and babies tend to be bigger, and as a result, obstetrical complications can occur, said Robert A. Gabbay, MD, the chief scientific and medical officer for the American Diabetes Association. For the mother, GD can cause pre-eclampsia, which is when the mother develops high blood pressure with possible liver or kidney damage. GD can also lead to shoulder dystocia, which occurs when the babys shoulder get stuck inside the mothers pelvis during a vaginal delivery. Babies born to mothers with gestational diabetes tend to be bigger and may develop hypoglycemia after birth, he said.
Other issues may include babies who have trouble breathing, develop jaundice or experience low blood sugar at birth. They may also spend time in a neonatal intensive care unit or have an increased risk of stillbirth, according to the American College of Obstetricians and Gynecologists . Potential problems for the mother include labor difficulties, heavy bleeding after delivery, and requiring a Cesarean delivery.
Ive Tried A Bedtime Snack And Its Not Working
We often get ladies in our support group saying Ive tried a bedtime but it doesnt work for me, yet when asking what theyve tried theyve had fruit or toast etc.
The best things to eat are high protein and high natural fat.
Bedtime snacks may take some playing around with to find what works best for you. As your pregnancy progresses and your insulin resistance increases, you may need to change to find things that work better.
A bedtime snack does not work for everybody.
Depending on what is eaten, some ladies see higher fasting levels from eating bedtime snacks, but many that have eaten bedtime snacks have had good success.
Please note: It is very common to be advised not to eat after a certain time of day by your dietician or diabetic team. This causes some huge problems for shift workers, night workers, or those that eat late in the evening. Our advice of eating little and often may be opposed by the advice given to you by your diabetes team. Only you can be the judge of this and see what works best for youpersonally, but eating little and often and having bedtime snacks has been successful for the majority of our support group members.
How Many High Numbers Before Medication
I started testing 34 days ago and in that time I’ve had 3 high postprandial numbers – 140, 184, and 148. All of these were after I had white rice, so it’s clear to me now that I have to cut this out of my diet entirely.
My fasting numbers are always below 90 and all other meals are between 90 – 120 .
I seem to remember my doc saying that if I got more than 3 high numbers in the first 2 weeks I’d have to consider insulin. But since it’s been 5 weeks, I’m not sure what their response will be. I’ve already emailed them, but I’d love to hear what others have experienced .
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Importance Of A Balanced Diet
A balanced diet is essential for the control of blood glucose levels and for a healthy pregnancy. When there is gestational diabetes, certain modifications need to be made to the mothers diet, including to the amount of carbohydrates in each meal. A carbohydrate-controlled diet is the foundation of the treatment. It is essential not to eliminate carbohydrates completely but rather to distribute them throughout the day.
Treatment For Gestational Diabetes
Luckily, even conventional treatment suggests a healthy or balanced diet and exercise before resorting to insulin or medications. Unfortunately, the kind of diet conventional healthcare providers recommend may leave some room for improvement.
Conventional wisdom tells us that whole grains and dairy are healthy foods. In reality, both of these provide a large amount of carbohydrates and very little nutrition .
Because carbohydrates are so important during pregnancy many clinicians are wary of restricting pregnant womens carbohydrate intake. Its generally accepted that pregnant women should be no less than 175 carbohydrates each day. This guideline is followed for women with gestational diabetes as well.
The concern is that starvation ketosis or diabetic ketoacidosis can be harmful in pregnancy. However, research published in Diabetes shows that low-level pregnancy ketosis is common and does not carry the same risks including fetal brain development.
This makes sense when you think about the biological reason that women have slight insulin resistance. Pregnancy insulin resistance is the protection against dangerously low blood sugar.
Here is the difference between dangerous ketosis and normal ketosis:
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Which Type Of Diabetes Is Your Worry
- Type 1 diabetes? which can be develop at any age, but occurs most frequently in children and adolescents. When you have type 1 diabetes, your body produces very little or no i.n.s.o-l.e.n, which means that you need daily i.n.s.o-l.e.n injections to maintain blood glucose levels under control.
- Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes cases. When you have type 2 diabetes, your body does not make good use of the i.n.s.o-l.e.n that it produces.
- Gestational diabetes is a type of diabetes that consists of high blood glucose during pregnancy and is associated with complications to both mother and child. GDM usually disappears after pregnancy but women affected and their children are at increased risk of developing type 2 diabetes later in life.
SOME SIGNS AND SYMPTOMS YOU MIGHT BE EXPERIENCING
- Increased thirst
- Extreme hunger
- Unexplained weight loss
- Presence of ketones in the urine
- Slow-healing sores
Myth #: The Glucola/glucose Test Is Fail Safe: If You Pass The Glucose Test You Can Eat Whatever You Want
Theres a lot of black and white thinking when it comes to gestational diabetes. You might think that as long as you pass your GD screening test you are fine and can eat whatever you want. On the other hand, if you fail, suddenly the sky is falling! Now youre high risk, will have to be on insulin, will have a large baby that will get stuck during delivery, and then youll be induced or need a C-section, etc, etc.
And full disclosure I entirely understand these fears, especially that your birthing options could be limited because of a label. If your healthcare providers fall into this fear-based thinking and have never seen gestational diabetes well-managed, they dont always understand that there can be another way and they immediately go to worst case scenario.
Its important to understand that blood sugar is on a continuum and the relative risk of complications relies on your blood sugar levels, not a label!
Plus, the glucose tolerance test is not perfect. Some women with an elevated first trimester A1c, indicating prediabetes, will pass the glucola despite clear blood sugar problems .
Others will fail the glucola despite normal blood sugar metabolism, but as a result of eating a healthy, lower-carb diet . I described the pros and cons of different testing methods in this post .
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Tip #: Self Monitor With A Home Glucose Monitor
Women at higher risk of GD, with a confirmed GD diagnosis, or who are interested in knowing about how their pregnancy and their diet is impacting their blood sugar, should consider getting a home glucose monitor. Times of the day to test are: a fasting blood glucose first thing in the morning and one to two hours after every meal or snack. Or even better, ask your doctor for a prescription for a continuous glucose monitor .22
Both note that if you have a couple of weeks showing normal blood sugar, you can keep eating the way you are eating. Just be aware that if your readings looked great in early pregnancy, you need to check again for a few weeks in the 24-28 week window since insulin resistance goes up later in pregnancy.24 Some people like Natalie Thompson Cooper have chosen to self-monitor their blood sugar regularly through their entire pregnancy.
Many types of home glucose monitors are available from your local pharmacy. Follow the instructions that come with your particular meter. In general, wash your hands with soap and water and dry well before testing. Do not use alcohol wipes as this may alter the result. Also, do not touch any food before testing, as this can raise the readings.
The general consensus is that you are aiming for the following results:25
- Fasting blood glucose less than 95 mg/dl .
- 1-hour post meal blood glucose less than 140 mg/dl
- 2-hour post meal blood glucose less than 120 mg/dl
Myth #: Cut Back On Carbohydrates But Not Less Than 175g Of Carbohydrates/day
The conventional nutrition advice for gestational diabetes is mind-numbingly nonsensical. Youre given the diagnosis of GD, aka carbohydrate intolerance, yet told to eat a bunch of carbohydrates. You fail a 50 or 75 gram glucose tolerance test, yet are told to eat 45-60 grams of carbohydrates at almost EVERY MEAL. Its no wonder roughly 40% of women will require insulin and/or medication to lower their blood sugar when theyre consistently filling up their carbohydrate-intolerant body with lots of carbohydrates.
Perhaps not-so-shocking is that researchers have shown that eating a lower-glycemic diet reduces the chance a women will require insulin by HALF. Its common sense, friends.
Unfortunately, theres oodles of misinformation low-carb diets. Women are warned not to eat low-carb because they might go into ketosis . Plus, theres entirely no acknowledgement that ketosis can exist outside of diabetic ketoacidosis. Sadly, few healthcare professionals have fully investigated the details and continue to fear-monger based on false information.
Im one of the few that has done the research and Im the first dietitian to scientifically defend the safety of a lower-carbohydrate diet to manage gestational diabetes .
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What Are The Signs And Symptoms When Does It Develop
GD is typically diagnosed in the third trimester, though its not always obvious, experts say. The signs and symptoms arent very helpful, because it is only when blood sugar gets really high that you see excessive thirst and urination, said Gabbay. The majority of women have no symptoms.
According to ACOG, a health care professional will screen you earlier in your pregnancy by asking about your medical history to determine if you have risk factors for GD. If you do, youll get tested to determine your blood sugar levels. If you dont show signs of diabetes , youll undergo the standard glucose screening test.
Eating A Healthy Diet
Because eating the right diet is central to controlling diabetes, you should not try to “wing it” or create a diet on our own. Instead, work with your healthcare provider to ensure that it is tailored to your specific condition and health.
This includes getting the right balance of carbohydrates to give you the energy and glucose you need but not so much that it throws your blood sugar off balance. This may require you to count your carbs every day and plan your meals around that, making sure you have just the right amount of starches, fruits, vegetables, proteins, milk, and fats.
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Taking Insulin If It’s Needed
Even if you do everything your doctor tells you, you may still need to take insulin during your pregnancy to keep your blood sugar under control. This doesnt mean that your baby will be at any greater risk of complications it simply suggests that extra steps need to be taken to prevent fluctuations that neither diet nor exercise can fully control.
If insulin is prescribed, your doctor will show you how, when, and how much you would need if ever your blood sugar is high. This can often occur if you get sick or are under extreme stress. It is also important to be aware of the signs of hypoglycemia and the dangers of low blood sugar during pregnancy. While less common in women with gestational diabetes, the use of insulin can increase the risk considerably.
Ultimately, the goal is to keep your blood sugar under control no matter how much insulin it takes. Most women on insulin will take two shots per day, but you may get better control with three. With proper monitoring and guidance from your doctor, you should be able to attain the controls needed to ensure a normal, healthy pregnancy.
Is The Current Advice Based On Solid Science
Dr. Jovanovic and U.S. dietitian Lily Nichols both agree. Jovanovic has been consulting in the last few years around the US, telling endocrinologists and ob/gyn doctors that women can safely cut carbs to the level that keeps their blood glucose tightly controlled even if that means no carbs at all. She says to doctors looking after women with GD: Repeat after me: pregnant women do not need to eat carbohydrates!14
Nichols has specialized in gestational diabetes for most of her career, initially with a California GD program called Sweet Success, which also recommended the minimum 175 grams of carbs daily. It was always really disappointing to see how many of my prenatal clients would end up, as we say, failing diet therapy and would have to go on insulin. It didnt make sense to me why somebody with gestational diabetes, which translates as carbohydrate intolerance, would need such a high level of carbs, said Nichols.
That experience set Nichols off digging into the historical literature to find out why 175 grams per day had become the minimum standard. It turns out that this number is a best guess and not based in solid science. There is no evidence that eating fewer than 175 grams of carbohydrates is harmful.15
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Myth #: All Women With Gestational Diabetes Will Have Big Babies
Not so fast One of the big fears associated with gestational diabetes is the risk of having a large baby . Statistically its true. As a whole, we see more macrosomic babies among women with gestational diabetes. However you dont have to be a statistic. The chances of having a large baby correlates very strongly to blood sugar control during pregnancy.
So if you know what to do to keep your blood sugar under control, your risk of having a big baby goes way, way, way down. And if your blood sugar stays at pretty much normal levels, you are at no higher risk than a women without an official gestational diabetes .
I have yet to have a participant in my online Real Food for Gestational Diabetes Course have a macrosomic baby. Take that, statistics.
Ehealth Medicine: Telehomecare And New Technologies For Glucose Monitoring And Healthy Behaviour Interventions
Use of new technologies and web-based platforms for BG monitoring in pregnant women with diabetes in Canada and worldwide is rapidly increasing. These initiatives allow for 2-way communication with women monitoring and transmitting their BG results in real time to health-care providers for feedback. Studies have demonstrated 38.0% to 82.7% reduction in face-to-face medical visits and decreased insulin use in pregnant women using telehomecare in conjunction with conventional care, without an increase in maternal or perinatal complications. While 4 studies of GDM women have demonstrated comparable glycemic control and pregnancy outcomes , other studies with type 1 diabetes and GDM have shown improved glycemic control and pregnancy outcomes in the group using web-based programs compared to standard care. Enhanced patient empowerment and greater satisfaction with the care received are also reported in groups using new monitoring technology . However, generalizability of those studies is questionable as these studies were small, conducted in very specific settings and used different types of technologies and e-platforms. Furthermore, acceptance of these interventions by marginalized population subgroups and in remote regions would also be important to determine. Finally, studies assessing cost effectiveness of these measures, both direct and indirect are needed.
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What Else Should You Know And Expect
You may need to check your blood glucose levels several times a day during pregnancy, said Gomez. Its important not to miss your appointments with your obstetrician, as they will guide you on how to handle GD as the pregnancy progresses.
The good news is that with the proper management of gestational diabetes and good management of blood sugars, a womans risk and her babys risk are no different than those women without gestational diabetes, said Gabbay. There is something they can do about it, and they can have good outcomes.
Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management by Gary Scheiner, the author of Think Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.
Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.
She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.
Medication Or Insulin May Not Work Immediately
Many ladies are confused to see higher or even worse levels the morning after starting medication and/or insulin.
Metformin and insulin cannot cause higher blood sugar levels. However, stress or concern over starting meds, alongside rapidly increasing insulin resistance may mean it takes a little while, or increased doses before the benefit is seen
Medication such as Metformin, can take a while to build up in your system before you see an improvement in blood sugar levels and doses may need to be increased before sufficient impact is made.
Slow release insulin will start working immediately , BUT it may take a while to get the dose right and doses may need continually increased until the benefit is seen on a daily basis. Insulin doses are started low to prevent hypos and are titrated as needed until the benefit is seen.
Its typical that insulin doses will have to be titrated as the pregnancy progresses. Its important to work closely with your diabetes team to ensure you increase doses as necessary. Please do not sit and wait for your team to call you, or for your next appointment if you are experiencing high fasting levels. After 3 or more high fasting levels, give your team a call to discuss insulin doses.
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