31 January 2017First Step Towards Understanding Gestational Diabetes
A sudden diagnosis of gestational diabetes for yourself or someone you love can be unnerving and leave you with a host of questions. The good news is that gestational diabetes can be managed through diet, exercise and if needed medications. Read on to learn more about how it is diagnosed as well as diet and lifestyle changes which can help to manage blood sugars.
Gestational Diabetes Defined:
Gestational diabetes or GDM is a type of diabetes that develops during pregnancy. It happens when glucose or sugar levels in the blood are higher than normal. Blood sugar levels tend to rise in the 2nd and 3rd trimester of pregnancy. This happens as a result of hormones released by the placenta. For a pregnant woman without GDM the pancreas would simply produce more insulin, lowering the blood sugar. However in GDM this process is more complicated. Changing what you eat and how much you move can improve blood sugar control. In the United States it is estimated that GDM impacts about 7-9% of all pregnancies. Being overweight before getting pregnant or having parents with diabetes as well as being older than 35 years of age when pregnant increases the chance of developing GDM. Having GDM during pregnancy will not result in birth defects in your baby. However there are several other concerns to be familiar with. The size of your baby is often the most common outcome of GDM. If your baby is big or large for gestational age, this can increase the chance that your doctor will perform a caesarian section at birth. Your baby may also have hypoglycemia (low blood sugar) immediately after they are born. Risks for moms with GDM include recovering from a c- section and both mother and child are at an increased risk of developing diabetes later in life.
Blood sugar levels during pregnancy are quite low during the first trimester and move up during the second and third trimester. Thus, most women will be routinely tested for GDM during an OBGYN appointment between weeks 24-28 of pregnancy. The test looks to see how well the body is processing glucose or sugar in the midst of pregnancy hormones. For some women, their doctor will test them earlier than 24 weeks. This typically happens if a woman has a first degree relative with diabetes or had abnormal glucose tolerance prior to pregnancy.
There are two types of tests that doctors perform to check for GDM. The most common test at the clinic I work at in Colorado is the 2 step test. Step 1 does not require any preparation. You will simply be asked to drink a 50g carbohydrate sweet drink. One hour later blood will be drawn to determine how much glucose is in the blood. If the result is greater than 135mg/dl additional testing will be ordered. Your doctor’s office will instruct you on how to prepare for the second test. At this appointment a 3 hour glucose tolerance test will be ordered to see how well the body manages high amounts of sugar at 1,2 and 3 hours after consuming a sweet drink containing 100g of carbohydrate. If 2 or more blood glucose levels are higher than normal this means the body is struggling to manage that heavy carbohydrate/sugar load thus indicating gestational diabetes.
What you eat matters:
If you are reading this article and you are a MyNetDiary member you already know the importance of good nutrition and understand that food choices matter. This is certainly the case when it comes to gestational diabetes. Following diagnosis you’ll be encouraged to meet with a Registered Dietitian to discuss an individualized meal plan that reduces carbohydrate load at each meal. Together you will decide on a meal plan that contains nutritious foods to promote appropriate weight gain and avoid foods that tend to spike blood sugar levels. During the first appointment the Dietitian will also discuss your current activity patterns and suggest creative ways to add more physical activity in your day to counteract the insulin resistance that comes with GDM. If blood sugar levels do not fall into target range quickly with dietary and physical activity changes, medications may be prescribed to further lower blood sugar levels. To best understand how your body is managing blood sugar, doctors will prescribe daily blood glucose checks using a glucometer. I encourage checking blood glucose at least 4 times a day: fasting, 1-2 hours after breakfast, 1-2 hours after lunch and 1-2 hours after supper. Certain foods and amounts of these foods impact folks differently, another important reason to check blood sugar. Here are the blood sugar targets specified by The American Diabetes Association.
- Fasting blood sugar goal: 60-95 mg/dl
- Blood sugar goal 1 hour after eating: less than 140 mg/dl
- Blood sugar goal 2 hours after eating: less than 120 mg/dl
After delivery your healthcare team will encourage you to lose the excess baby weight and continue with a healthy diet. This is especially important to prevent or delay the development of type 2 diabetes. In fact the American Diabetes Association guidelines suggest you see your doctor 6-12 weeks after delivery for blood sugar evaluation and to ensure you are losing weight.
What can I do now?
If you are currently pregnant or planning to become pregnant and concerned about developing GDM here are some dietary strategies to adopt now to reduce your risk:
-Avoid sugary drinks. Such as juice, lemonade, soda, sweetened tea
-Avoid eating significant portions of desserts, pastries, cookies, cakes, ice cream containing simple sugars. If you are having a craving for a sweet treat try to eat 3 bites and call it good
-Limit adding simple sugars to foods such as: honey and agave nectar, jam, jelly, maple syrup
-Eat whole foods. Examples include quinoa, oatmeal, whole meats, veggies, squash, low fat dairy, nuts, avocados, whole fruits
-Go for a 15-20 minute walk after your largest meal of the day
Expectant moms want the best for their baby. With attention to food choices and their impact on blood sugar as well as regular physical activity it is possible to manage gestational diabetes. Remember to work closely with your healthcare team and check out these resources for additional information.
Be well, Joanna
Joanna is a Registered Dietitian Nutritionist and Certified Diabetes Educator with a passion for supporting individuals as they move towards a healthier lifestyle.Have questions or comments about this post? Please feel free to comment on MyNetDiary's Community Forum or Facebook page – We would love to hear from you. And consider visiting our new Pinterest page!
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