Gestational Diabetes: Everything to Know
Gestational diabetes is a condition that is diagnosed for the first time during pregnancy (gestation).
Like other types of diabetes, gestational diabetes affects how your cells use sugar (glucose). Gestational diabetes causes high blood sugar that can affect your pregnancy and your baby's health. Between 2% and 10% of pregnancies in the US are affected each year. If you are diagnosed with gestational diabetes, managing it will help ensure that you have a healthy pregnancy and baby.
What is gestational diabetes?
Gestational diabetes occurs when your body is unable to create enough insulin during pregnancy. Insulin is a hormone produced by your pancreas which serves as an important mechanism for distributing blood sugar into your cells to be absorbed as energy. During pregnancy, your body produces more hormones and undergoes other changes such as weight gain. These changes cause the cells in your body to use insulin less effectively, a condition referred to as insulin resistance. Insulin resistance raises your body's need for insulin.
During late pregnancy, all pregnant women experience some insulin resistance. Some women, however, exhibit insulin resistance even before they become pregnant. They have an elevated insulin requirement at the onset of pregnancy and are more prone to develop gestational diabetes.
What causes this condition during pregnancy?
Not much is known about what causes GD, but we do know the placenta is the culprit. When hormones increase during pregnancy, they can block the action of the mother’s insulin to her body, causing a problem called insulin resistance. When the body cannot process insulin effectively, it needs more to accomplish the same functions. With GD, a pregnant person may need up to three times as much insulin to compensate. Without enough insulin, glucose cannot leave the blood stream and be converted to energy. It then builds up in the blood, causing hyperglycemia.
What are some common symptoms of gestational diabetes?
Gestational diabetes typically doesn’t have any symptoms. Your medical history and whether you have any risk factors may suggest to your doctor that you could have gestational diabetes, but you’ll need to be tested to know for sure. It’s important to be tested for gestational diabetes so you can begin treatment to protect your health and your baby’s health. Gestational diabetes usually develops around the 24th week of pregnancy, so you’ll probably be tested between 24 and 28 weeks. If you’re at higher risk for gestational diabetes, your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.
What related health problems are associated with this condition?
High blood pressure during pregnancy can be increased if you have gestational diabetes. It may also raise your chances of having a large baby who requires a cesarean surgery (C-section). After your baby is born, your blood sugar levels should return to normal. However, around half of all women who have gestational diabetes go on to develop type 2 diabetes. You can reduce your risk by maintaining a healthy body weight after giving birth.
If you have gestational diabetes, your baby is more likely to:
Being quite huge (9 pounds or more), which can complicate delivery
Being born prematurely, which can result in breathing and other issues
Low blood sugar levels
Later-life onset of type 2 diabetes
What is the typical treatment plan for pregnant patients?
You have a lot of options for managing your gestational diabetes. Attend all of your prenatal appointments and follow your treatment plan, which includes:
Checking your blood sugar levels to ensure they remain within a healthy range
Eating healthy foods in the appropriate amounts and at the appropriate times
Regular moderate-intensity physical activity such as brisk walking reduces blood sugar and makes you more responsive to insulin (check with your doctor to see what forms of physical activity you can undertake and which ones you should avoid)
Monitoring your baby's growth and development during pregnancy
Are there ways to prevent gestational diabetes?
Before you get pregnant, you may be able to prevent gestational diabetes by losing weight if you’re overweight and getting regular physical activity. Don’t try to lose weight if you’re already pregnant. You’ll need to gain some weight—but not too quickly—for your baby to be healthy. Talk to your doctor about how much weight you should gain for a healthy pregnancy.
Dr. Hickey's Personal Story
If you follow us on social media, you may be aware that I have GD. I'd like to talk about my personal path and what was beneficial to me. Despite the fact that I have been quite open about my experience, I felt humiliated and as if I had done something wrong. Despite the fact that every provider advised me that I had no influence over the situation, I felt guilty. So, if you're on the same path as me, I hope this provides answers and support. After failing my three-hour glucola test, I was invited to join the GD club. I was still vomiting numerous times a day from hyperemesis at this point, and I was, as you might guess, miserable.
After failing the test, the first stage was to pass a one-hour test. Because I had been vomiting so frequently, I was apprehensive about being able to keep the glucola drink down; it's not something you'd want to drink for the flavor! If you vomit after drinking it, you must restart it. Because I was still vomiting on a regular basis at 28 weeks, I decided to wait until I had a day where I felt less nauseated and wasn't in the office seeing patients. The glucola drink comes in a variety of flavors, and I chose lemon-lime because it was devoid of harsh colors and lemon was a flavor I could normally handle with less nausea. My midwife advised chilling it and placing it over ice, which helped. My midwife advised me I could eat before drinking the glucola, so I had two hard-boiled eggs to boost my protein intake. Overall, it wasn't too bad, and I was able to keep it down! I went to my appointment and got my blood drawn; of course, I kept refreshing MyChart every hour or so throughout the day, anxiously awaiting results. Of course, the results were submitted at the end of the day, revealing that I had failed terribly, and I didn't receive a response from my provider until the next day. After asking a few friends about their experiences, I prepared a bag of snacks to consume after the test, which was brilliant. I fasted the night before and awoke bright and early to go to the lab. Because the lemon lime flavor was unavailable at the lab where I went, I went with the orange taste instead. In comparison to the one-hour test, the three-hour contains 100g of sugar and felt like sipping syrup. The lab expects you to drink it in front of them, and they didn't even bother to chill it; believe me when I say that room temperature glucola isn't my fave! I was nauseated afterwards, but I stood outside in the crisp March air and was able to keep it down.
I didn't get my findings while waiting since laboratories send their samples to the hospital for testing.The following three hours flew by as I sat in the car, worked, and went through Instagram. Aside from being hungry, I felt fine while waiting. My spouse and I went out for breakfast after my time was over. We drove home after dinner since I was so weary. I slept for around two hours... I'd been BEAT. My findings were uploaded after the office had closed, and it was too late for my provider to contact. I could see that I had failed three of the four draws; not by much, but my numbers were outside of the required range. I was devastated... I wasn't sure what the next steps were, but I felt defeated. I waited for the call the next day informing me that I had failed. They were going to have MFM contact me and link me with a dietitian. A prescription was issued to me to check my blood sugar... But I wasn't given any direction at this point, so I had no idea when or how to execute this. It was frustrating, and I felt isolated.
I don't think it hit me until the next day, when I burst into tears. As my doctors explained, GD is caused by your hormones and is completely out of your control. But, if you're like me, you can't help but feel bad. I'd been ill my entire pregnancy, so adding this didn't seem fair. Fortunately, I had a few close friends who had experienced GD on whom I could lean at this time. They were all quite helpful, offering me valuable advise and words of support. It is critical to have individuals around you that can offer you support! I did a lot of web reading and learned how to test my blood glucose. I accomplished all of this before meeting with the nutritionist, which was extremely useful in determining where my numbers should be. Typically, they will have you test your blood sugar 4 times a day. First you check your fasting numbers and then you’ll check your numbers one hour after each meal.
BS monitoring: You have to prick your finger 4 times a day.
Upon waking (to get fasting number) You want this number below 95
1 hour after breakfast, this number should be 140 or below
1 hour after lunch >140
1 hour after dinner >140
Prior to meeting with a nutritionist, I did a lot of research, which was quite empowering! I also bought Lily Nichols' book Real Food for Gestational Diabetes, which was very educational. I started listening to a lot of GD podcasts and spent most of my free time trying to figure out what was going on with my body. Most of the facts and advice the dietician provided with me were familiar to me, and my diet was not bad. The most difficult part for me was getting into a habit! I had a hectic work schedule and didn't have much time to consume a well-balanced snack in between meals.
The basic goal of GD is to maintain your blood sugar stable; eating snacks helps prevent a dip in BS. Some people may be tempted to avoid carbohydrates, but this is a typical mistake! Any type of carb can cause a blood sugar increase, so choosing the carb that works well for your body and balancing it with protein, fiber, and fat is critical. Another thing I had to figure out was my evening snack. I tried a variety of foods, but I couldn't keep my fasting levels below 95. Fasting is the most difficult statistic to control because it cannot be controlled through diet or activity. Your body produces a large amount of hormones during night, which contributes to insulin resistance. I also discovered that my fasting number was greater on nights when I didn't sleep well and days when I felt more stressed. It's remarkable to see how much stress and sleep effect your body, and I noticed it right away with my fasting statistics.
I scheduled a consultation with a second dietician, who advised me to eat extra carbohydrates with my evening snack, which she suggested would help prevent a blood sugar surge overnight. Yasso ice cream bars with 2 tablespoons peanut butter worked incredibly well for me and were delicious- I wasn't grumbling because I adore dessert. It took some getting used to eating so many meals and forcing snacks throughout the day, even when I didn't feel like it. Because your placenta is more prone to create difficulties like insulin resistance between 32 and 36 weeks, my physicians wanted to start me on insulin due to my fasting readings. They provided me with a video on how to use the insulin, which looked terrifying to me. Because I lacked confidence, my spouse agreed to do it for me. But now that I'm a pro and it's a simple process, trust me when I say it becomes easier with practice. I started insulin at 12 units before bed. If my fasting was 95-100, I needed to increase by 2 units, and if it was over 100, I needed to raise by 4 units. I'm currently at 32 units, but now that I'm 39 weeks, I won't have to raise for another 2-3 weeks! I was rising nightly for a while at the 32-36 week stage, so you're not alone! Some moms report that their bodies adjust and become less insulin resistant after 36 weeks; I believe I was fortunate in this regard.
So what does this mean for baby?
This is a vital concept to grasp, and I recommend doing some research if you have GD.
When the infant is born, he or she may have difficulty controlling their blood sugar. It's crucial to understand that their blood sugar will be tested via a heel prick, which I believe you can prepare your heart for if you know ahead of time. If those numbers aren't regulating, a stay in the NICU is a feasible. I discussed harvesting colostrum with my midwives because it can be very beneficial if baby has trouble regulating their blood sugar. The goal of harvesting before birth is to freeze it and carry it with you to the hospital. If your baby is having difficulty latching, you can use the syringes you've collected to feed it to them. I'll publish a follow-up blog with tips and tactics that were useful on harvesting colostrum!
Gestational Diabetes Resources:
You can do a lot to manage your gestational diabetes. Your blood sugar levels will usually return to normal after your baby is born. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes. You can lower your risk by reaching a healthy body weight after delivery. Visit your doctor to have your blood sugar tested 6 to 12 weeks after your baby is born and then every 1 to 3 years to make sure your levels are on target. Managing gestational diabetes will help make sure you have a healthy pregnancy and a healthy baby.
By: Dr. Hickey
Owner and Chiropractor at ANH Wellness