Gestational Diabetes | The 5 M's of Successful Management
Gestational diabetes affects 8-10% of pregnant women, and the incidence is increasing every year.
The rise in diabetes may be related to factors like increasing obesity rates, eating more processed foods, and not exercising, but family history and ethnic background also affect the risk.
Testing and risks
Women usually have diabetes screening between 24 and 28 weeks of pregnancy, using a one-hour glucola test, then a three-hour test if the initial screen is elevated. High blood glucoses can be harmful to both you and your baby. Because glucose passes readily from you to baby, if your blood glucoses are elevated, then so are the baby's. Over a period of time, elevated blood glucoses make the baby grow larger; a bigger baby means a higher risk of birth injuries.
There are other risks for the baby, too – low blood glucoses in the newborn period, a higher risk of childhood obesity and diabetes, damage to the heart, even a higher risk of stillbirth.
For you, having gestational diabetes increases the chance that you will stay diabetic after pregnancy, or become diabetic within a few years. When you are referred to the perinatologist’s office for gestational diabetes, we work with you to understand the condition and manage it. When we work together to keep your blood glucoses normal, we reduce the risk of complications for you and your baby. Although there are many approaches to managing gestational diabetes, some basic principles apply to everyone.
I call them the 5 Ms – measure, meals, move, medication, and monitoring. Over the next five posts, we will talk about each of these elements in more detail.
The 5 M's
Measure: We advise monitoring blood glucoses four times daily – in the morning before breakfast, and two hours after starting each meal.
Meals: What, when, and how you eat is essential to managing your diabetes. Following a diabetic meal plan is really not much different from any healthy diet. You will have to avoid sugary snacks and sodas; you also need to reduce the consumption of processed and starchy foods – bread, rice, pasta, and potatoes.
Monitoring: When you have gestational diabetes, surveillance of fetal well-being is important. We typically check fetal growth every 3-4 weeks with an ultrasound. At some point in the third trimester, we usually begin fetal testing.
Movement: Activity is a really helpful tool for diabetes management. You don’t have to spend an hour on the treadmill; you just have to move, for a little while each day.
Medication: If your sugars are elevated, there are medications that we can employ to help lower your glucoses. Insulin may be needed; in some women, oral medication is an option. Your regimen will be developed based on your individual needs.
A bonus M is for "Mental", which is also really imporant, but more on that to come really soon.
Over the next month we will be diving more deeply into each of these topics, but if you're looking for more information about gestiational diabetes I recommend you get started by reading this post, 10 Lies About Gestational Diabetes.
In conclusion
These are the basic tools for managing gestational diabetes.
Remember that glucose control is an imperfect science. Don’t become frustrated if you eat the same foods two days in a row and find that your glucoses don’t respond the same way. Stress, lack of sleep, illness, the timing of meals, how you combine foods - all these things play a role in glucose control. Bring your glucose log to every visit with your OB and perinatologist, talk with them about your concerns, and ask questions. The more you know, the better able you are to manage your diabetes.
Now I want to hear from you. Have you or someone you know been diagnosed with gestational diabetes?