What Is Gestational Diabetes?
As a high-risk OB specialist, I talk about diabetes in pregnancy all the time. In this week’s episode, we talk in simple terms about what gestational diabetes is.
How your glucose affects your baby's glucose
During pregnancy, the placenta makes hormones that make you more resistant to insulin, making your blood sugar a little bit higher. Maybe this is your body's way of ensuring that the baby has enough nutrition and energy. Having a little bit higher blood sugar in pregnancy makes sense so that glucose can "slide downhill" to the baby. Glucose crosses the placenta pretty readily, so the baby's glucose is about 80% of whatever mom's blood glucose is.
Why is gestational diabetes on the rise?
A hundred years ago, gestational diabetes was not a thing. There was more food uncertainty then. The average person couldn't count on three meals a day. Today, most of us have more than enough calories. Food is everywhere, especially processed foods. When we eat too much, too often, or have too many processed foods, we may have too much glucose circulating. Even if you're a healthy eater, you may have a genetic predisposition for diabetes.
When our blood sugars are higher than they should be, that's gestational diabetes. And that leads to a chain of events that can be harmful to you and your baby. Babies may start to grow faster, leading to an increased risk of a difficult delivery, birth injuries, and low blood sugar after delivery.
Getting tested for gestational diabetes?
Pregnant moms are usually tested for gestational diabetes between 24 and 28 weeks, just before the third trimester. This timing is early enough so that we have plenty of time to detect and treat elevated blood sugars. Most providers test for diabetes by giving you glucola, which is a sweet drink with 50 grams of glucose in it. Your blood glucose will be tested one hour after you drink the glucola.
If your blood glucose is higher than 140 (some centers use 135 or even 130), then you come back for a three-hour glucose tolerance test (with 100 grams of glucose), which is the definitive diagnostic test for gestational diabetes.
If your three-hour test is abnormal, then you are diagnosed with gestational diabetes. You may be referred to a perinatologist like me, or a dietitian, or a diabetes educator. Whatever your diabetic education looks like, be sure, and look for all the information that you can on your own. Ask a lot of questions, take a proactive approach, and you will do great.
Glucose quick reference
Remember that we usually want your fasting glucoses in the morning to be less than 95
One hour after you eat it should be less than 140
Two hours after you eat it should be less than 120
Once you're diagnosed with diabetes, you'll get a glucometer so you can start checking your blood sugars at home. Your provider will tell you how they want you to check your glucoses. Most people check before they eat breakfast and then two hours after each meal. Some providers will have you check before breakfast and one hour after meals.
There's no one right way to do this. Check your sugars the way your provider tells you and try to adhere to the guidelines you've been given.
The key to healing gestational diabetes
Remember that the mainstay of therapy for gestational diabetes is your diet.
It is all about what you eat. Food is very powerful medicine, for better or worse. Eating the right foods in the right combinations in the right order at the right times of day can make the difference between success and failure when you have diabetes.
The majority of people who have gestational diabetes are able to keep their glucoses under control by following a diet. Sometimes medication may be needed. Your provider may talk to you about starting an oral medication like metformin, or they may recommend starting insulin injections. That can be kind of a scary thought, but remember that medication is usually temporary and most people don't need it after the baby is born.
What happens after you have your baby?
About 60 to 70% of women who have gestational diabetes during pregnancy eventually become diabetic. About 30% of women remain diabetic after they have their babies. Another 30% of women will become diabetic within five to 10 years. That adds up to a good chance that diabetes will stick around or come back to haunt you after you've had your baby. How you manage your diabetes in pregnancy can help determine your future risk.
If reading all this has you feeling overwhelmed wondering what to eat or where to go for information, I have good news.
I'm excited to introduce a course in September on conquering diabetes in pregnancy. It's going to have lots of great information you need about nutrition in pregnancy, how to manage your exercise, plan meals and everything else that you have to know in order to conquer gestational diabetes.
For now, subscribe to the blog to get more information about healthy ways to eat in pregnancy. And don't forget I've got a brand new free guide for you when you sign up - a printable PDF checklist looking at four different diets that help with gestational diabetes, so you can get started conquering diabetes right now. And when you subscribe, you'll be the first to know when the course comes out. There's no need to worry. You've got this! Stick with me and I will show you how.