Managing Gestational Diabetes
- Jade Fedele
- Jul 6, 2017
- 6 min read
“There is no calamity that befalls a Muslim but Allah
expiates (sin) thereby, even a thorn that pricks him.”
[Narrated by al-Bukhaari, 5640; Muslim, 2572]
June 7, 2017 - One-hour Glucose Tolerance Test
For the one-hour glucose test, I was asked to fast for at least 10 hours before. After having the sugary drink, I waited one hour for my blood to be drawn and tested. Ideally, after an hour a person's glucose levels should be below 140 mg/dl. My level was 189 mg/dl, which is considered to be high. The next step was to schedule another glucose test to prove whether or not I did, indeed, have gestational diabetes. This test was done in a lab at Ochsner Baptist.
June 27, 2017 - Three-hour Glucose Tolerance Test
For this test, I was also asked to fast at least 10 hours prior, however, it wasn't exactly the same as the last test. Before I had to drink the orange drink they needed to draw blood in order to see my fasting glucose level. Then, after having the drink, I gave blood every hour for 3 hours. This means that I wasn't allowed to leave the building or eat anything (besides the orange drink). I had this test at Ochsner West Bank.
Each of these tests made me feel extremely nauseous and light-headed, most likely from having high blood sugar. By far, the worst part was the multiple needle sticks (which left bruises for a week) and waiting in the office for 4 hours.
Normal glucose values:
Fasting: < 95 mg/dl
1 hour: <180 mg/dl
2 hour: <155 mg/dl
3 hour: <140 mg/dl
My glucose values were:
Fasting - 94 mg/dl
1 hour - 207 mg/dl
2 hour - 189 mg/dl
3 hour - 146 mg/dl
At the end, it was clear that I have gestational diabetes. My OBGYN messaged me about my failed results the same day and put me in touch with a diabetes nutritionist to learn more about gestational diabetes and get a glucose monitor. On June 29, I met with the dietitian to learn how to use the monitor (OneTouch Verio).
Since then, I have been able to manage my blood glucose levels with diet and haven't needed any insulin or medicine, although my fasting glucose still is running high. I use a free iPhone app called "AgaMatrix" to monitor my carbs and glucose, which I finds has helped a lot!
Keep in mind that no pregnancy and gestational diabetes is the same and each person reacts differently to carbs and medicine.
I have started experimenting with my getting used to my new diet as of late, but today (July 5, 2017) I had my diabetes education class. The class focused on educating me on what GD is, how it is treated, what are blood sugar goals and how to monitor it, exercising, meal planning, and any medications that may be needed.
What is Gestational Diabetes (GD)?
This is a type of diabetes that only occurs in pregnancy. It develops in 2-5% of all pregnancies and usually detected at 24-28 weeks of pregnancy. It is caused by hormones that are made by the placenta, which block how insulin works. The pancreas attempts to make more insulin but can't keep up with demands, causing blood sugar levels to rise. There are few, if any, symptoms of GD, including: excess thirst, urinary frequency, sudden weight loss, numbness or tingling in hands and feet, changes in eye sight, slow healing cuts, and fatigue.
Risk Factors?
Age 35 or older
Overweight/obesity
High blood pressure
Polycystic Ovary Syndrome
Mother born at low birth weight
History of large baby
Baby with birth defects
Certain races & ethnicities
Family history of diabetes
What's the Cause?
Gestational Diabetes prevents your body from using carbs properly. Carbohydrate is a nutrient found in food that is turned into glucose by the body. These are foods such as: table sugar, honey, soft drinks, bread, cereal, pasta, fruit, milk, and potatoes. The inability to use carbs properly causes blood sugars that are higher than normal. The pancreas should sense how much glucose is present in the blood and deliver the right amount of insulin (a hormone) to lower the blood glucose by allowing glucose to enter your body's cells and be used for energy. In GD, your pancreas can't make enough insulin and your blood sugar levels remain too high. Your body's organs cannot use the glucose for energy and an unhealthy level builds up in your blood. Your body also tries to rid itself of the extra glucose through your urine.
How GD Can Affect Pregnancy
Gestational Diabetes may cause:
High blood pressure (pre-eclampsia)
Polyhydramnios (increased amniotic fluid)
Preterm Labor
Infections (vaginal, bladder, kidney)
C-section
How GD Can Affect Baby
Mother's blood brings extra glucose to fetus.
Baby makes more insulin to handle extra glucose
Extra glucose gets stored as fat and fetus becomes larger than normal (macrosomia)
At birth, babies may be large (>9lbs), hypoglycemic (low blood sugar), have respiratory distress, jaundice, have a difficult birth that could cause injury to the baby's head, neck, & shoulders, or stillborn.
Keep in mind: not all of these concerns apply to Zakariya. Babies with Congenital Heart Defect (especially serious cardiac defects like HLHS) are often underweight when they are born. The most important thing for mothers who have GD and are carrying a HLHS baby is to gain enough weight. GD puts some limitations on the mother but there is no reason not to eat enough. Eat smaller meals MORE often, don't eat less and lose weight, especially not in the last trimester!
Here are some sample meals for GD:
How to Control GD?
Gestational diabetes is best controlled with blood sugar monitoring (4 times a day: once after waking before eating, once 2 hours after breakfast, once 2 hours after lunch, and once 2 hours after dinner), exercise, and meal planning. Medication may also be used if necessary. Blood sugar monitoring should be recorded on a log or machine and brought to all OBGYN visits. During pregnancy, exercise should be done 4-5 times a week for 20-30 minutes (unless being advised to avoid exercise).
Since my pre-pregnancy BMI is above 29 and considered obese, I should only gain 11-20 lbs. my entire pregnancy.
How to read a nutrition label:
Meal Planning
For planning meals, the 3 basic groups to consider are carbohydrates, proteins, and fats.
Carbs break down to sugar and raise the blood sugar the most of all food groups. Starches can raise blood sugars if too many are eaten at one meal or snack.
Carb Counting:
Basically, you should only have 30-45 grams of carbs for breakfast, 45-60 grams of carbs for lunch and dinner, and 15-30 grams of carbs for snacks in between each meal.
Sample servings of Carbs:
Here are some snack suggestions:
I have stayed on the lower end of grams of carbs for my meals to keep my blood sugar levels within range for the last week.
Protein and Fat Servings:
Artificial sweeteners
These are safe (in moderation):
Stevia (rebaudioside)
Equal or NutraSweet (aspartame)
Splenda (Sucralose)
These are not recommended during pregnancy:
Sweet 'N Low (saccharin)
Crosses placenta and may remain in fetal tissue
Sunett ( Acesulfame Potassium)
Questionable
How will this Affect the rest of my Pregnancy?
Blood sugar logs will need to be reviewed at every doctor visit
Assessment for diabetes medication
Fetal movement counting starting at 28 weeks
Non stress test the last 1-2 months of pregnancy
More ultrasounds to assess baby's growth
The weekly non-stress tests alert the doctors if the baby is not doing well before delivery. If the baby needs to be born early, tests can be done to detect lung maturity.
Delivering with GD
Vaginal birth is possible if the baby isn't too large. During labor your blood sugar will be checked. Since labor is like exercising it lowers the blood sugar. The baby will be checked for hypoglycemia and jaundice after delivery.
What to Expect After Delivery
Most blood sugar levels return to normal as soon as the placenta is delivered. The doctor will order a 2 hour, 75 gram glucose tolerance test 6 weeks after delivery to be sure.
Will I have Diabetes Later in Life?
5 - 10% of women with GD are found to have type 2 diabetes after pregnancy. There is also a 40 - 60% chance of developing diabetes in the next 5 to 15 years. The baby is also at risk for childhood obesity and developing type 2 diabetes later in live.
Preventing Type 2 Diabetes
Eating Healthy
Being Physically Active
Losing Weight
Breastfeeding
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