DIABETES EDUCATION

Even if you have never had diabetes before, your blood glucose can become too high during pregnancy.

The doctor says I have gestational diabetes. What is gestational diabetes?Gestational diabetes is a type of diabetes that happens during pregnancy. Even if you have never had diabetes before, your blood glucose (sugar) can become too high during this time. About 7% of pregnant women have pregnancies complicated by gestational diabetes; this means more than 200,000 cases a year. For most women, the high blood glucose goes away when you deliver the baby. Women who have gestational diabetes are at a higher risk for future development of type 2 diabetes.

How is gestational diabetes diagnosed?According to the new guidelines set by the American Diabetes Association in 2011, all pregnant women not previously diagnosed with diabetes will be screened for gestational diabetes mellitus (GDM) at 24 - 28 weeks of pregnancy. Screening should take place in the morning after an overnight fast of at least eight hours. The screening test consists of having a fasting blood glucose (sugar) done and then drinking a special sweet beverage containing 75 grams of carbohydrate. The blood glucose test is repeated again one hour and two hours after drinking the liquid. A diagnosis of GDM is made if any of the following blood glucose values is exceeded: · Fasting blood glucose equal to or above 92mg/dl· One hour blood glucose equal to or above 180mg/dl

· Two hour blood glucose equal to or above 153mg/dlFor women found to have risk factors for diabetes at their first prenatal visit, a screening for type 2 diabetes (not gestational diabetes) should be done using one of the following diagnostic tests. · Fasting blood glucose equal to or above 126mg/dl (confirmed by a repeat test on a different day) · A1C level equal to or above 6.5% Women diagnosed with gestational diabetes should be screened for type 2 diabetes 6 to 12 weeks after delivery.

What causes gestational diabetes?Hormones which are produced by the placenta (afterbirth) make it more difficult for your body to use insulin efficiently. The cells become “resistant” to insulin and it becomes more difficult for the glucose in the blood to be transported into the cells where it is needed to produce energy. As a result of the insulin resistance, the glucose level in the blood rises causing higher than normal blood glucose level. Another factor that adds to this problem of insulin resistance is the weight gain that naturally comes with pregnancy. To compensate for this insulin resistance, the pancreas attempts to make more insulin but is unable to lower your blood glucose enough. Gestational diabetes isn’t caused by anything that you have done but there are risk factors which can put you at a higher risk of developing gestational diabetes.

Gestational Diabetes: At a Glance

gestational diabetes

Can gestational diabetes affect me and my baby?Studies have shown that you can have a healthy pregnancy and a healthy baby if you keep your blood glucose in a target range as near to normal as possible. The risk of developing problems is increased if your blood glucose stays too high during your pregnancy. The baby’s size can get too large and a vaginal delivery can be more difficult. Also, your baby can have problems at birth such as low blood glucose, low blood calcium, jaundice (yellow color to the skin), breathing problems, or an abnormal amount of red blood cells. During pregnancy, gestational diabetes can increase your risk of high blood pressure and of having a caesarean section.

Gestational DiabetesCarbohydrates, which are found in many foods, are broken down to a substance called glucose (sugar) in our bodies and as a result, our blood glucose level goes up. An organ called the pancreas senses that the blood glucose is higher and releases a hormone called insulin. Insulin goes into the blood stream and helps the glucose in the blood get into your body’s cells where it is used to produce energy. As the glucose is helped into the cells by the insulin, the glucose level in the blood returns to a normal range. When you are pregnant, the placenta (afterbirth) produces hormones that make the cells resistant to your insulin so that it can’t move the glucose into the cells as well as it did before you were pregnant. Your pancreas continues to make larger amounts of insulin to compensate. As your baby grows, the placenta makes more of these hormones that cause the insulin resistance and you continue to produce more insulin.

Most women are able to produce enough insulin to meet the extra demands during pregnancy, but if your body is not able to keep up with the extra demand for insulin, the glucose level in your blood gets higher and you have gestational diabetes. Gestational diabetes usually goes away with the delivery of your baby.

Managing Gestational DiabetesYou can take steps to manage your blood glucose during your pregnancy. Managing gestational diabetes will help decrease the risk of problems for you and your baby. Use tools like meal planning, physical activity and sometimes insulin. You and your health care team can discuss treatment options and decide which treatments are right for you.

Meal PlanningFood plays a major role in the regulation of your blood glucose (sugar). What, when and how much food you eat will affect your blood glucose level. Following an individualized meal plan can help you to control your blood glucose after you eat. Work with a dietitian who has special knowledge about gestational diabetes to learn more about how to eat and keep blood glucose in a normal range.

• Of all the foods we eat, carbohydrates raise blood glucose the most. This doesn’t mean that you shouldn’t eat carbohydrates; it means you need to learn how to include the right carbohydrates and the right amounts in your meals and still be able to control your blood glucose. Carbohydrates include foods we all eat every day - such as bread, milk, yogurt, fruit, pasta and cereals, to name a few. A registered dietitian can help you to learn how many carbohydrates you can eat at each meal.

You may need to check your blood glucose after your meal yourself at home to see how these foods are affecting your blood glucose. Many women with gestational diabetes find it harder to control blood glucose in the morning due to the insulin resistance, so you may need to have fewer foods with carbohydrates at this time. Talk to your health care provider or registered dietitian about using artificial sweeteners during your pregnancy.

Fact

Risk factors for gestational diabetes

• You are overweight

• You have a parent, brother or sister with diabetes

• You are African American, Latino/Hispanic, Native American, Asian American or Pacific Islander

• You are 25 years or older

• You’ve had gestational diabetes with a previous pregnancy or delivered a baby over 9 pounds at birth

• You have a condition called pre-diabetes or impaired glucose tolerance or impaired fasting glucose. This means your blood glucose is higher than normal but not high enough to be considered diabetes.

DIABETES EDUCATION

Physical ActivityPhysical activity can work to lower your blood glucose. If you are currently exercising, talk to your health care provider about continuing since this can help you to maintain a healthy pregnancy. Late stages of pregnancy are not a good time to begin an exercise program but this does not mean you can’t benefit from being active. Talk to your health care provider to see what type of activity might be right for you.

Insulin InjectionsYou, like many women with gestational diabetes, may need more help to keep your blood glucose in a normal range and this may mean having to take insulin injections. Insulin injections, along with a meal plan and physical activity, can work together to help assure more normal glucose levels and help lower the risk of problems for you and your baby. It is not recommended that pregnant women take diabetes pills to lower their blood glucose during pregnancy, since the effect of these pills on your baby is not known. Insulin is not passed on to your baby; it stays in your

own body to help lower blood glucose. If you take insulin during your pregnancy, you will need to check your blood glucose with the use of a blood glucose meter several times daily. A diabetes educator can teach you how to use the meter, and what the results mean.

Insulin and Low Blood GlucoseInsulin can put you at risk for low blood glucose (hypoglycemia). If you skip meals or snacks, you don’t eat enough carbohydrates or if you are more physically active than usual - you could have hypoglycemia. It is also important that you know how you may feel if your blood glucose is too low and what to do.

Symptoms of low blood glucose may include shakiness, sweating, hunger, feeling nervous or anxious and light-headedness. If you think your blood glucose is low, use your glucose meter to check your blood glucose right away. If your blood glucose is below 70 mg/dl, treat by taking 3-4 glucose tablets, 8 ounces of skim milk or 5-7 hard candies and check your blood glucose in 15 minutes. If it is still below 70 mg/dl,

retreat it and check again in 15 minutes and continue treating and checking until your blood glucose is at least 70 mg/dl. Be sure to write the episode in your logbook along with the blood glucose number. Do call your health care provider to talk about how to avoid these episodes. Your health care provider may give you instructions to call the office if your blood glucose drops below a certain number. Follow your health care provider’s instructions.

Checking Blood Glucose (sugar)Checking your blood glucose number at home is one of the best ways for you to know if the tools you are using, such as a meal plan, physical activity and insulin, are working to keep your blood glucose in a target range. Checking your blood glucose at home involves using a small machine called a blood glucose meter or monitor. You will need to obtain a small drop of blood by pricking your finger with a pen-like lancing device to do your blood glucose test. You then place a drop of blood on a special test strip, which is then placed in the meter. Your meter will then give you a reading of what your blood

Fact

Of all the foods we eat, carbohydrates raise blood glucose the most. This doesn’t mean that you shouldn’t eat

carbohydrates; it means you need to learn how to include the right

carbohydrates and the right amounts in your meals and still be able to control

your blood glucose. Carbohydrates include foods we all eat every day - such

as bread, milk, yogurt, fruit, pasta and cereals, to name a few. A registered

dietitian can help you to learn how many carbohydrates you can eat at each

meal. You may need to check your blood glucose after your meal yourself

at home to see how these foods are affecting your blood glucose. Many

women with gestational diabetes find it harder to control blood glucose in the

morning due to the insulin resistance, so you may need to have fewer foods

with carbohydrates at this time. Talk to your health care provider or registered

dietitian about using artificial sweeteners during your pregnancy.

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Hormones which are produced by the placenta make it more difficult for your body to use insulin efficiently.

glucose is at that moment. Your healthcare provider may give you instructions to call if your reading is too high or too low. Check with your healthcare team about when to test and what your goals should be.

Checking KetonesKetones are substances that are formed when your body burns fat instead of the carbohydrates you eat to help produce energy. Burning fat for energy is not recommended during pregnancy. Ketones can be harmful to your baby. Your health care provider may ask you to check for ketones in the morning. You can check for the presence of ketones in your urine or in a drop of blood by using a special ketone urine strip or special ketone blood test strip used also in your blood glucose meter. A diabetes educator or your health care provider can teach you how to check for ketones. If ketones are present, you may need to change the amount or type of food that you eat or to change the times that you eat your meals or snacks. Your health care providers, including the registered dietitian, will help you to know what to do.

Follow-UpAfter you deliver your baby, gestational diabetes usually goes away. Both your blood glucose and your baby’s blood glucose will be checked after the delivery. Your baby may need to be observed temporarily in a special unit to watch for any episodes of low blood glucose. Since having gestational diabetes can put you at higher risk for developing type 2 diabetes, it is recommended that you be screened for diabetes 6-12 weeks after delivery and also you should be followed-up with subsequent screening for the development of diabetes or pre-diabetes. Gestational diabetes doesn’t cause diabetes in your baby. However, since babies from mothers with gestational diabetes tend to be overweight, they have a greater risk of developing type 2 diabetes in their teen or early adult years. Eating healthy, staying active and maintaining a healthy weight have been shown to be successful strategies in reducing the chance of developing type 2 diabetes.

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