What is Gestational Diabetes? When a woman develops insulin resistant during pregnancy it is referred to as gestational diabetes. The disease acts in the same manner as when a person who is not pregnant has diabetes. In most cases, after the baby is born the diabetes goes away and a woman's blood glucose control and insulin production return to normal. The placenta that provides nourishment and keeps the baby alive as it grows inside the uterus also releases a hormone that effectively blocks or inhabits a woman's insulin production from the pancreas. It can also affect the way a woman's body uses the insulin that is produced. When there is too much sugar (glucose) in a woman's system that is not being converted to energy it produces high blood sugar. This condition is known as hyperglycemia. Every woman is routinely screened for gestational diabetes at her monthly doctor's exam during pregnancy. The urine sample that the woman provides is checked for glucose (among other things). If there is glucose in the urine it is a red flag to the doctor to have the woman screened for gestational diabetes. The doctor will then send the patient to a medical lab for blood work and if the results come back positive a referral will be given to an endocrinologist (a doctor specializing in the treatment of diabetics). A treatment and management plan will be put into action for the women to follow for the remainder of the pregnancy. Although gestational diabetes is a serious condition that affects both the mother and the developing fetus there is no cause for alarm. There are many things known about treating diabetes in pregnancy -- although not as much information on why it occurs. With good control of blood sugar levels, following a proper diet, and regular exercise a mom with gestational diabetes can go on to deliver a healthy baby. Gestational Diabetes -- Risks for Baby When you first discover that you have gestational diabetes most likely you are going to be upset and worried about your baby. There are risks to the baby when a mother has gestational diabetes but with careful monitoring and strict control of diet and blood glucose levels these risks can be minimized. Remember to use a tool to monitor your diabetes in order to make sure your sugars are in line. The most frequent complication associated with babies whose mothers have had gestational diabetes is how big they become. The extra glucose in the mother's system is also shared by the baby and the baby creates extra insulin which in turn produces unneeded fat stores -- this is not healthy for the baby and the baby's size can become dangerous. A large baby (known as macrosomia) can make labor and delivery more difficult. The baby can get injured during delivery (shoulder injuries are common) and a higher percentage of moms with gestational diabetes having a caesarian section. If your diabetes is poorly controlled while you are pregnant your baby will be born producing more insulin than it should. Once the baby is born and is no longer exposed to your high glucose levels, he or she will still be producing insulin at the same rate they were in the womb. This can cause your baby's own blood sugar level to drop dangerously low, this condition is called hypoglycemia. When a baby is born with high insulin levels the affects are long-lasting. The baby will grow up and be at a higher than normal risk of developing type 2 diabetes for the rest of its life. These same babies may also suffer from childhood obesity because of the additional fat stores that were creating during pregnancy. These risks give moms the incentive and drive to stick with the diabetic diet and exercise regime -- it is the way to give your baby the best start. Gestational Diabetes -- What Happens after the Baby is Born The light at the end of the tunnel with gestational diabetes is that the condition is only present when you are pregnant. In almost all cases once your baby is born your pancreas will continue to produce enough insulin for your and your body will process it properly. In the rare case where it does not, it is likely that you were diabetic prior to becoming pregnant and the diagnosis did not happen until the routine screening for pregnant women. In either case, your doctor will have you continue to monitor your blood glucose levels after the birth of your baby. At a minimum you should test for two days afterwards but your doctor may request that you test for a period of up to two weeks. During this time you will not be taking insulin. Your doctor is going to want to see how your body is processing your food without the help of additional insulin. It is recommended to continue with the diabetic diet going forward, it is a healthy way to eat and if you are breastfeeding it will ensure that you and your baby are getting the nutrients you need. Another reason to continue with the diabetic lifestyle even after it is determined that you no longer have gestational diabetes is to prevent getting type 2 diabetes. You are at an increased risk of becoming insulin resistant (also known as type 2 diabetes) once you have had gestational diabetes. Continue to eat the foods you would have while pregnant and watch your portion sizes. After your doctor gives the okay, resume a routine of physical activity even taking your baby for a walk in the stroller. You will probably feel a sense of relief once your doctor pronounces you diabetes free and you can concentrate on enjoying your new baby. Snack Ideas for Women with Gestational Diabetes An outsider's perception of a pregnant woman is that she can eat whatever she wants, whenever she wants. And for some pregnant women this is the case but not for the one that has diabetes in pregnancy. There are still many healthy foods to choose from but there is not going to be any tales of you polishing of the carton of ice cream or how many chocolate bars you ate. For any pregnant women, with or without gestational diabetes, the foods that are eaten should be of the highest quality and nutritional value to give your baby the best start in life. You don't want to get bored with your snack choices or you are more likely to indulge in something you shouldn't. Try to mix up the snacks you choose and use some of the suggestions from the list below to add more variety. Snack suggestions: * A small fruit (such as an apple or orange) and a few mixed nuts * Celery sticks with natural peanut butter spread in the center * Half a sandwich made with whole wheat bread and lunch meat and/or cheese * A handful of baked tortilla chips with salsa and shredded cheese (this can be mixed together and warmed up in the microwave too) * A banana milk shake made with 1/2 banana, 1/2 cup of milk, 2-3 ice cubes and 2 tablespoons of natural peanut butter Using left-overs from your main meals in small portions work well for snacks too. Make your snacks something to look forward to. If you enjoy eating your food you are going to make it easier for yourself to stick with your diabetic diet. There are also protein mixes that you can buy to add to milk that are nice for a bed time snack. Something that is light and provides protein to help with your blood sugar level until morning. Support for Women with Gestational Diabetes A pregnant woman who has been diagnosed with gestational diabetes is going to receive a lot of medical support in the form of frequent doctor appointments and nutritional counseling. But she may also be in the need of emotional support. It is hard to change the way you eat and live your life when you are pregnant and adjusting to a new disease in addition to that can be overwhelming. There are many forms of support you can seek out. The support from your spouse or partner is going to be very important. They cannot be eating an ice cream sundae in front of you while you are expected to abstain. Since eating like a diabetic is a healthy lifestyle change, you both should follow the diet set forth for you keeping in mind the extra caloric needs of different people. Joining a group of pregnant women is helpful too. You can go through your pregnancies together and when your babies are born you can continue with your support network as your children grow up together. Touch base with your endocrinologist to see if they know of a support group specifically for women with gestational diabetes. You can share recipe tips and provide the emotional support needed as you ride the roller coaster of pregnancy with diabetes. There are many online support groups too with a specialization in many different complications that can arise in pregnancy. Or join a support group for woman online whose babies are due at the same time as yours. You may even meet someone online that lives in your neighborhood. Don't feel that you have to deal with your diabetes on your own. Help and support are available. If you can't find it readily with a little research you are sure to find what you need. Lunch Ideas for Women with Gestational Diabetes A sandwich can be a diabetic's best meal choice. It combines many of the food groups in one easy to prepare meal. Choosing whole wheat bread over white and including a protein increases the nutritious value of the sandwich. But you don't have to be pinned down to eating a sandwich every day for lunch for months on end (unless of course you want to). Good sandwich choices for diabetics include tuna fish, egg salad, deli meat, and cheese. The addition of vegetables is a good idea and recommended. Be careful with the condiments you add to your sandwich though. Check the labels to get an idea of the sugar content as a guideline mustard is better than mayonnaise and whenever possible go for a lighter or fat free version of your favorite spreads. If you are looking for ideas that go beyond the four corners of a sandwich try out one of these lunch ideas: * Instead of making a sandwich with bread try using a tortilla wrap or whole wheat pita pocket. * A variety of soups whether home made or store bought can be hearty and filling. Eat with some cheese slices and crackers for a filling meal. * Pasta salad with chicken, ham, or cheese mixed in. * Chef's salad with egg and a meat choice. Be aware of how much sugar is in a serving of your salad dressing. A vinaigrette or balsamic vinegar are better choices. * A small portion of what you had for dinner the night before. The eating habits you will develop and the food choices that you make when you have gestational diabetes are ones that you would be smart to continue with once the baby is born. Eating like a diabetic is very healthy if you follow the rules and the food guide for portion sizes. Dinner Ideas for Women with Gestational Diabetes Dinner is the meal of the day when people like the most variety. You don't want to eat the same thing each night (pregnant or not). Here is the time to be creative. But a cookbook or borrow one from the library to stock up on good ideas for dinner combinations that fit in with your diabetic diet. The dinner meal traditionally consists of a starch (whole grains, potatoes, and rice), a vegetable, and a protein. You can be creative in how you combine these elements but take the appropriate portions. Your dietician will give you guidelines on is considered a proper portion of meat and other food groups. If you are having difficulty with this, you may want to consider purchasing or borrowing a food scale until you learn how to judge a portion size by sight. Here is a selection of different dinner ideas that can be made: * Cheese quiche, you can try making one without the crust to cut fat and calories. * Sloppy Joe sandwiches on whole wheat buns topped with shredded cheese (use a lean or extra ground beef). * Bell peppers stuffed with rice and ground beef and then baked in the oven. * Use a slow cooker to make a chili or beef stew full of veggies. There are numerous dinner combinations available by mixing up protein choices (fish, steak, pork chops, and chicken) grains (brown rice, potatoes, pasta, and couscous), and the various ways to cook vegetables (raw in a salad, steamed, grilled, or boiled). If you are going out to eat for dinner, don't be afraid to ask for your food done differently than what the menu offers. Ask for substitutions and sauces on the side where appropriate. Most restaurants are flexible and are willing to accommodate special dietary requirements especially for pregnant women with diabetes. Treatment Options for Gestational Diabetes Once you have been diagnosed with gestational diabetes you will see an endocrinologist and develop a treatment plan. You may also see a nutritionist or dietician to help you develop a food plan that will meat the needs of you and the baby and not be detrimental to your blood sugar level. What you eat will have a major impact on your blood glucose levels. It is not only foods high in sugar that you have to avoid. A good meal plan will make use of the recommended food guide with several small meals spaced throughout the day. Ideally, you should eat six times a day: breakfast, snack, lunch, snack, dinner, and a bedtime snack. By eating frequent and small meals you can keep better control of your glucose level by trying to keep a slow and steady supply of energy for your body. Having a small amount of protein at each meal and snack is beneficial in maintaining a healthy blood glucose level. Physical exercise is also very important. You can control and lower your glucose levels by getting active. Before you start any physical routine, be sure to consult with your doctor. The exercise you do does not have to be vigorous. You can take three small walks after breakfast, lunch, and dinner for 15-20 minutes to help burn off the extra sugar in your body. A strict diet and physical exercise are going to be used for any woman with gestational diabetes. But for woman who have higher insulin needs (and the need for insulin is going to increase as the pregnancy progresses) they will have to have additional insulin by way of injections. This isn't as scary as it sounds and it is something you will get used to quite quickly. With the help of your doctor you will learn how to adjust your insulin based on your blood sugar readings from your glucose monitor. Gestational Diabetes -- Risks for Moms after Pregnancy After your baby is born it is going to be a relief to not have to take insulin injections anymore or to watch every single thing you put in your mouth. But not so fast, you still need to be careful and mindful of the increased risks that you now face as a mom who has had gestational diabetes. Even though your health choices do not directly affect your baby as they did when you were pregnant (unless you are nursing), your health is still just as important to take care of for the sake of your baby. The biggest risk for moms who have had gestational diabetes is a significantly increased chance of contracting type 2 diabetes down the road. It is highly advisable to have a blood screening done six months after the birth of your baby to ensure glucose levels are still being managed properly and that the pancreas is producing enough insulin. After the initial six month screening, an annual test should be conducting to watch for diabetes or a condition known as pre-diabetes. Women who have had gestational diabetes in a previous pregnancy should consult with their doctor prior to becoming pregnant again. A blood test can be ordered to ensure blood glucose levels are in the normal range which is important in the crucial first weeks of pregnancy. After giving birth, breastfeeding is the best thing for you and your baby. In addition to the myriad of other benefits that will be derived from breastfeeding it can reduce the chances of your baby developing diabetes later in life. Taking good care yourself while pregnant can help you reduce the risks associated with diabetes in pregnancy. Continue to eat sensibly and exercise regularly to maintain a healthy body weight -- this is crucial to preventing and managing diabetes. Preventing Diabetes after having Gestational Diabetes After having a taste of what it is like to have diabetes while pregnant you probably want to do what you can to avoid getting type 2 diabetes. The management of diabetes isn't hard but the complications that can occur and having to take insulin daily can take their toll. The good news is there are things that you can do to lessen the chances that you will not be diagnosed with type 2 diabetes. The same methods that were used during your pregnancy to manage your diabetes can be utilized to help prevent you getting diabetes later in life. Eating a balanced diet is good advice for anyone but for someone that could get diabetes it is even more important. Small meals that include multiple food groups and combining them whenever possible with protein are better choices than large unbalanced meals. Physical exercise will continue to play a role in your health. It will help your body process the food that you eat and burn off any extra glucose in your system. Activity will give you more energy and if you followed the doctor's orders during pregnancy you should already be in the habit of going for regular walks every day. If you are overweight, by losing a few pounds you can help your body process the food you consume. In type 2 diabetes you become insulin resistant, your pancreas cannot keep up with your insulin needs and there is a need to supplement with injections or when you are not pregnant you can take an oral pill. But if you lose weight, you will lessen your insulin needs and in turn take the strain off of your pancreas. These tips may not prevent you from ever getting type 2 diabetes but they will lessen the chances or delay the onset of getting the disease. When your Blood Sugar is Too Low In a perfect diabetic world, you take your insulin, eat your meals and exercise and your blood glucose levels remain stable. But things happen, you take your insulin late, you eat a light meal and then spend all afternoon running errands. This is a recipe for hypoglycemia -- a condition when your blood glucose levels fall dangerously low. Hypoglycemia isn't so much a hazard for the baby but it is for a mom with gestational diabetes. The best way to prevent this from happening is to know the signs and how you feel when you blood sugar is getting low and to carry emergency supplies with you at all times. Some of the symptoms of low blood sugar include feeling: * Hungry * Nauseous * Light-headed * Faint In the case of any of these symptoms, you should test your blood sugar right away and have something to eat. The best choice is a glass of juice or another food item that is considered fast-acting such as a piece of fruit or a piece of candy. Carry something with you at all times and a regular snack too. If you are out and need to eat (say you are stuck in your car during a traffic jam) it is important to have food with you. Other precautions that you should take when you have gestational diabetes include carrying a card or another item that identifies you have diabetes and what type of insulin you are taking. The worse case scenario is you passing out and the people who come to help you need to know that you are diabetic. Make sure people at work and your family members are aware of your condition and know what warning signs to look for if you need help and when to bring your some juice or something else to eat. Testing for Ketones When you are diagnosed with gestational diabetes it is going to be very important to monitor your blood sugar levels several times per day. You want to ensure you are remaining within your target range given to you by your doctor. In addition to testing your blood sugar you will also be testing yourself daily for ketones. You test for ketones in your urine first thing in the morning with strips from your doctor or pharmacy. This is the most common method but this can also be done through a blood test. The presence of ketones in your urine during pregnancy is a signal that you need to adjust your diet -- usually it means you are not eating enough or enough of the right kinds of food. The presence of ketones signals that your body utilizing energy from your fat stores instead of from the food that you are eating. This is something you would aim for when you are trying to loose weight but not when you are pregnant. If you found a low to medium amount of ketones in your urine after testing in the morning, you should test again the same day in the evening. If they are still present, contact your doctor. If when you test there is a high amount of ketones in your urine you should contact your doctor immediately. If you are unsure it is always best to consult with your doctor. Once you see your doctor, he or she will review your diet and either help you or refer you to a dietician to see what dietary changes need to be made. By acting promptly when you discover ketones in your urine you can prevent the condition of ketoacidosis from developing. Symptoms of ketoacidosis can include stomach pangs and nausea or vomiting.. Blood Sugar Levels during Labor Because of all the risks and complications associated with poor control of blood glucose levels during pregnancy it is best to keep them in check all the time. But if there is a time during your pregnancy where it is considered more important to have your blood glucose levels under control it is when you are in labor. If you have a very high blood glucose level while you are in labor, your baby is going to produce enough insulin to compensate for the sugar in your system. But what happens when your baby is born is he or she is no longer exposed to your high blood sugar and has an excess of insulin in their system. This will cause the baby to be hypoglycemic and can be quite dangerous for the baby. For this reason, your baby's blood sugar levels will be tested a few times after the birth. The test is administered immediately after the birth and when the baby is a couple of hours old. The blood is taken from the baby's heel and is tested in the same manner as when you test your own blood with your glucose monitor. When you go into labor, do not take any more insulin even if it is time for your next injection. When you go to the hospital be sure to bring your insulin and glucose monitor with you and advise all medical staff of your condition. Your doctor will give you more specific instructions to follow about nutrition and your blood sugar. When you pre-register at the hospital, ensure that you write down on your paperwork that you have gestational diabetes and who your care providers are. The more information you can provide the better the care you will receive when you are admitting to the hospital.
Gestational Diabetes -- Risks for Moms during Pregnancy Even though in most cases gestational diabetes is temporary and is rectified after your baby is born, it is still serious and needs to be managed properly. You will have the support of your doctor and most likely an endocrinologist and a dietician but the actual work of eating properly and exercising falls into your lap. There are risks for your baby if you don't and risks for yourself too. For moms, the knowledge that having gestational diabetes can cause complications for their unborn child is incentive enough to stick to the diet and exercise even when they are too tired to do so. But, it needs to be done for you too. One of the complications that is associated with gestational diabetes is high-blood pressure that can lead to preeclampsia in pregnancy -- dangerous to both mom and baby. When a baby becomes bigger than average due to mismanaged diabetes during pregnancy, the large size is not good for the mother. It can lead to a more complicated delivery where the baby could be hurt or the mother can have a third or fourth degree tear due to the baby's size. If a baby is considered macrosomic (a term that means obese) it increases the chances that the mother is going to have to have a caesarian section. Having a caesarian section is major surgery and comes with all the risks associated with that including infection. Having gestational diabetes with one pregnancy significantly increases the chances that you will have it again with subsequent pregnancies. It is wise to be tested for the disease as soon as you fall pregnant to ensure the healthiest pregnancy for both you and your baby. It is best to follow the diabetic diet you were given from your first pregnancy as soon as you know or even before you become pregnant again. How is Gestational Diabetes Diagnosed Each month of your pregnancy you should have a prenatal exam by your health care provider. During your visit to the office or clinic you will provide a urine sample to the nurse. Amongst other things, the doctor or midwife wants to determine if there is in glucose in your urine. If your body is spilling glucose into your urine, it is a warning sign that you may have gestational diabetes. The next step that your doctor may take is to test your blood sugar level in the office with a glucose monitor. This is a small, transportable device that comes with an electronic reader, lancets, and testing strips. A small pin prick is made on your finger with the lancet and the drop of blood is placed on one of the strips and placed into the reader. Depending on the reading the monitor provides your doctor may or may not order a blood test at the lab. To be on the cautious side, most doctors will send you for a glucose tolerance test at the lab regardless of the blood sugar level in the office. This is a fasting test and you will not be able to eat for 10 hours before having your blood tested. For this reason, the tests are performed first thing in the morning and you don't eat anything before going to bed. When you arrive you will have your blood drawn and then be given a drink high in sugar. After drinking this, you will be asked to wait one hour and have your blood tested again. The results of this test will tell how your body is processing the sugar in your body. If the tests come back positive, most likely you will be referred to a specialist for further care and treatment. Breakfast Ideas for Women with Gestational Diabetes Depending on when you are diagnosed with gestational diabetes during your pregnancy (most likely between weeks 24 and 28) you are going to have many weeks of watching what you eat ahead of you. If you find a meal that you like and works well with your blood sugars you may be tempted to eat it again (and again and again). You are going to reach a point where you do not want to even think about a piece of toast with peanut butter again. And when you do, here are some ideas for a diabetic friendly breakfast: * One piece of whole wheat toast with 1 tablespoon of natural peanut butter and a glass of milk * A bowl of cereal and milk with almonds sprinkled on top * One egg (cooked to your preference) a piece of toast and a glass of milk * Natural peanut butter spread on half a banana * Egg and cheese omelet with your choice of vegetables Go for quality foods because as you can see, meal sizes are going to be small. By combining your breakfast foods with a protein you will assist your body in processing the sugar. The added benefit of the protein is be satiating for a longer period of time. If you fill up on carbohydrates (which is very easy to do at breakfast) you are going to be hungry sooner and have a higher blood sugar for your next reading. As breakfast is going to set the tone for the rest of the day, don't cheat. If you have a high-sugar cereal for breakfast, your blood sugar will be elevated for the rest of the day. After indulging you will have to make up for it during subsequent meals by having less to even out your blood glucose levels. Restaurant Dining and Gestational Diabetes It is not expected of you to eat at home for your entire pregnancy but you are going to have to exercise caution when you are dining out in a restaurant or even at a friend's house for that matter. Many foods are not prepared as healthily as they could be but you can make choices and requests that will make eating out less stressful for you and easy on your blood sugar. Many restaurants today make different eating requirements easy for their clients by designating food choices as "light" or "heart-healthy" these are the ones that should be the first choices on your list. But don't worry; you are not bound to just these choices. Speak up, let your server know of your special dietary requirements and ask if they take special requests or substitutions (very few restaurants will say no). Here are some ideas of items that can be changed on the menu: * If you are unsure how a dish is made or with what -- ask * Find out how big he meal is. If you know that is a very large portion ask that they box up half before bringing it to you and you will be less tempted to eat more than you should. * When ordering salad, baked potato, or another item that comes with toppings ask for them on the side if at all. If you are going to a fast food restaurant it can be even trickier to find something on the menu that is appropriate. But there are some choices available. Steer clear of the fries and look for menu items that include the words broiled or baked. A grilled chicken burger or deli sandwiches are smart choices. Try to stick to your regular eating time, if you arrive at the restaurant early enough you can hope to be served around the same time you would have eaten at home. What Causes Gestational Diabetes? The exact cause or causes of what causes gestational diabetes are not known. But there are risk factors that can increase the chances of getting it. As with any disease, risk factors are not a guarantee that you will contract the disease they just make the likelihood of getting it higher. Some of the risk factors you will have control over and some you do not. A family history of diabetes will increase the chances of developing gestational diabetes in pregnancy. The closer the relative is to you (first generation like a parent) means the risk is increased. If your family suffers from diabetes, your own pancreas may not be able to produce the amount of insulin necessary while pregnant. This deficit combined with the hormones released by the placenta can lead to diabetes in pregnancy. Women who are overweight and are clinically considered obese run a higher risk of being diagnosed. The excess wait puts a strain on your body, including your pancreas, and makes it hard for enough insulin to be produced and used by your body effectively. If you have had a previous baby with a higher than average birth weight, you are considered at risk for your next pregnancy of getting gestational diabetes. It could have been possible that you had it in your first pregnancy and it went undiagnosed. Babies born from moms with diabetes in pregnancy tend to be larger unless her blood sugars are strictly managed. Or if you had diabetes in your first pregnancy, chances are very high that you will get it again. Since there is still no known cause a woman may have all of these factors or none and still get diabetes. It is best to attend all of your prenatal appointments with your doctor so he can be on the look out for any signs that you may have gestational diabetes. Eat Small Meals throughout the Day Eating and pregnancy go hand in hand. Even though it doesn't seem fair to be pregnant and not get to eat what and when you want it is healthier for you and your baby. The old adage of eating for two is true but many women overeat when they are pregnant and gain more weight than they should. The more food that you eat in one sitting the harder it is going to be for your body to produce enough insulin to turn the sugar into energy. Not only is what you eat important so is the portion sizes. Your doctor or dietician will provide you with a meal plan and it is wise to follow it as closely as possible. Since you will be eating smaller meals, you are going to need to eat more frequently to keep your energy up. The best way to do this is plan on eating six smaller meals throughout the day. You will keep a steady stream of nourishment going into your body and if you eat at the same time each day it will make it easier for your body to regulate insulin production and use. A schedule that works for many women is to eat a small breakfast and then continue to eat approximately every two to three hours. This will include a mid-morning snack, lunch, an afternoon snack, dinner, and a bedtime snack. If you are still finding you are hungry in between meals or are finding ketones when you test your urine, consult with your doctor or dietician. They are sure to have suggestions to help you make changes that will work better for you. Such as eating more protein at meals or filling up on more vegetables (something that can be eaten as a free food at any time). Testing your Blood Sugar When you have gestational diabetes your doctor is going to run tests at the beginning but then it is going to be up to you to monitor your own blood sugar on a daily basis. You will still get the support that you will need but a lot of the process of keeping your blood sugar under control is going to be left in your hands. This will be done with a glucose monitor. It is a very quick and simple procedure. You prick your finger with a lancet using a lancet device. A lancet is a plastic piece with a pointed metal tip that is put into a pen-like device that is used to draw blood from your finger. It is relatively painless and with newer monitors there is very little blood that is needed to run the test. Your monitor will also come with testing strips, a piece of plastic that has a microchip in one and a place to put the droop of blood on the other. This strip is placed into the monitor, you put the drop of blood from your finger onto the strip and the monitor performs the test. Different monitors take varying amounts of time but the average is between five and twenty seconds. When you are first diagnosed with gestational diabetes you will be asked to test your blood sugar seven times in one day. You will test: * First thing in the morning before you eat (a fasting test) * 1 hour after eating breakfast * Before you eat lunch * 1 hour after eating lunch * Before you eat dinner * 1 hour after eating dinner * Before going to bed The more you test the better idea you will have on how well you are managing your diabetes. It is all the way to determine if you are giving yourself enough insulin. The Risk of Gestational Diabetes in Future Pregnancies If you are diagnosed with gestational diabetes in pregnancy the chances are very high you will also get the disease in future pregnancies. There have been cases where this hasn't happened and there may be steps you can take to lessen your chances of getting it again. Before you plan on becoming pregnant again, start to follow the diabetic diet you were given during your previous pregnancy. It will provide a lot of the nutrients your body needs and will start you off on the right track to eating right while pregnant. Maintaining a healthy body weight is also crucial to prevent a reoccurrence of diabetes in pregnancy. If you are overweight, even losing 10-15 pounds before becoming pregnant will help your body better manage the insulin production and use. A risk factor for getting gestational diabetes in the future is also based on how soon in your pregnancy you were diagnosed. Some woman do not find out they have diabetes in pregnancy until the final weeks before the birth while others may be diagnosed as early as the first trimester. The earlier you are diagnosed the greater the chance that you will also have the same problem again. When planning your next pregnancy, book an appointment with your doctor. Let him or her know your plans and a blood test will be ordered. Your doctor can order a blood test that will show you average blood glucose levels for the previous few months. This will make sure that before you become pregnant you blood glucose levels are at an optimal level. And if they are not it is recommended that you do not become pregnant until they are under control. Not having your blood sugars under control before you become pregnant can lead to complications for the baby during the crucial first weeks of development. Blood Sugar Guidelines for Gestational Diabetes In order to diagnose you with gestational diabetes, your healthcare provider will order a test from the lab. There are two levels of the test that can be taken -- the one hour glucose tolerance test and the three hour glucose tolerance test. The one hour test involves taking a blood sample after you have fasted and then drinking a beverage high in glucose and testing your blood again one hour later. With the three hour version, you proceed the same except the drink has a higher concentration of sugar and your blood is tested each hour for three hours instead of one. The purpose of these tests is to see how your body reacts to and process the large amount of sugar in the drinks. The American Diabetes Association lists the following blood glucose levels that would indicate gestational diabetes is present: * Fasting 95 mg/dl or higher * One hour 180 mg/dl or higher * Two hours 155 mg/dl or higher * Three hours 140 mg/dl or higher If any two of the above readings come back in the ranges indicated you will be diagnosed with gestational diabetes. Once you have been diagnosed, you doctor will provide you with the blood glucose guidelines that should be maintained for the optimal health of you and your baby. They are: * First thing in the morning -- below 95 mg/dl * One hour after a meal -- below 140 mg/dl * Two hours after a meal -- below 120 mg/dl There will be occasions when your blood sugar reading is higher than the recommended range. In that case, adjust your next meal. If you had planned on having a meal that was higher in carbohydrates it should be changed so that there is more protein. Protein helps to lower your blood sugar and carbohydrates convert to sugar raising your glucose levels. How Exercising can help with Gestational Diabetes Unless you already have a regular fitness routine, you probably don't want to start one half way through your pregnancy. But the benefits that you will derive as a woman with gestational diabetes who exercises will make the physical activity worth it in the end. Before you begin any new physical activity or routine, discuss with your doctor any guidelines you need to follow or warning signs you should heed. You do need to be aware and careful about when you eat and take your insulin in relation to any physical exercise. If you wait too long after eating to exercise you will cause your blood sugar to drop dangerously low. A good rule to follow at any time -- exercising or not -- is to have a snack with you to raise your blood sugar quickly. A good snack is something high in sugar that will raise your blood sugar quickly like a juice box or a piece of fruit. Have a snack with you that is long-acting too such as a granola bar. You can also purchase glucose tablets for emergencies when you become hypoglycemic. The best time to exercise is after one of your main meals. If you can fit in a 15-20 minute walk three times a day it would be idea. But if you cannot try and go for a bit of a longer walk at least once per day. When at work go for a walk after lunch or schedule a family walk every night after dinner. If you already have an established exercise routine it is probably safe for you to do more but a vigorous or leisurely walk is extremely beneficial. Exercising will help you keep your blood glucose levels under control and increase your energy. Getting in shape through exercise before delivery can help your labor progress smoothly as well. Giving yourself an Insulin Injection You may be upset when you are diagnosed by gestational diabetes, but there are ways to treat and manage the disease. It is probably more realistic that you are more upset or nervous about giving yourself a daily injection (yes a needle) of insulin. Getting a needle is no big deal for most people, but giving one to yourself for the first time can be intimidating. The best advice is to just get it over with. After you have done it once it gets much easier. There are different places on your body that you give use to give yourself a needle (called injection sites). A fleshy part of your body is the best place such as the back of your arm, back of your leg, in your buttocks or the upper part of your abdomen. It is recommended to rotate your injection sites, if you prefer to give yourself a needle in the back of your arm it is okay to use that area every time. But you should not use the exact same spot on the back of your arm. You will be taught the proper method of drawing insulin into the syringe by your doctor or endocrinologist. It is important to take special care and attention to the amount of insulin that you are injecting. Too little and your blood sugar will be too high and too much you can suffer from hypoglycemia (a very low blood sugar). It is important to store your insulin in the refrigerator but once you prepare your syringe it is okay to have it out for some time before using it. You may even prefer this because when the insulin is cold it may sting more as you inject it. If it turns out that you really cannot give yourself a needle you will have to get your partner to do it for you. When you get Sick and have Gestational Diabetes Aside from the morning sickness that many women suffer from in the first 12 weeks of pregnancy, you may catch a cold or the flu before your baby is born. In of itself, this isn't a fun experience but when you have gestational diabetes and are on insulin it is very important that you take extra good care of yourself. It is important to remember that no matter how you are feeling, you need to take your insulin. Your body relies on the external source of insulin and needs it to keep functioning properly. But what do you do if you have the flu and are vomiting or don't have any appetite to eat. As a short term solution, take your insulin and drink a soda that is not diet (you want the sugar in this case). If you are able to, nibble on crackers or dry toast. All the while, you need to keep a very close eye on your glucose levels with your monitor. You need to balance the insulin you are taking and the food you are consuming so your blood sugar levels do not drop. If you are unsure of what to do, contact your doctor. A better plan is to have this discussion with your doctor before you get sick. Your health care provider will give you guidelines to follow when you become ill and when you should contact the office or go to the hospital if things are progressively getting worse. Getting sick is never fun but being pregnant and sick isn't just about you. You have to still take care of your baby and yourself. Be aware that when you are sick, your blood sugars may not act as they normally do, test more often to keep track of what the results are.
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