I am pregnant & have Diabetes! Everything you need to know about Gestational Diabetes

 

You were on seventh heaven after having discovered that you were pregnant. Then your doctor told you that you will have to take a glucose test. And you are now being told that you failed this glucose test. You have been handed a diagnosis of “Gestational diabetes mellitus” (GDM) by your doctor and you don’t have a clue what this is.

shutterstock_174163166You have a hundred questions which your doctor probably does not have the time to answer. What is GDM? Do I have to take insulin? Will I be able to deliver naturally or would I need a caesarean? Will my baby be alright? Do I have to give up all my favourite sweets?

Read on to know how you can have a happy and healthy pregnancy despite GDM.

What is GDM?

GDM is a type of diabetes that develops only during pregnancy in women who have never had diabetes before.Gestational diabetes leads to high levels of glucose or sugar in your blood that may impact your pregnancy and your baby’s health.

But don’t worry yet! You can control GDM by following a healthy lifestyle including a healthy diet, exercises and, if necessary, taking medications. Getting your blood sugar under control can help prevent a difficult delivery and go a long way in keeping you and your baby healthy.

Although your blood sugar usually returns to normal soon after delivery, you are still at risk for type 2 diabetes due to the GDM.

When can this develop during pregnancy?

It is usually diagnosed in the later stages of your pregnancy and doctors most often test for it between 24 and 28 weeks of pregnancy. If you are found to have diabetes in the earlier stages of your pregnancy, it is more likely that you have had diabetes from before your pregnancy.

Why did I develop GDM? Is it because I love sweets? What causes GDM?

GDM does not develop just because you had too many sweets. It happens when your body is not able to make enough insulin during pregnancy. Insulin is a hormone made in your pancreas, an organ located behind your stomach. It is released by the pancreas in response to high glucose levels in your blood. Insulin helps your body use this glucose from the blood for energy and thus helps control your blood glucose levels.

During pregnancy, your body undergoes a lot of changes including making more hormones and weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. In turn, insulin resistance increases your body’s need for insulin. If your pancreas are not able to produce enough insulin to match this requirement, you develop gestational diabetes.

Generally, all pregnant women have some insulin resistance during late pregnancy. However, some women especially if they are overweight, have insulin resistance even before they get pregnant. These women are more likely to develop GDM as they start their pregnancies with an increased need for insulin.

Do certain factors increase my risk for GDM? What are the risk factors?

The following are considered risk factors for the development of GDM in a pregnant woman:

  • Being overweight/obese
  • Had GDM before in previous pregnancies
  • Has given birth to a baby weighing more than 4 kgs in the past pregnancies
  • Has a parent, brother, or sister with type 2 diabetes
  • Has prediabetes, meaning her blood glucose levels are higher than normal even in the pre-pregnancy phase, but are not high enough to be diagnosed as diabetes
  • Has a hormonal disorder called polycystic ovary syndrome, also known as PCOS

What do I need to be worried about right now? Will it affect my baby in any way? What about other complications?

Most women with GDM who maintain good control over their blood glucose levels have healthy pregnancies and deliver healthy babies with normal deliveries. Problems may arise mostly if the blood glucose levels are not well controlled leading to certain complications for you and your baby.

Complications that may affect your baby

  • Baby may have excessive birth weight (also called macrosomia)
  • Early (preterm) birth and respiratory distress syndrome: Your high blood glucose levels may increase your risk for early labour which in turn may put your baby at risk for respiratory distress syndrome, which leads to difficulty in breathing.
  • Low blood sugar in the baby: Sometimes babies of mothers with GDM develop low blood sugar soon after birth because they are producing high levels of insulin as a response to the mother’s high blood glucose levels. Very low blood glucose levels may lead to seizures in the baby.
  • These babies may be at a higher risk of obesity and thus type 2 diabetes mellitus later in life

Complications that may affect you

  • High blood pressure and preeclampsia: Preeclampsia is a serious complication
    of pregnancy that leads tolife-threateningly high blood pressure and seizures.
  • Future diabetes: Your risk of gestational diabetes increases in
    future pregnancies if you are having it in your current pregnancy. Also the risk of type 2 diabetes mellitus (another kind of diabetes) as you age increases, which can be prevented or delayed by choosing a healthy lifestyle early.

How do doctors usually diagnose this?

A routine blood glucose screening is done for all pregnant women between 24 and 28 weeks of your pregnancy. If your blood glucose levels are found to be high, you will be called in for a consultation immediately.

What should I do before my blood glucose screening test and my subsequent consultation?

  • Ask for all the pre-testing pre-requisites including if fasting is required and if so, for how long or any other preparations you may have to do.
  • Keep a note of all the symptoms you are having and inform your doctor about the same.
  • Remember and tell your doctor all your personal information, and past medical history including any recent major life changes or stressors if any.
  • It is better to take a family member or a friend along for the test and the consultation
  • Make a list of all the questions you want to ask your doctor related to diabetes, its treatment, self-care tips, impact on baby, need to consult with other specialists, any warning signs and symptoms that you need to be worried about for which you may need to seek immediate medical attention, etc.

Always get all your doubts clarified with your doctor. Don’t feel embarrassed to ask any question.

What happens during the screening test? Do I have to take many pricks? Are there different types of screening tests?

If you are at high risk for GDM, for example you are obese or have a family member with diabetes then your doctor will screen you for GDM at the first visit itself. If you are at low risk then, you will be screened between 24 and 28 weeks of your pregnancy. The following are the screening tests usually done:

  • Initial glucose challenge test. A blood test will be done one hour after you drink a glucose syrup solution. The test result is considered normal if your blood sugar level is below 130 to 140 milligrams per decilitre (mg/dL). However, this may vary with different clinics or labs.
    • This is not a confirmatory test as, if your blood sugar level is higher than normal, it only means you have a higher risk of GDM. You’ll need a glucose tolerance test to confirm if you really have GDM.
  • Follow-up glucose tolerance testing. Your blood glucose level will be measured after an overnight fast. Then you’ll drink another sweet solution with a higher concentration of glucose. After this, your blood sugar level will be checked every hour for three hours. You will be diagnosed with gestational diabetes if at least two of the blood sugar readings are higher than normal.

Does my life change drastically after diagnosis with GDM?

To some extent! You will be called for frequent check-ups especially during your last three months of pregnancy. During each of these visits, your blood sugar will be monitored. You may also be asked to monitor your own blood sugar daily so that a closer watch could be kept over your blood glucose levels.

You would be told to follow a healthy diet, and indulge in some amount of physical exercise, of course as recommended by your doctor. If your healthy lifestyle and diet is not able to control your blood glucose levels, only then will you be recommended medications.

Some doctors may prescribe oral medications while some may recommend insulin if they feel that there is not enough research on the safety of oral medications in pregnancy.

Your doctor may advise other additional tests to evaluate your baby’s health, if you have other complications in addition to GDM.

Consistently high blood glucose levels may affect the placenta (the organ that connects your blood supply with that of your baby’s and delivers oxygen and nutrients to your baby) and hamper the passage of oxygen and nutrients to the baby. Thus, your doctor would monitor the function of the placenta frequently and thus assess your baby’s well-being during your pregnancy.

What kind of healthy diet do I need to follow?shutterstock_196238198

A healthy diet includes a lot of foods that are high in nutrition and fibre, but are low-fat and low calorie such as fruits, vegetables and whole grains.

You would be advised to limit your intake of highly refined carbohydrates, including sweets.

However, it is impossible to recommend a single diet for every woman and you may need to consult a dietitian or a diabetes educator to create a meal plan based on your current weight, pregnancy weight gain goals, blood sugar level, preferences and budget.

While your doctor will not recommend that you lose weight during pregnancy, he will set realistic and safe targets for weight gain so that you don’t gain too much weight which might worsen your blood glucose control and lead to complications.

Can I do any kind of exercise?

You need to consult your doctor before any kind of exercise, to know if that is right for you.

With your doctor’s consent, try to include moderately vigorous exercise on most days of the week such as walking, cycling and swimming. Routine housework and gardening are also good workouts during pregnancy. Remember to go slow and gradual, if you are starting to exercise after a long time.

What are the benefits of exercise during pregnancy?

  • Promotes overall well-being
  • Lowers your blood sugar by helping your body to move the extra glucose from your blood into your cells, to be used for energy
  • Increases your cells’ sensitivity to insulin, so that less insulin is needed to deal with all the excess sugar in your blood
  • Can help relieve back pain, muscle cramps, swelling, constipation and trouble sleeping, which are common in most women with pregnancy
  • Can also help build up your stamina and strength for labour and delivery

Do I have to monitor my blood glucose all the time? How do I find time to do that?shutterstock_173816219 copy

Your doctor may ask you to measure your blood glucose four to five times a day, in the morning on an empty stomach and after all your meals. This is to make sure that your blood glucose levels stay consistently within the healthy range throughout the day.

Although this may be inconvenient and difficult to begin with, but as you go about your pregnancy, it will only get easier with practice.

How do I do this test?

To test your blood sugar, you can use a small lancet to prick your finger to draw a drop of blood. Place this blood drop on a test strip inserted into a blood glucose meter — a device that measures and displays your blood sugar level (please see the image on the right).

What happens to blood glucose monitoring during labour and delivery?

During labour and delivery, your doctor will constantly monitor and manage your blood sugar. This is to monitor and prevent your baby from developing low blood sugar after birth which can happen if your blood sugar is so high that your baby’s pancreas may release high levels of insulin.shutterstock_117415363 (2)

 

Do I have to continue monitoring my blood glucose even after delivery? If so for how long?

Monitoring your blood glucose levels for some time after delivery is important.

Your doctor will check your blood glucose levels immediately after delivery and again between six to 12 weeks to make sure that your blood glucose levels have returned to normal.

If everything is normal, then you will have to get your blood glucose levels checked at least every three years as GDM increases your risk of developing type 2 diabetes later in life. Maintaining good lifestyle habits, such as a healthy diet and regular exercise, can help reduce your risk.

Will I need to take drugs or injections for the control of my blood glucose levels?

Not necessarily. Quite a few women with GDM are able to control their blood glucose levels during pregnancy purely with lifestyle changes including a healthy diet and exercise. You will need medications only if your levels fail to get controlled with lifestyle changes.

You would be told to take an oral medication called metformin or inject yourself with insulin. Your doctor will train you on how to use insulin. You will also be trained on how to store insulin and how to watch out for low blood glucose symptoms, which is common in people on insulin. It is essential to monitor your blood sugar closely, whichever medication you are on.

Do I have to worry about anything during the delivery?

If you don’t go in to labour by your due date, your doctor may induce the labour. Sometimes this may be done even before the due date, if the doctor feels the need based on your and your baby’s health. Delivering after your due date may increase the risk of complications for you and your baby. Your baby’s health will be constantly and closely monitored throughout labour and delivery.

I was diagnosed with GDM during my last pregnancy. Is there a way that I can prevent it during my next pregnancy? Can I do something beforehand?shutterstock_235927471 (2)

There are no guarantees about preventing GDM especially if you have had GDM in your past pregnancies. But you can try to adopt healthy lifestyle choices before you plan your next pregnancy that may help reduce the risk of developing GDM again.

You can try the following as part of a healthy lifestyle even before you plan your pregnancy:

  • Eat a healthy, balanced diet with foods rich in fibre and low in fat and calories such as fruits and vegetables.
  • Engage in 30 minutes of moderate activity on most days of the week such as a brisk daily walk, riding your cycle, or swimming
  • Try to lose all the excess weight before planning a pregnancy
  • Focus on making all the above lifestyle changes permanent in your life, so that you will have a healthy heart, more energy and you will cut down the risk of developing type 2 diabetes in the long run.
  • Consult your doctor before you plan your pregnancy for added information on preventing GDM

I feel so helpless and distressed with this diagnosis. I don’t know how to cope with it.

The fear of the unknown is always distressing. Added to that the fear of something happening to your unborn baby is enough to give you sleepless nights. But be assured that the steps you take to deal with your GDM will eventually relieve you of the stress/fear and help you nourish your baby and ensure a safe and smooth delivery.

Here are some tips that will help you cope better:

  • Stick diligently to your healthy diet and exercise regimen as prescribed by your doctor and dietician.
  • Try to learn as much as you can about GDM. Read articles and books about GDM.
  • Ask as many questions as you wish to your doctor.
  • Don’t hesitate to reach out to your spouse, family and friends for all kinds of support.
  • Join a support group, if not available locally at least online. You will feel better when you know that there are more people like you out there.
  • Don’t hesitate to reach out to your spouse, family and friends for all kinds of support.
  • Join a support group, if not available locally at least online. You will feel better when you know that there are more people like you out there.

Remember, the more you know, the more in control you will feel. Knowledge will empower you!

 

 

 

 

 

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