In people with diabetes, the body cannot use. the energy from the food that’s eaten. Gestational diabetes mellitus, also known as. GDM, is a high blood …
Managing Your Diabetes Gestational Diabetes
Caring for yourself and your baby
Lilly Partnership in Diabetes
What is gestational diabetes mellitus?
Our bodies use the food we eat to get the sugar we need for energy Insulin is a chemical made by the pancreas It helps sugar leave the blood stream and go into our body cells, where it is used as a kind of fuel When this happens the way it should, the level of sugar in the blood stays in the normal range and our bodies have the energy we need In people with diabetes, the body cannot use the energy from the food thats eaten Instead, the sugar stays in the bloodstream rather than going into the cells of the body Gestational diabetes mellitus, also known as GDM, is a high blood sugar condition that about 7 of women get during pregnancy GDM usually develops after the sixth month of pregnancy and generally goes away after the baby is born
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Managing Your Diabetes
Who is at risk for GDM?
Women who are over the age of 25, are overweight, or have a family history of diabetes have the greatest chance of getting GDM But it can happen to any pregnant woman GDM usually cannot be prevented If you have GDM
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in one pregnancy, you are likely
to have it again in later pregnancies GDM occurs in about 7 of all pregnant women1, but it is much more common in:
Hispanic Americans African Americans American Indians Asian Americans
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1 2001 Clinical Practice Recommendations, American Diabetes Association page 77
Managing Your Diabetes
How do I know if I have GDM?
GDM usually has no symptoms, which is why pregnant women should be tested A blood test is the only way to tell for sure if you have it If you had GDM in an earlier pregnancy, your doctor should test for it at your first visit for this pregnancy If you have never had GDM before or have any of the risk factors of GDM, your doctor should test for it between the 24th and 28th weeks of your pregnancy
Testing for GDM
When you are checked for GDM, you will be asked to drink a sugary soft drink and have a blood test one hour later If your blood sugar is above a certain level, you will be asked to take a two-hour glucose sugar tolerance test GTT This test will tell your doctor if you have GDM
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If so, you will need to be treated at once It is important to do this test as soon as possible Because this is a fasting blood sugar test, it is also important that you not
eat or drink anything on the morning of the test
How does GDM affect my baby?
During pregnancy, everything the baby needs to grow and be healthy comes from the mother Things like vitamins, minerals and sugar are carried to the baby through the mothers bloodstream If everything works as it should, the mother and baby will both have the energy they need With GDM, sugar builds up in the blood instead of being used for energy High blood
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Managing Your Diabetes
sugar levels are unhealthy for both mother and baby High blood sugar levels early in the first trimester three months increase the risk of birth defects The good news is that GDM will not cause your baby to have diabetes after it is born In fact, if you keep your blood sugar in a healthy range during pregnancy refer to the Target Blood Sugar Values chart in this brochure, you have a good chance of having a healthy baby If not, your baby can have some serious problems
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Large birth size
When you have higher than normal blood sugar, a lot of the extra sugar goes to your baby The babys body then makes extra insulin in an effort to lower its blood sugar This extra sugar and insulin cause the baby to grow large Large birth size
can make delivery harder for you and the baby A surgical operation, called a cesarean section, is sometimes needed to help deliver larger babies
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Managing Your Diabetes
Low blood sugar
If you had high blood sugar during pregnancy, your babys body will have gotten used to making extra insulin to keep up Your baby may continue making extra insulin after birth even though all the insulin is no longer needed This extra insulin can cause your babys blood sugar to drop to low levels, called hypoglycemia Hypoglycemia can be a serious condition It is most likely to occur if your blood sugars were high during the last few days before delivery Your babys blood sugar level should be checked often for several hours after birth
Jaundice
A slightly yellow skin color called jaundice is fairly common in newborns It is due to a build-up of a body chemical called bilirubin A certain amount of this build-up is normal and is usually not serious Often it goes away by itself
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Jaundice is more likely to be severe in babies of mothers with GDM Sometimes these babies need to receive a special kind of light treatment to help break down the extra bilirubin that has built up in their bodies
Other
problems
High blood sugar can cause early labor and/or birth Babies can have serious breathing problems if they are born early before their lungs are fully developed
How does GDM affect me?
Most women with GDM deliver healthy babies If blood sugar has been well-controlled during pregnancy and the baby is a normal size, most women can have a vaginal delivery
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Managing Your Diabetes
Difficult labor and cesarean delivery
If your baby is large, your labor may be difficult and you may need to have a cesarean delivery There can be other reasons for having a cesarean delivery, too Although millions of babies are born safely this way each year, it may take you longer to heal after a cesarean delivery Also, any kind of surgery increases the risk of problems
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Increased risk of infection
Women with GDM may have a greater risk of infection Vaginal, bladder and kidney infections are the most common Having an infection will usually mean youll have to take antibiotics Your doctor may do monthly urine cultures to look for infections
Toxemia
Women with GDM sometimes develop a serious complication of pregnancy called toxemia It causes high blood pressure and
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Managing Your
Diabetes
swelling This is unhealthy for both the mother and the baby, and needs prompt treatment It may require that you go to the hospital or stay in bed Toxemia generally goes away after delivery
Diabetes after pregnancy
The most serious problem for mothers with GDM is that diabetes may not go away after the baby is born This happens to about 2 of all women with GDM Another 8 have blood sugars that are higher than normal, but not high enough to be called diabetes This is called impaired glucose tolerance Up to 60 of women who had GDM will get diabetes later in life Obese women have the greatest risk of developing lifelong diabetes
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What can I do to take care of myself and my baby?
The goal for caring for GDM is to keep your blood sugar levels as close to normal as possible There are several ways to help you do this
Work with a healthcare team
Before being diagnosed with GDM, you were probably cared for by your regular doctor or obstetrician Now you may need the additional care of a team of experts Your healthcare team may include:
An endocrinologist a doctor who is an
expert in diabetes
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Managing Your Diabetes
A perinatologist
a doctor who is an
expert in
high-risk pregnancies
A Certified Diabetes Educator CDE A Registered Dietitian RD
Follow your meal plan
A Registered Dietitian will help you create a healthy, well-balanced meal plan Your meal plan will be just for you and will include many of the foods you like to eat Staying on this meal plan will be a key to your success with GDM
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It is important to include all the basic food types, including starches, in your meal plan Taking starches out of your diet entirely could be harmful to your baby The meal plan you get from your dietitian will help you balance your meals, especially the amount of starches you need, throughout the day Meal plan goals are:
blood sugars in a healthy range see the
next section Test your blood sugar
a total pregnancy weight gain of
between 25 to 35 pounds
no ketones in your urine more about
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this later
Managing Your Diabetes
You should avoid:2
caffeine alcohol artificial sweeteners with saccharin
in them It may also be necessary to avoid concentrated sweets and/or high carbohydrate foods to control after-meal blood sugar levels
Test your blood sugar
Testing your blood sugar is a good way to tell how well you are doing Since blood
sugars change throughout the day, you will probably need to test four to six times a day Blood sugars are generally lowest before meals and highest one hour after meals
2 Diabetes Pregnancy: What to Expect American Diabetes Association; 1992:27-28
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Ideal blood sugar values3
Before breakfast 1 hour after meals less than 95 mg/dL less than 140 mg/dL
2 hours after meals less than 120 mg/dL
When to test
before breakfast 1 hour after breakfast 1 hour after lunch 1 hour after dinner
Your blood sugars are likely to be their highest at these times of day Your baby will do well if your test results are in 
the recommended range at these test times Blood sugar goals for women with GDM are the same as in normal pregnancy Meeting these goals during pregnancy will reduce the risks for you and your baby
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3 Gestational Diabetes Mellitus American Diabetes Association Clinical Practice Recommendations 2001; Diabetes Care, January 2001
Managing Your Diabetes
How do I test my blood sugar?
Your healthcare team can show you how You will need:
A small drop of blood There are
automatic devices, called lancet devices that can help you prick your finger simply, quickly and almost
painlessly
A glucose meter This is a hand-held
device that is used to read your blood sugar level To use it, you place a small drop of your blood on a special test strip and the results appear within seconds Most insurance plans cover the cost of blood sugar testing
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Test your urine for ketones
When possible, your bodys cells burn sugar to get energy But blood sugar cannot be used for fuel when there is not enough insulin to help When this happens, your blood sugar stays too high, which is very dangerous If you dont have enough insulin in your body, or if you are not getting glucose from carbohydrate foods, your body will burn fat as another fuel source The problem is that when the body uses fat for fuels, waste products called ketones are formed Ketones build up in the blood and spill into the urine
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Managing Your Diabetes
Because ketones are more acidic than healthy body tissues, high levels of ketones change your bodys normal chemistry Ketones also pass through the placenta and are dangerous for the baby You may make ketones during pregnancy if:
it has been a long time between meals you are not eating enough calories
or carbohydrates
you are not making enough
insulin,
and your blood sugars are too high
Preventing Ketones
Check your urine for ketones every
morning before eating The test is very easy to do
Eat a snack before bedtime This will
usually protect you during the night
Do not skip or delay meals Eat the amount of starch that has been
planned for each meal
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Will exercise help my GDM?
Exercise can lower blood sugar Taking a brisk 20- to 30 -minute walk after meals can help you control your blood sugar Many women find that a walk after breakfast is especially helpful Some women need to walk after each meal to keep their sugar levels in control Talk to your doctor before starting any type of exercise program
Moderate exercise
Your heart rate should not exceed 140 beats per minute Do not exercise for more than 30 minutes at a time If you exercise too hard or too long, your body may get too hot
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Managing Your Diabetes
Good exercise choices during pregnancy include:
brisk walking swimming prenatal stretching exercises
Exercises that are not generally recommended during pregnancy include:
jogging tennis racquetball volleyball water skiing
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Additional help
If your meal plan and exercise do not keep your
blood sugar in control, your doctor may prescribe insulin Insulin is taken by 20 to 50 of women with GDM Insulin must be given as an injection Your diabetes educator will teach you:
the names and types of insulin
you will use
when to take insulin
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Managing Your Diabetes
how to give yourself insulin how much insulin to take
The amount of insulin you will need may change as your pregnancy progresses This is not a sign that you are doing anything wrong or that your diabetes is getting worse Needing more insulin is just a normal result of your baby growing
how to balance your insulin with meals how to avoid low blood sugar
hypoglycemia
Is taking insulin safe for my baby?
Insulin does not cross the placenta, but blood sugar does High blood sugar is very dangerous for your baby If your blood sugar is high in spite of your best efforts, your doctor may prescribe insulin to help keep your blood sugars in control
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Starting or changing insulin therapy should be done cautiously and only under medical supervision
Keeping Records
Its important for you to keep a record of
your blood sugar test results your urine ketone test results any change in your diet, exercise
or
insulin Your healthcare team will want to check your records at each office visit Thats how they know when changes are needed in your treatment plan Your babys safety depends on these results
Will I need follow-up tests?
If you have GDM, your doctor may want to see you more often Starting around the
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Managing Your Diabetes
34th or 36th week of pregnancy, your doctor will start doing tests to see how your baby is doing
Ultrasound sonogram
This is a safe and painless test that uses sound waves to make a picture of the baby Ultrasound may be done every 1 to 4 weeks near the end of pregnancy Many doctors order an ultrasound to check the babys size before choosing the safest way to deliver the baby
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Kick counts fetal movement records
The kicks you feel from your baby are a good indication of the babys health You may be asked to count the number of times your baby moves during a period of time each day The doctor or nurse will teach you how Call your doctor at once if you notice any decrease in the number or kicks or any change in the pattern of the babys movements
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Managing Your Diabetes
Non-stress testing NST
NST is a painless test that uses a microphone to record the
babys heartbeat The babys heart should beat faster during movement This test is usually done once or twice a week near the end of pregnancy
The biophysical profile
This test combines an ultrasound with an NST This test may be done as often as once a week near the end of pregnancy
What about after the delivery?
Breast-feeding
GDM does not affect your ability to breast-feed your baby Breast milk is a good source of infant nutrition and helps the baby fight infections Breast-feeding can also help you lose weight
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Post-partum after-delivery check-up
It is very important for you to have your blood sugar tested 6 weeks after your baby is born This will help your doctor find out if you still have diabetes In over 90 of women with GDM, diabetes goes away after delivery Some women have blood sugars that are higher than normal, but not high enough to be considered diabetes This is called impaired glucose tolerance If you still have diabetes or impaired glucose tolerance, it is very important that you continue to receive regular medical care Even if you have normal blood sugars after birth, you need to take extra care Have a fasting blood test done at least every three years to make
sure that your blood sugars stay normal
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Managing Your Diabetes
How will GDM affect future pregnancies?
If you have had GDM once, you are more likely to have it again in later pregnancies With each pregnancy, you should have a screening test at your first doctors visit If the test is normal, you should be checked again at 24 to 28 weeks
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Your future health
Staying active and at a healthy weight are the most important tools to prevent future diabetes About one-half of all women who have had GDM eventually develop diabetes4 It may happen years after your baby is born Thats why its so important for you to be tested for diabetes regularly beginning with a glucose test at your first doctor visit after you have your baby Its also a good idea to learn the symptoms of type 2 diabetes, so that you can watch for them
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4 Gestational Diabetes American Medical Association; 1992
Managing Your Diabetes
Diabetes symptoms
In its early stages, type 2 diabetes often has no symptoms When symptoms do occur, they may come on gradually and be very mild They include:
feeling tired dry, itchy skin numbness or tingling in hands or feet frequent infections, and slow healing
of cuts or
sores
blurred vision problems with sexual function increased hunger and thirst increased urination
But most importantly, you should have your blood sugar tested before becoming pregnant again5
5 Diabetes 1991;40 suppl 2: 197-201
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A final word
GDM is a problem you and your baby can live with Just remember to:
work with your healthcare team test your blood sugar and urine
ketones as instructed
stay active maintain a healthy weight stop smoking
If you do, you should be able to control your blood sugar and have a healthy baby Remember, your baby needs you
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With diabetes, knowledge is good medicine The more you learn, the better you can manage your diabetes and the better youll feel This brochure is only part of Lillys comprehensive diabetes patient education program Its available to patients at every level of learning Ask your healthcare provider for more information
wwwLillyDiabetescom wwwDiabetesEnEspanolcom
Managing Your Diabetes is a registered trademark of Eli Lilly and Company HI-25727 PRINTED IN USA 3000024885 01035 COPYRIGHT 2003, ELI LILLY AND COMPANY ALL RIGHTS
RESERVED
Source:nutrition.org.uk
