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My Doctor Says I Have Gestational Diabetes
What do I Do Now?
Indispensable to human health
Gestational Diabetes
Educational Information from BD Consumer Healthcare
This guide will answer your questions about gestational diabetes and explain the steps you can take to help you have a normal pregnancy and healthy baby What is Gestational Diabetes?
Gestational diabetes is a type of diabetes that occurs only in pregnancy and usually disappears after the birth of the baby It is present in less than 15 of all pregnancies and is usually detected at 24-28 weeks 1 of pregnancy
Who Is Likely To Have It?
Your chances of developing gestational diabetes increase if you: Have a family history of diabetes Had a previous birth of a very large baby or a stillbirth Are overweight Had an earlier pregnancy with gestational diabetes Have too much amniotic fluid polyhydramnios Are older than 25 years Pregnant women are usually screened for gestational diabetes between 24-28 weeks Women with a strong family history of diabetes or with gestational diabetes in an earlier pregnancy may be tested at 16-20 weeks Just because you did not have the condition in your first pregnancy does not mean you
will not develop it in later pregnancies
What Is the Cause?
Gestational diabetes prevents your body from using carbohydrate properly Carbohydrate is a nutrient found in foods that is turned into sugar glucose by the body Foods that contain carbohydrate include sweet foods such as table sugar, honey, jams, sweets, soft drinks, and starchy foods such as bread, cereal, pasta, potatoes, fruit and milk The inability to use carbohydrate properly results in blood sugars that are not within normal levels When you eat food, your body breaks down carbohydrates into sugar during digestion and the sugar enters your blood stream Your body needs sugar to provide energy just like your car needs gasoline to run Energy is needed by your brain for thinking and by your muscles for activity The pancreas, located behind your stomach, senses how much sugar is present in the blood and delivers the right amount of a hormone called insulin Insulin lowers blood sugar by allowing sugar to enter your bodys cells
1
American Diabetes Association Clinical Education Series, Medical Management of Pregnancy Complicated by Diabetes, Third Edition, pp 114-115, 2000
Insulin Resistance
In all pregnancies, the
placenta creates hormones that work against the action of insulin, reducing its effectiveness This is called insulin resistance These pregnancy hormones are at their highest level at about 24-28 weeks of pregnancy As pregnancy progresses and the placenta grows, more hormones of pregnancy are produced and there is even greater insulin resistance In most women the pancreas is able to make extra insulin to overcome insulin resistance If your pancreas cannot make enough insulin and your blood sugar remains too high, this is known as gestational diabetes Your bodys organs cannot use the sugar for energy and an unhealthy level builds up in your blood Your body tries to rid itself of the sugar through the urine
What could happen to my baby?
When gestational diabetes is detected early, it can be managed and controlled to prevent complications for both you and your baby The key is to keep your blood sugar at normal levels as soon as gestational diabetes is detected You will learn how to do this by using the following tools: Meal Planning Blood Glucose Monitoring Insulin if needed
When blood sugar is not kept under control, two conditions could affect your baby: macrosomia and
hypoglycemia
Large baby macrosomia Your baby receives nutrients directly from your blood through the placenta If your blood has more sugar than normal, your baby responds by producing its own insulin The babys insulin could cause your baby to grow faster and bigger, a condition called macrosomia Although the baby grows larger, it does not mature more rapidly, so a normal size baby may still be premature Occasionally, a baby grows so large that a cesarean section delivery becomes necessary An ultrasound test is usually done to determine the size of your baby and the best method of delivery Macrosomia can be avoided by keeping your blood sugar level as close to normal as possible Low blood sugar Hypoglycemia Once your baby is born, the babys insulin could still be present, causing a sudden drop in your babys blood sugar Gestational diabetes increases the chances of hypoglycemia or low blood sugar As a safeguard, your babys sugar level will be checked at birth and several times afterwards Your baby may be fed sugar water and placed in a special care nursery for observation Keeping your blood sugar at a normal level during pregnancy can prevent low blood sugar in your baby at
birth
What about birth defects - You should not worry that gestational diabetes will cause birth defects in your baby Birth defects that can occur as a result of diabetes usually happen during the first trimester or first 13 weeks of pregnancy The insulin resistance that develops as a result of gestational diabetes does not begin until about the 24th week of pregnancy Could my baby be born with diabetes? - Having gestational diabetes does not cause your baby to have diabetes Your childs risk of developing diabetes is related to family history, body weight and lifestyle choices, such as eating habits and exercise
What are the other types of diabetes?
Gestational Diabetes is different than other types of diabetes, because it only occurs during pregnancy and usually disappears after the baby is born Research studies have shown that 40-60 of women with a history of gestational diabetes will develop type 2 diabetes later in life2 They are less likely to develop type 2 diabetes if they are able to achieve and maintain a healthy weight Type 1 diabetes - This type of diabetes occurs primarily in children and young adults About 10 of people with diabetes have type 1 In type 1 diabetes,
the pancreas produces little to no insulin Therefore, diabetes pills cannot be used as a treatment and insulin injections are necessary for survival A well-balanced meal plan, exercise program and insulin are necessary to control type 1 diabetes Type 2 diabetes - People diagnosed with type 2 diabetes are usually over 40 years of age, but the condition has also been seen in overweight and inactive children and may occur earlier in groups at high risk such as Latino-Americans Approximately 90 of those with diabetes have type 2 diabetes They tend to have a family history of diabetes, be overweight and not very active In type 2 diabetes, the pancreas produces insulin However, either there is not enough insulin or the insulin that is made is not working properly Many of these people can control their diabetes by following a well-balanced meal plan, exercising and if necessary, taking diabetes pills Some may also require insulin in order to control their blood sugar levels and to feel better
2 Coustan
DR, Carpenter MW, OSullivan PS, Carr SR: Gestational Diabetes Mellitus: Predictors of Subsequent Disordered Glucose Metabolism AM J Obstet Gynecol 168:1139-45 1993
How do I take care of
my baby and myself?
You can help control your blood sugar by taking these five steps: Checking your blood sugar Appropriate exercise Testing for ketones Insulin, if necessary Following a special meal plan
Your doctor may recommend that you see a registered dietitian and diabetes nurse educator to help you understand how to use these vital tools to successfully manage your gestational diabetes The following information will help you learn more
1 Checking your blood sugar - Self-blood glucose monitoring is a simple way to check your blood sugar Several types of glucose meters are available to help you check your blood sugar levels Glucose meters read either plasma or whole blood Check the manual that comes with your meter to find out if your meter reads plasma or whole blood Plasma readings are closer to the results you will receive in the laboratory Your nurse educator or doctor will help you select the one that is best for you, teach you how to use it and record the results Your blood sugar readings will change throughout the day, depending on what you eat, your activity level and the action of your hormones Your doctor and the other members of your health care team will ask
you to check your blood sugar several times a day to better understand these changes and develop the right treatment plan for you When to test - Ask your doctor how often he wants you to check your blood sugar each day Most doctors suggest that you test four times a day: before eating in the morning and one or two hours after each meal Your blood sugar will reach its highest level one-hour after you eat, so testing at this time will let you know the highest amount of blood sugar to which your baby has been exposed Using a logbook - Your healthcare team will provide you with a special logbook that you must bring to each visit with your doctor and educators It is important to carefully record your blood sugar readings The logbook should indicate the date, time of test and result Any changes from your normal meal plan should also be noted Your doctor will use this information to make decisions about your treatment The doctor will look for patterns in your blood sugar records over a period of time For example, are your readings higher in the morning than the evening? Are they related to your meal plan or activity or do you require more insulin at that time of day? See the sample
logbook on the next page
Self Blood Glucose Monitoring Logbook
Before Eating AM 90 94 115 92 90 After Breakfast 1 hr 2 hr 135 121 117 130 115 128 124 122 118 After Lunch 1 hr 2 hr 118 After Dinner 1 hr 2 hr 122 133 118 119 115
Date Mon Tues Wed Thurs Fri
Insulin 2R - 5N 2R - 5N 2R - 5N 2R - 5N 2R - 5N
Insulin 5R 5R 5R 5R 5R
Insulin 8N 8N 8N 8N 8N
Ketones N N N N N
Notes
Ate Birthday Cake for Snack
Ideal blood sugar results - The goal of treatment is to keep your blood sugars as close to normal as possible Your blood sugar results should be in the following ranges:
Plasma Whole Blood
Fasting Blood Sugar Before Breakfast Less than or equal to 105 mg/dl Less than or equal to 155 mg/dl Less than or equal to 130 mg/dl Less than or equal to 95 mg/dl Less than or equal to 140 mg/dl Less than or equal to 120 mg/dl
Target Blood 3 Sugar Results
1 hour after meals 2 hours after meals
Recent studies have shown that the plasma levels should even be lower before breakfast less than 90 mg/dl and lower one hour after meals less than 120 mg/dl Women with Gestational Diabetes who have blood sugars at these lower levels have been found to reduce their chances of giving birth to large
babies Check with your doctor or health care team to set the correct target values for you 2 Testing for ketones - Your doctor may ask you to test your urine for ketones Ketones occur when the body begins to break down fat for energy instead of sugar and weak acid substances are formed as a result These substances may spill over into the urine or leave the body through the urine Ketones may be found in the urine if one or more of the following circumstances occur:
Your blood sugar is out of control You did not eat enough carbohydrate You did not eat enough calories You skipped a meal or snack You did not eat for more than 10 hours between bedtime and breakfast
Large amounts of ketones in the blood can cause a condition called ketosis that may harm your baby There should be no ketones present in your urine It is important to report any positive ketone tests to your doctor
Testing for ketones -You can buy ketone test strips at your local drugstore The test strip has a chemically-treated pad that is passed through a stream of urine or dipped into a container with urine It is then compared to a color chart on the bottle with a scale The result should be noted in your logbook Any
signs of ketones should be reported to your doctor or health care team immediately Ketones should be tested first thing in the morning, if you are sick, when you have not eaten enough or when your blood sugar is high greater than 200 mg/dl
3 American
Diabetes Association, Clinical Practice Recommendations 2001: Gestational Diabetes Mellitus Position Statement, Diabetes Care, 24:supplement1: S78, 2001
3 Will I need to follow a special diet?
What you eat and how much you eat will affect your blood sugar Most women with gestational diabetes can control blood sugar by following a healthy meal plan A healthy meal plan is a guide to help you select the right types and amounts of food and includes a variety of foods such as bread, starches, fruit, milk, meat and vegetables A registered dietitian can help you develop a meal plan specifically designed to meet your individual needs A meal plan should take into consideration your likes and dislikes as well as your usual food habits The goals of your meal plan are: To provide the necessary nutrition for you and your baby To keep blood sugar glucose levels within a normal range To allow for adequate weight gain To avoid spilling ketones
in your urine If you are not eating enough throughout the day or if you are not eating enough food for your bedtime snack, you may detect ketones in your urine To find a qualified dietitian: Ask your doctor or local hospital Call your local chapter of the American Diabetes Association Check the American Dietetic Association Consumer Hotline 1-800-366-1655 or web page wwweatrightorg See the American Association of Diabetes Educators web page wwwaadenetorg Healthy Weight Gain - How much weight you should gain during pregnancy is determined by what you weighed before you became pregnant See Table below The total amount is not as important as your weekly weight gain If you were gaining two pounds per week before you were diagnosed, slowing down to one pound per week may help blood sugar levels return to normal Pre-Pregnancy Weight Normal Weight Underweight Overweight Obese Twin Pregnancy Recommended Weight Gain4 25 - 35 pounds 28 - 40 pounds 15 - 25 pounds 15 pounds 35 - 45 pounds
4 American
Diabetes Association Clinical Education Series, Medical Management of Pregnancy Complicated by Diabetes, Third Edition, pp74-75
Many women, after learning they have gestational diabetes, may
find they lose weight or stay at the same weight for one to two weeks after they change their meal plan If this happens to you and you are not spilling ketones this is not cause for concern This may happen because: You reduced the carbohydrates in your diet by eating fewer sweets and carbohydrate rich foods You may be eating fewer calories However, if you do not begin to gain weight two weeks after changing your eating habits, you may need to discuss this with your doctor or dietitian Remember, even if you were overweight before you became pregnant, now is not the time to lose weight During the second and third trimester you should gain approximately 3/4 to 1 pound per week if you were at a normal weight before becoming pregnant and slightly less weight per week if you were overweight Your doctor or dietitian can help you determine how much weight you should gain each week Calories - In order to determine the right number of calories for you, your height, pre-pregnancy weight, age, number of weeks pregnant and activity level must be taken into consideration A detailed diet history can help your dietitian determine the right calorie level for you so you continue to gain weight at
the rate you should How Does Food Affect My Blood Sugar? - Food is made up of three ? nutrients: carbohydrate, protein and fat Each of these nutrients supplies calories but has an effect on your blood sugar level Remember that when you eat a meal or a snack your body breaks down food into sugar glucose and eventually, with the help of insulin, it is turned into energy so you can perform the activities of daily living When you have gestational diabetes your body can not use sugar properly Sugar builds up into the bloodstream and results in a high blood sugar level that is not healthy for you and your baby Carbohydrate - Carbohydrate has the greatest effect on your blood sugar because it is completely turned into sugar one to two hours after eating Complex carbohydrates include foods such as bread, bagels, potatoes, corn, peas and lima beans Simple carbohydrates sometimes s called simple sugars include foods such as fruit, juice, milk, cake, cookies, candy, honey, sugar, ice cream and soft drinks
Complex vs simple carbohydrates - You may have heard that foods with simple carbohydrate will raise your blood sugar quicker and higher th 
an food with complex carbohydrate Therefore, some
women will avoid simple carbohydrates such as milk and fruit that are an important source of needed vitamins and minerals, to avoid high blood sugar Everyone handles food differently It is not necessary to eliminate foods such as these unless they cause problems with your blood sugar This is why it is important to test your blood sugar one to two hours after a meal in order to see how specific foods affect your blood sugar Carbohydrate control - Avoid eating large amounts of simple l carbohydrates such as cake, cookies, candy, soft drinks and sweeteners such as sugar and honey because they are of little nutritional value and high in carbohydrate They are not good carbohydrate choices Regardless of the type of carbohydrate you eat it will turn into sugar It is important for you to control the amount of carbohydrate and eat the same amount of carbohydrate at the same times each day in order to control blood sugar Protein - Protein has very little effect on blood sugar levels Protein foods include meat, fish, chicken, cheese, eggs and peanut butter Fat - Fat has very little impact on t blood sugar, however foods high in fat content are high in calories If eaten in excess they can lead
to unwanted weight gain Some examples of fat are butter, margarine, oil, mayonnaise, salad dressing, bacon and nuts Food servings - Your dietitian will help you decide how many servings you should eat from each food group and when to eat meals and snacks Non-starchy vegetables such as broccoli, cauliflower, carrots, string beans and lettuce greens are low in carbohydrate, fat and calories They may be eaten more freely than other foods Check with your dietitian to find out how many servings to eat each day Remember it is important for you to eat a variety of foods to meet your nutritional needs while you are pregnant
Food Groups Carbohydrate Group
Each of the following is equal to one serving of carbohydrate:
Bread and Starches 1/2 - 3/4 cup dry cereal 1/2 cup cooked cereal 1 slice of bread 1/2 small bagel 1 oz 1/3 cup rice 1/2 cup pasta 3 oz potato 5 crackers 3/4 oz pretzels 1 small roll 1/2 cup corn or peas 1 small ear corn Milk 1 cup milk 1 cup plain yogurt 1 cup fruited yogurt sweetened with aspartame Fruit 1/2 cup fruit juice 1/2 large or 1 small banana Small piece of fruit 1-1/4 cup berries 1/2 grapefruit
Protein Group
Each of the following is equal to one serving of
protein:
1oz meat, fish or poultry chicken, turkey 1oz cheese 1 egg 2 tablespoons peanut butter 4 oz Tofu
Fat Group
Each of the following is equal to one serving of fat:
1 teaspoon butter, margarine, oil or mayonnaise 1 tablespoon salad dressing 1 tablespoon reduced calorie salad dressing 2 tablespoons cream cheese
Sample Meal Plan - 2200 Calories Breakfast
1 egg or 1/4 cup cottage cheese 2 slices toast or 1 English muffin Decaffeinated tea or coffee 1-cup skim or 1 lowfat milk 2 teaspoons margarine or butter
Morning Snack
Small piece fresh fruit 5 saltine crackers
Lunch
3 ounces lean meat, fish or poultry 1 cup skim or 1 low-fat milk 2 slices bread or 2 ounce roll 2 teaspoons mayonnaise or oil Lettuce and tomato 1-1/4 cup strawberries or small banana 1/2 large banana
Afternoon Snack
1 cup milk 3 graham crackers
Dinner
4 ounces lean meat, fish or poultry 1-1/2 cups pasta or 1 cup rice or 1-1/2 cup starchy vegetable or large potato 2 teaspoon oil or margarine or 2 tablespoons salad dressing Water or decaffeinated coffee or tea 1 cup vegetable or tossed salad
Bedtime Snack
1 cup skim or 1 low-fat milk 3 graham crackers or 3 cups popcorn
Portion control - When you begin
following your meal plan it is l advisable to measure foods to make sure you are eating the right amount The measuring equipment you will need includes measuring cups, measuring spoons and a food scale If you eat too much at one meal or snack, especially carbohydrate-rich foods, your blood sugar may be high after that meal or snack
Timing of meals and snacks - Your meal plan will probably include three meals and three snacks daily It is helpful to divide the food you eat at meals into frequent smaller meals to prevent blood sugar from getting too high Frequent small meals may also help prevent heartburn Your dietitian or doctor may ask you to eat less carbohydrate in the morning because this is when insulin resistance is the greatest and therefore you can tolerate less carbohydrate at this time It will be important for you to include a bedtime snack to help prevent urine ketones in the morning As your pregnancy progresses, you may need a bigger bedtime snack or more calories during the day to prevent morning urine ketones - Saccharin, an artificial sweetener found in , can cross the placenta to the
Sweet n Low
baby, health experts recommend saccharin should be avoided during
pregnancy Aspartame, also known as Nutrasweet or Equal , is an artificial sweetener that does not cross the placenta and is considered to be safe for use during pregnancy in small amounts Talk to your doctor about how much aspartame is acceptable during pregnancy
Sweet n Low is a trademark of Cumberland Packaging Corporation Sugar Twin is a trademark of Alberto-Culver Company Nutrasweet and Equal are trademarks of the Nutrasweet Company
4 Will exercise help control my blood sugar?
Exercise is important for a healthy pregnancy Daily exercise protects against back pain, maintains muscle tone, strength and endurance For women with gestational diabetes, exercise also serves to increase the efficiency of the bodys own insulin Often called invisible insulin, exercise helps to lower blood sugar without medication If insulin is required, exercise may allow you to use a smaller dose You should discuss your exercise program with your doctor Your doctor will alert you to any activity limitations, warning signs or special considerations Duration and timing - Exercising four to five days per week for 20 to 30 minutes is necessary to see the effect of invisible insulin on your blood glucose
levels The best time to exercise is right after a meal when your blood sugar level is at its highest If you are taking insulin, this is also the safest time to exercise
5 How do I know if I need to take insulin?
If your blood sugar is over the acceptable ranges, you may need insulin to bring them to normal ranges These readings do not mean that you are not following your meal plan or exercising They just indicate that you do not have enough insulin working properly Diabetes pills cannot be used during pregnancy, because they may affect the baby If necessary, your doctor will start you on insulin injections and may ask you to see a nurse educator who will teach you how to draw up the insulin in the syringe, as well as how, when and where it should be given Important facts about insulin - Insulin works to lower your blood sugar Your doctor will determine your insulin dose, when and how often it should be given The dose of insulin you take and how often you take it is based on your blood sugar records As your pregnancy progresses, the placenta will make more pregnancy hormones; larger doses of insulin will be needed to keep blood sugars within acceptable ranges It is common for women
to take two to three injections of insulin a day
Insulin adjustment - Often women will begin taking one or two shots of NPH insulin NPH is intermediate acting insulin that works to meet the bodys constant need for insulin As insulin requirements increase, there may be a need to combine NPH insulin with Regular insulin, a short-acting insulin The shortacting insulin works to lower your blood sugars quickly after a meal By combining quick-acting and longer-acting insulin, there is 24-hour insulin coverage of blood sugars The following table describes how they work5 Lowers the Blood Sugar Name of Type of Starts Stops the Most Insulin Insulin Working Working Regular NPH or Lente Short-acting
Intermediate-acting
30 minutes 1 - 3 hours
2 - 4 hours 4 - 10 hours
6 - 8 hours 16 - 24 hours
How do I take Insulin? Where do I give it? The thought of taking insulin by injection might cause you some concern After you give the first injection, you will be surprised at how comfortable it can be Todays insulin needles are very thin and short Your educator or doctor will teach you how to draw up the insulin into a syringe and give yourself the injection How do I store insulin? - Insulin can be
stored at room temperature or in the refrigerator Cold insulin tends to hurt, so if you do keep it in the refrigerator, let it sit at room temperature for 15 minutes before you give yourself an injection Insulin needs to be stored away from extremes of hot or cold It cannot be frozen If the temperature is greater than 70 degrees and you are traveling in a car, you should put it in a cooler Never use insulin that is expired The expiration date stated on the label refers only to a bottle that has never been opened Once an insulin bottle is opened, it is only good for 28 days For that reason you should write the date when the bottle was opened on the label and check it frequently to ensure that you do not use it after 28 days
5
American Diabetes Association Clinical Education Series, Medical Management of Pregnancy Complicated by Diabetes, Third Edition, pp 92, 2000
Are there any dangers in giving insulin? - When using insulin, a low blood sugar reaction or hypoglycemia may occur if you do not eat enough food, skip a meal, do not eat at the right time of day, or exercise more than usual Remember that insulin and exercise both lower blood sugar, while food raises blood sugar
Hypoglycemia is a very uncomfortable feeling It is a medical emergency and should be treated immediately Common signs and symptoms of low blood sugar: Sudden hunger Headache Sweating Shaking Fast heartbeat Dizziness Fatigue Irritability
Treatment for low blood sugar - If low blood sugar is not treated you may start to feel confused or even pass out If you think you are having a low blood sugar reaction, you should: If possible, verify blood glucose by checking your blood sugar If your blood sugar is less than 60 mg/dl, treat with 15 grams of carbohydrate 10-oz glass of skim milk or 4 oz of juice Wait 15 minutes and retest If your blood sugar is still less than 60mg/dl, treat with another 15 grams of carbohydrate If you are away from home you can take glucose tablets, four ounces of orange juice or six ounces of regular soda If you are unable to check your blood glucose, treat as described above and wait 15 minutes If you do not feel better repeat the treatment All treatment for hypoglycemia should be followed by the next meal or snack If a meal or snack is not scheduled for 30-60 minutes, eat a snack that includes 15 grams of carbohydrate five crackers, a piece of
fruit or a slice of bread If your next meal is more than an hour away, eat 15 grams of carbohydrate and one ounce of protein such as 5 crackers and one ounce low fat cheese
All hypoglycemia reactions should be reported to your doctor and noted in your logbook If you cannot identify a cause for the low blood sugar, such as a delayed meal or not eating enough, contact your doctor immediately An adjustment in your insulin dose may be necessary You can avoid low blood sugar reactions by eating on time and eating the right amount of food as outlined in your meal plan Low blood sugar and exercise - Since both insulin and exercise lower blood sugar; following are some additional steps you should take to prevent hypoglycemia reactions during exercise Always carry some form of sugar such as glucose tablets or hard candies One serving of fruit or the equivalent of 15 grams of carbohydrate should be eaten for most activities lasting about 30 minutes One serving of fruit and one serving of starch or the equivalent of 30 grams of carbohydrate should be consumed for activities that last longer than 60 minutes If you exercise right after a meal, eat the snack after the exercise If you
exercise two hours or more after a meal, eat the snack before the exercise
Will my labor and delivery be different because I have gestational diabetes?
Your labor and delivery should be similar to any pregnant woman who does not develop complications Gestational diabetes should not prevent you from delivering your baby normally As long as your baby is growing normally and is not too large you should be able to deliver close to your due date A very large baby may need to be delivered by Cesarean section Your blood sugar will be monitored every one to two hours during labor If you are taking insulin and your blood sugar is less than 90 mg/dl, the insulin will probably be stopped Labor is like exercise and it should lower your blood sugar to a point where you need no or very little insulin during this process Once the baby is born and the placenta is removed, your blood sugar should return to normal
What happens to my baby after delivery?
Your babys blood sugar will be tested immediately after birth If the blood sugar is low the baby will be given sugar water to drink or by intravenous feeding IV Usually, babies of mothers with gestational diabetes are sent to a special care nursery
for observation of low blood sugars for the first few hours after birth as a precaution
What happens to my diabetes after I deliver my baby?
After the placenta is delivered, the pregnancy hormones are also removed and your blood sugars should fall back into normal range However, there are a very small percentage of people for whom this is not true You should have another blood test six weeks after the baby is born to be sure that your blood sugars are normal It is important to remember that women who develop diabetes in one pregnancy, have a 90 chance of developing it in following pregnancies6 You should discuss this with your doctor at each pregnancy Chances of developing type 2 diabetes later - Women with gestational diabetes have a 60 chance of developing type 2 diabetes later in life The best way to avoid this is to reach and maintain a healthy body weight and be physically active Achieving the right body weight for you will reduce your chances of developing type 2 diabetes to 257 You should be alert to the signs and symptoms of diabetes and your blood sugars should be checked every year Signs and symptoms of diabetes include: Extreme thirst Feeling tired Excessive
urination Changes in eye sight Extraordinary hunger Frequent infections Sudden weight loss Slow healing of cuts or sores Numbness and tingling in hands and feet This may seem like a great deal of information and a lot of things to do but remember there are many people who can help you Your doctor and other members of your health care team are available to answer your questions and help you take care of yourself and your baby It is important to remember that all this work will result in a beautiful healthy baby Take one step at a time and read this book as often as you need to remember how to take care of your gestational diabetes
6
Philopson EH, Super DM: Gestational Diabetes Mellitus: Does It Recur In Subsequent Pregnancy? AM J Obst Gynecol 160:1324-31, 1989 7 Coustan DR, Carpenter MW, OSullivan PS, Carr,SR: Gestational diabetes melliuts: predictors of subsequent disordered glucose metabolism Amercian J Obstet Gynecol 168:1139-45, 1993
Treatment Plan For Health Care Team: Doctor: Nurse Educator: Nutrition Educator: Fax : Target Blood Glucose Range: Fasting: One hour after meals: Two hours after meals: Bedtime: Blood Glucose Monitoring: Check your blood sugars at the
following times: Fasting Before Breakfast: One hour after meals Breakfast Lunch Dinner Two hours after meals Breakfast Lunch Dinner Urine Ketones: Check your urine ketones at the following times: Phone : Phone : Phone :
Meal Plan Instructions:
Insulin: You should take the following dose of insulin at the times listed below: Type of Insulin and Dose Time of Day
Contact your doctor or healthcare team:
Written by: Rita Saltiel-Berzin, RN, MPH, CDE, CHES BD Consumer Healthcare Franklin Lakes, NJ Dina Hulbert, RD, CDE Joslin Center for Diabetes, Saint Barnabas Health Care System Livingston, NJ We wish to acknowledge the following health professionals for reviewing this publication and providing their valuable insights: Sharon Palmer, RN, BSN, CDE Kaiser Permanente Walnut Creek, California Diane M Reader, RD, CDE International Diabetes Center Minneapolis, MN Helen R Seifert, RN, MSN, CDE Lehigh Valley Hospital Allentown, PA
Educational Information from BD Consumer Healthcare BD, BD Logo and all other trademarks are the property of Becton, Dickinson and Company 2001
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