Pregnant women who were not diabetic before but who have high blood sugar levels during pregnancy are said to have gestational diabetes (GD). Normally, the disease affects women quite late in her pregnancy, around the 24th week. The disease does not show noticeable signs or symptoms. In some cases however, gestational diabetes may cause excessive thirst or increased urination.
How is gestational diabetes caused?
Scientists are not sure what causes gestational diabetes (GD) but the most likely theory is that hormones from the placenta may be responsible for the same. The placental hormones help the baby develop but they may also block the action of mother’s insulin in her body. This causes insulin resistance. Since the body cannot make and use the insulin required for pregnancy, high levels of glucose build up in the blood and cause gestational diabetes.
Why is gestational diabetes dangerous?
Although GD does not cause birth defects the way diabetes (mothers who had diabetes before pregnancy) does, it still can hurt the baby. Since it occurs in the later stages of pregnancy, the body of the baby is already formed but the baby is still growing and developing.
What happens is, the blood sugar (glucose) levels are high in the mother with gestational diabetes and this blood glucose goes through the placenta and into the baby’s blood. Now, the pancreas in the baby begins to produce more insulin so as to process the extra glucose and convert it to energy. The baby thus gets more energy than is required for growth and development. The extra energy is then stored as fat leading to ‘macrosomia’ or fat baby and causing health problems such as –
- Damage to their shoulders during birth
- Very low blood sugar levels at birth because of extra insulin produced by the baby’s pancreas
- Higher risk of breathing problems
- Higher risk for obesity (because of excess insulin production)
- Higher risk for type-2 diabetes as adults (because of obesity and excess insulin)
Gestational diabetes in India
32 million people are living with diabetes in India, and more than 16 percent of pregnant Indian women have gestational diabetes. And the prevalence percentage of gestational diabetes mellitus (GDM) is increasing rapidly. According to a study published in the Journal of the Association of Physicians of India, an overall prevalence of GDM in their study area is about 17% in Chennai, 15% in Trivandrum, 21% in Alwaye, 12% in Bangalore, 18.8% in Erode and 17.5% in Ludhiana. The study also indicated that Indian women have high prevalence of diabetes and their relative risk of developing GDM is 11.3 times compared to white women. Further, Asian women are ethnically more prone to develop glucose intolerance compared to other ethnic groups.
It has also been seen that pregnant women in the age group of 30 to 39 years had greater prevalence of GDM as compared with those in the age group of 20 to 29 years. Considering all these facts, the researchers suggest screening all pregnant women for glucose intolerance.
Screening for gestational diabetes
Oral glucose tolerance test (OGTT) measures the body’s ability to use glucose and it is the normal procedure to diagnose GDM. The World Health Organization (WHO) proposes using a 2-hour 75g OGTT, with a threshold plasma glucose concentration of greater than 7.8 mmol* /L (140 mg/ dL) at 120 minutes as screening for gestational diabetes.
The procedure is simple and cost effective, but the disadvantage is that the pregnant woman has to come in the fasting state to undergo the OGTT. So, Diabetes in Pregnancy Study Group India (DIPSI) came out with a modified version of WHO OGTT wherein pregnant women are given 75 g oral glucose load irrespective of their last meal timing and 2-hour plasma glucose greater than or equal to 7.8 mmol/L (140 mg /dL) is diagnosed as GDM.
This is because after a meal, a non-GDM woman would be able to maintain normal glucose levels despite glucose challenge due to brisk and adequate insulin response. Whereas, in a woman with GDM who has impaired insulin secretion, glucose levels increases with a meal and with further glucose load, plasma glucose levels will rise further.
Risk factors for gestational diabetes
Knowing the risk factors for GDM can help you to incorporate early intervention measures.
- Women who have a history of infertility have an increased risk of developing GDM.
- Studies have found that low socioeconomic status women in India are at an increased risk for gestational diabetes.
- Women with irregular menstrual cycles are more prone to gestational diabetes.
- Overweight and obese Indian women are more prone to develop GDM say researchers at Sree Chitra Tirunal Institute for Medical Sciences, Thiruvananthapuram.
- Increased BMI and insulin resistance is also linked to polycystic ovary syndrome (PCOS), especially in Indian subcontinent Asian women and is a predictor for GDM.
- Family history of diabetes in first-degree relatives from the mother’s side of the family is significantly associated with a risk of GDM, besides, subsequently developing type-2 diabetes later on in life.
- History of UTI (urinary tract infection) and history of moniliasis (an infection caused by fungi of the genus Monilia or Candida) are also associated with GDM.
- Polyhydramnios, another risk factor for GDM, is a condition in which an excess of amniotic fluid builds up in the amniotic sac. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm.
What is the treatment for gestational diabetes?
Due to high prevalence of GDM in India, it is necessary to closely monitor and control blood sugar when you are pregnant and in the risk category. The Diabetes in Pregnancy Study Group India (DIPSI) lays down the following guidelines to manage GDM –
- Know the implications of GDM for your baby and yourself. Learn how to monitor blood glucose yourself. It may be inconvenient to always seek professional help.
- Reduce stress and anxiety. Develop techniques to cope with denial and anxiety issues. If necessary seek professional help.
- You need to intake adequate calories and nutrients to meet the needs of pregnancy. The expected weight gain during pregnancy is 300 to 400 gm/week and total weight gain is 10 to 12 kg by term. Avoid excess weight gain and post prandial hyperglycemia (increase in blood sugar levels after meals). Your calorie requirement is 30 to 40 calorie per kilogram of your ideal body weight.
- Distribute your calorie consumption especially the breakfast. It is best if you split the usual breakfast into two equal halves and consuming the portions with a two hour gap in between.
If nutrition therapy fails to achieve normal blood glucose levels, then insulin therapy may have to be initiated. The success of the treatment for a woman with GDM depends on the glycemic control maintained with meal plan or pharmacological intervention.
Prevention of gestational diabetes – some myth busters
Know that, nothing you had done triggered the onset of gestational diabetes for you. But what you can do is avoid potential complications by monitoring your blood sugar and modifying your diet accordingly.
It is a common belief in India that eating eggs, pineapples and few other fruits can cause abortion. But it’s very far from true! Ripe fruits and vegetables in moderate quantities should be essential part of your diet. And egg is a very rich in protein and other essential nutrients, and if your doctor does not say ‘no’ to it, go ahead and make it a part of your diet.
And of course, most pregnant Indian women know how they are cajoled into eating a lot of carbs because ‘you need to eat for two’. That’s a potentially dangerous habit during pregnancy. You need only 300 calories extra for carrying the baby. Excess carb intake will only result in extra glucose in your blood leading to blood sugar and insulin sensitivity problems.
In the same way, you might want to avoid consuming lot of ‘ghee’ because it is an unsaturated fat and it does not serve any other purpose other than making you overweight or fat. And being fat or overweight is one of the significant risk factors of gestational diabetes.
10 Tips to Control Gestational Diabetes without Medication
Hi, I’m Amykinz!
Update: When I wrote this post, I was thinking that I was going to be put on insulin. However, by the grace and goodness of God, I ended up making it full term without insulin and had a beautiful waterbirth!
I’ve been debating whether to write this post or not.
The status of my Gestational Diabetes has changed. The last 3 weeks, I’ve been unable to manage it on my own with diet & exercise. The first week, I had 5 high readings. The 2nd week, another 5 high readings. This past week, I had 6 high readings. It’s not because I’ve changed anything I’ve done. It’s because your hormones in pregnancy change, throwing everything off, including your Gestational Diabetes numbers sometimes.
Due to the recent 3 weeks numbers, my Endocrinologist will be putting me on either medication or insulin. This means I need to find an OBGYN & possibly switch hospitals. It also means my plans for a waterbirth are out. While I’m disappointed, I know there was nothing more I could’ve done. And as the Diabetes Educator said, “You are doing more than most people. In fact, you could probably write a book about the subject.”
So, that leads me here. Writing this post, in hopes of inspiring others to at least TRY to beat their Gestational Diabetes without medication. I managed mine with these tips for 33 weeks and no medication!
Before we begin, I must write a disclaimer: I am not a professional. I have no health degree and am not a dietician. These are simply things that I researched and tried on my own and had some success with. Always speak with your Endocrinologist or Diabetes Educators before beginning or changing what you’re doing.
Tip #1: Don’t be so hard on yourself.
I’m starting with this tip, because it’s the one I’ve had the hardest time with. I kept thinking that my Gestational Diabetes was due to something I was or wasn’t doing. That is simply untrue. As you’ll see in my further tips, I literally did everything I could and I still ended up with it and still will end up on medication/insulin. Sometimes our bodies just have a mind of their own. The constant change of hormones can mess with your body big time!
Also, a lot of what I’m sharing with you, I’ve done slowly over the past 8 months. I didn’t just change everything at once. So, give yourself some grace.
Tip #2: Keep breakfast simple.
I eat the same thing for breakfast every single day with a few variations here and there. The only carb that I consume is in my whey protein
and a glass of organic whole milk.
Here’s my recipe:
Breakfast Protein Shake
1 cup organic whole Milk
1 T Nut Butter of choice (avoid one’s w/added sugars)
1 tsp Coconut Oil
Sometimes I’ll vary it up and instead of having a nut butter in my shake, I’ll eat a scrambled or hard-boiled egg. But, I usually stick to this pretty tightly.
AVOID: fruit & high glycemic vegetables. The blood sugar naturally rises in the morning, so fruit & high glycemic vegetables tend to put your blood sugar numbers above where you want them.
Tip #3: Eat every TWO hours.
Originally, my Diabetes Educators told me to eat every 2-3 hours, but I was finding that the further into the pregnancy I got, the more high readings I’d have if I waited every 3 hours. But every TWO hours, and my numbers would be fine. I know it can be a pain and yes, you do feel like a stuffed pig, but I literally set the timer on my phone for every 2 hours. I always have little snacks in my purse that I can eat, so if we are on the go, I have no excuse.
Here are my typical eating times:
Breakfast – 8:30 a.m.
Snack – 10:30 a.m.
Lunch – between 12:30 p.m. & 1:00 p.m.
Snack – 3:00 p.m.
Dinner – between 5:30 p.m. & 6:00 p.m.
Snack – between 8:00 p.m. & 8:30 p.m.
Snack – between 10:30 p.m. & 6:30 a.m.
Tip #4: Protein is your friend.
If you’re eating every 2 hours, you’re consuming quite a few snacks throughout the day. Your snack should always be made up of a carb serving or two (15-30 grams) paired with a protein. Protein helps you break down the carbs easier. I found that having 2 carb servings was too many for me, so pairing a carb with a protein still gives me the calories, without the extra carbs.
1 small apple + 1 T peanut butter
1/2 c grapes + 1 string cheese stick
2 T raisins + 1/4 c nuts
1/2 banana + 1 T almond butter
My middle of the night snack, I either eat right before I go to bed (if I’m going to bed around 10:30 p.m. or later) or I eat it at one of the times that I get up in the night to use the bathroom (usually only if I’m going to bed later than 10:30 p.m.). This snack is always the same & looks vaguely familiar to breakfast!
1 cup organic whole Milk
For some reason, having a glass of milk before bed helps keep you from forming ketones during the night. However, I’ve heard that people then tend to have a higher fasting blood sugar reading. So, I add the protein to add calories to my diet and to help break that milk down a little easier throughout the night. It seems to help! My ketones have been great and my morning blood sugars are usually well under what they should be.
Tip #5: Only eat whole food carbs.
I don’t eat hardly any packaged foods, processed foods or restaurant foods. Most of those foods are hard to control your blood sugar with, because there’s so many additives and things that you can’t possibly know how it will effect your blood sugar until it’s too late.
When you know that you’ll be out of town or in the car all day, pack all your food for the day in a cooler & bring it with you. No excuses!
For carb choices, stick with the following options.
- Kefier, organic
- Milk, organic
- Yogurt, organic
- Squash, all types
- Potatoes, organic*
- Sweet Potatoes*
- Whole Fruit
- Rice (Brown, Wild)
- Sprouted Wheat*
*I’ve had some trouble, at times, with regulating my blood sugar eating these items. Every body is different and reacts differently to different foods, so try them out and see how your body reacts.
Tip #6: Fashion your lunch & dinners with a variety of carb choices.
If I try to eat 2 servings of ANY carb at lunch or dinner, my blood sugar is done for. So, I started using the following formula when creating my dinner & lunches.
1 CARB (15 grams) from the list in Tip #5
1 FRUIT (amount varies by fruit choice)
1 c organic Whole Milk
1-2 servings low-glycemic vegetables (those not listed in Tip #5)
2-3 oz meat or protein substitute
0-1 FAT choices
I also start by eating this list backwards, meaning, I eat my protein first, vegetables second, and carbs last (with the exception of milk, which I drink throughout the meal). Eating the protein and vegetables first helps your body break down the carb choices at a slower rate. It also fills you up fast, so if don’t have room to finish all your food, it’s the carbs that won’t get eaten, instead of the good protein and veggies that you need to process the carbs properly.
I also usually save my fruit for last. When you’re Gestational Diabetic, you don’t get to have the luxury of desserts. So, I’ve learned to enjoy my fruit as my dessert! And sometimes I get creative, like my Berries ‘n Cream recipe
An important note: You’ll notice that I only eat 3 carb choices at my main meals. This is because my body can’t handle the recommended 4 carbs in one sitting. This, of course, depletes calories that are needed in the diet. So, to make up for it, I add in a 2nd bedtime snack. (See Tip #3)
Tip #7: Meat is your friend.
I’ve been a vegetarian for the last almost year, so when my Kinesiologist recommended that I add in meat to help with my blood sugars, I was VERY resistant. Now we eat meat quite a few times a week, but we only consume grass-fed, hormone-free meats. I’m still not the biggest fan, but I have noticed that when I primarily eat vegetarian, I tend to have more high readings.
Tip #8: Go for a walk.
If you aren’t already (which you probably are) make sure you are writing down what time you eat, what you eat, how much you are eating & when/how long you’re exercising along with the type of exercise. And never skip taking a blood sugar reading. This little log is your saving grace.
You will be able to look back and notice patterns. For instance, I was having a lot of high readings and when I went back through to look and see if there was anything that I could contribute it to, I discovered that there was! I was eating potatoes at those meals. So, this taught me that I needed to cut out potatoes. Or eat less of them. Or don’t eat them at that meal time.
Another pattern you can start looking for is if your high’s are at any given meal time. For instance, a lot of my high’s are after eating dinner. Now knowing this, I add in a 5-20 minutes walk after my dinner meal. It works like clockwork! And yes, even a 5-minute walk can make a big difference in your blood sugar.
Tip #9: Avoid ALL forms of sugar.
I know you don’t want to hear this one. I know I didn’t want to hear this one. I was a “natural sugar” addict! It was okay that I was consuming sugar at almost every snack/meal because it was “natural”; you know, things like honey, sucanat, pure maple syrup, etc. I was in complete denial that sugar and diabetes were at all related.
Finally, I decided it was time to listen to everyone and give it up already. I gave up ALL sugars, cold turkey! My body didn’t respond well – I got headaches and had some trouble with just overall adjustment. BUT…there was a light at the end of the tunnel. It’s true what they say, the sugar cravings disappear! And it gets easier and easier to say “no” to sugar each time you do it.
If you are Gestational Diabetic, your body does NOT know what to do with sugar. It’s a foreign substance. You simply can not eat the stuff, unless you want to be very sick and you want your baby’s body to be very sick, too. Every time you see a high reading, your pancreas goes into overdrive, trying to make enough insulin. Guess what it’s doing to your baby’s pancreas? Same thing. This information is not given to make you feel guilty, but to let you know the cold hard facts. It is SO important for you to get control of your Gestational Diabetes if for no other reason.
Don’t worry, there are acceptable substitutes for diabetics. The ONLY sugar substitutes that I consume are stevia, agave nectar and whole fruit (no fruit juice or fruit concentrate). Stevia comes in a powder form and a liquid form. And agave nectar comes in liquid form. Both of these can be successfully substituted into almost any recipe.
Be careful with the agave nectar, because 1 T = 1 serving of carbs. Stevia has 0 carbs.
Tip #10: Don’t quit.
Don’t work so hard while you’re pregnant, only to go back to your old ways once you have the baby.
Does this mean I’ll never eat another donut? Of course not. But, it will be VERY few & far between and I’ll probably eat 1/2 the donut, instead of the whole donut (or a couple donuts). And I won’t be consuming sugar by the truckload anymore. I’ll only eat sugar or carbs on things I really want and only in small portions.
Remember that if you have Gestational Diabetes, your chances of developing Type II diabetes is greater. It’s better to make a life change and prevent the disease altogether.