We have the answers to your questions like, what is gestational diabetes, how is gestational diabetes diagnosed, or what causes gestational diabetes? Liberty Medical

1. DIABETES
EDUCATION
Even if you
have never
had diabetes
before,
your blood
glucose can
become too
high during
pregnancy.
The doctor says I have
gestational diabetes. What is
gestational diabetes?
Gestational diabetes is a type of diabetes
that happens during pregnancy. Even if
you have never had diabetes before, your
blood glucose (sugar) can become too high
during this time. About 7% of pregnant
women have pregnancies complicated by
gestational diabetes; this means more than
200,000 cases a year. For most women,
the high blood glucose goes away when
you deliver the baby. Women who have
gestational diabetes are at a higher risk for
future development of type 2 diabetes.
How is gestational diabetes
diagnosed?
According to the new guidelines set by
the American Diabetes Association in
2011, all pregnant women not previously
diagnosed with diabetes will be screened for
gestational diabetes mellitus (GDM) at 24
- 28 weeks of pregnancy. Screening should
take place in the morning after an overnight
fast of at least eight hours. The screening
test consists of having a fasting blood
glucose (sugar) done and then drinking a
special sweet beverage containing 75 grams
of carbohydrate. The blood glucose test is
repeated again one hour and two hours after
drinking the liquid. A diagnosis of GDM is
made if any of the following blood glucose
values is exceeded:
· Fasting blood glucose equal to or above
92mg/dl
· One hour blood glucose equal to or
above 180mg/dl
· Two hour blood glucose equal to or
above 153mg/dl
For women found to have risk factors
for diabetes at their first prenatal visit,
a screening for type 2 diabetes (not
gestational diabetes) should be done using
one of the following diagnostic tests.
· Fasting blood glucose equal to or above
126mg/dl (confirmed by a repeat test on a
different day)
· A1C level equal to or above 6.5%
Women diagnosed with gestational diabetes
should be screened for type 2 diabetes 6 to
12 weeks after delivery.
What causes gestational
diabetes?
Hormones which are produced by the
placenta (afterbirth) make it more difficult
for your body to use insulin efficiently. The
cells become “resistant” to insulin and it
becomes more difficult for the glucose in
the blood to be transported into the cells
where it is needed to produce energy. As a
result of the insulin resistance, the glucose
level in the blood rises causing higher
than normal blood glucose level. Another
factor that adds to this problem of insulin
resistance is the weight gain that naturally
comes with pregnancy. To compensate for
this insulin resistance, the pancreas attempts
to make more insulin but is unable to lower
your blood glucose enough. Gestational
diabetes isn’t caused by anything that you
have done but there are risk factors which
can put you at a higher risk of developing
gestational diabetes.
Gestational Diabetes:
At a Glance
gestational diabetes

2. Can gestational diabetes affect
me and my baby?
Studies have shown that you can have a
healthy pregnancy and a healthy baby if
you keep your blood glucose in a target
range as near to normal as possible. The
risk of developing problems is increased
if your blood glucose stays too high
during your pregnancy. The baby’s size
can get too large and a vaginal delivery
can be more difficult. Also, your baby can
have problems at birth such as low blood
glucose, low blood calcium, jaundice
(yellow color to the skin), breathing
problems, or an abnormal amount of red
blood cells. During pregnancy, gestational
diabetes can increase your risk of high
blood pressure and of having a caesarean
section.
Gestational Diabetes
Carbohydrates, which are found in many
foods, are broken down to a substance
called glucose (sugar) in our bodies and
as a result, our blood glucose level goes
up. An organ called the pancreas senses
that the blood glucose is higher and
releases a hormone called insulin. Insulin
goes into the blood stream and helps the
glucose in the blood get into your body’s
cells where it is used to produce energy.
As the glucose is helped into the cells
by the insulin, the glucose level in the
blood returns to a normal range. When
you are pregnant, the placenta (afterbirth)
produces hormones that make the cells
resistant to your insulin so that it can’t
move the glucose into the cells as well
as it did before you were pregnant. Your
pancreas continues to make larger amounts
of insulin to compensate. As your baby
grows, the placenta makes more of these
hormones that cause the insulin resistance
and you continue to produce more insulin.
Most women are able to produce enough
insulin to meet the extra demands during
pregnancy, but if your body is not able to
keep up with the extra demand for insulin,
the glucose level in your blood gets
higher and you have gestational diabetes.
Gestational diabetes usually goes away
with the delivery of your baby.
Managing Gestational Diabetes
You can take steps to manage your blood
glucose during your pregnancy. Managing
gestational diabetes will help decrease the
risk of problems for you and your baby.
Use tools like meal planning, physical
activity and sometimes insulin. You
and your health care team can discuss
treatment options and decide which
treatments are right for you.
Meal Planning
Food plays a major role in the regulation
of your blood glucose (sugar). What, when
and how much food you eat will affect
your blood glucose level. Following an
individualized meal plan can help you to
control your blood glucose after you eat.
Work with a dietitian who has special
knowledge about gestational diabetes to
learn more about how to eat and keep
blood glucose in a normal range.
• Of all the foods we eat, carbohydrates
raise blood glucose the most. This doesn’t
mean that you shouldn’t eat carbohydrates;
it means you need to learn how to include
the right carbohydrates and the right
amounts in your meals and still be able to
control your blood glucose. Carbohydrates
include foods we all eat every day - such
as bread, milk, yogurt, fruit, pasta and
cereals, to name a few. A registered
dietitian can help you to learn how many
carbohydrates you can eat at each meal.
You may need to check your blood
glucose after your meal yourself at home
to see how these foods are affecting
your blood glucose. Many women with
gestational diabetes find it harder to
control blood glucose in the morning due
to the insulin resistance, so you may need
to have fewer foods with carbohydrates at
this time. Talk to your health care provider
or registered dietitian about using artificial
sweeteners during your pregnancy.
Fact
Risk factors
for gestational
diabetes
• You are overweight
• You have a parent, brother or
sister with diabetes
• You are African American,
Latino/Hispanic, Native
American, Asian American or
Pacific Islander
• You are 25 years or older
• You’ve had gestational
diabetes with a previous
pregnancy or delivered a baby
over 9 pounds at birth
• You have a condition called
pre-diabetes or impaired
glucose tolerance or impaired
fasting glucose. This means
your blood glucose is higher
than normal but not high
enough to be considered
diabetes.

3. DIABETES EDUCATION
Physical Activity
Physical activity can work to lower
your blood glucose. If you are currently
exercising, talk to your health care
provider about continuing since this can
help you to maintain a healthy pregnancy.
Late stages of pregnancy are not a good
time to begin an exercise program but
this does not mean you can’t benefit from
being active. Talk to your health care
provider to see what type of activity might
be right for you.
Insulin Injections
You, like many women with gestational
diabetes, may need more help to keep
your blood glucose in a normal range
and this may mean having to take insulin
injections. Insulin injections, along with
a meal plan and physical activity, can
work together to help assure more normal
glucose levels and help lower the risk of
problems for you and your baby. It is not
recommended that pregnant women take
diabetes pills to lower their blood glucose
during pregnancy, since the effect of these
pills on your baby is not known. Insulin is
not passed on to your baby; it stays in your
own body to help lower blood glucose. If
you take insulin during your pregnancy,
you will need to check your blood glucose
with the use of a blood glucose meter
several times daily. A diabetes educator
can teach you how to use the meter, and
what the results mean.
Insulin and Low Blood Glucose
Insulin can put you at risk for low
blood glucose (hypoglycemia). If you
skip meals or snacks, you don’t eat
enough carbohydrates or if you are more
physically active than usual - you could
have hypoglycemia. It is also important
that you know how you may feel if your
blood glucose is too low and what to do.
Symptoms of low blood glucose may
include shakiness, sweating, hunger,
feeling nervous or anxious and light-
headedness. If you think your blood
glucose is low, use your glucose meter
to check your blood glucose right away.
If your blood glucose is below 70 mg/
dl, treat by taking 3-4 glucose tablets, 8
ounces of skim milk or 5-7 hard candies
and check your blood glucose in 15
minutes. If it is still below 70 mg/dl,
retreat it and check again in 15 minutes
and continue treating and checking until
your blood glucose is at least 70 mg/dl. Be
sure to write the episode in your logbook
along with the blood glucose number. Do
call your health care provider to talk about
how to avoid these episodes. Your health
care provider may give you instructions to
call the office if your blood glucose drops
below a certain number. Follow your
health care provider’s instructions.
Checking Blood Glucose
(sugar)
Checking your blood glucose number at
home is one of the best ways for you to
know if the tools you are using, such as a
meal plan, physical activity and insulin,
are working to keep your blood glucose
in a target range. Checking your blood
glucose at home involves using a small
machine called a blood glucose meter or
monitor. You will need to obtain a small
drop of blood by pricking your finger with
a pen-like lancing device to do your blood
glucose test. You then place a drop of
blood on a special test strip, which is then
placed in the meter. Your meter will then
give you a reading of what your blood
Fact
Of all the foods we eat, carbohydrates raise blood
glucose the most. This doesn’t mean that you shouldn’t eat
carbohydrates; it means you need to learn how to include the right
carbohydrates and the right amounts in your meals and still be able to control
your blood glucose. Carbohydrates include foods we all eat every day - such
as bread, milk, yogurt, fruit, pasta and cereals, to name a few. A registered
dietitian can help you to learn how many carbohydrates you can eat at each
meal.You may need to check your blood glucose after your meal yourself
at home to see how these foods are affecting your blood glucose. Many
women with gestational diabetes find it harder to control blood glucose in the
morning due to the insulin resistance, so you may need to have fewer foods
with carbohydrates at this time. Talk to your health care provider or registered
dietitian about using artificial sweeteners during your pregnancy.

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Hormones
which are
produced by
the placenta
make it more
difficult for
your body to
use insulin
efficiently.
glucose is at that moment. Your healthcare
provider may give you instructions to call if
your reading is too high or too low. Check
with your healthcare team about when to
test and what your goals
should be.
Checking Ketones
Ketones are substances that are formed
when your body burns fat instead of the
carbohydrates you eat to help produce
energy. Burning fat for energy is not
recommended during pregnancy. Ketones
can be harmful to your baby. Your health
care provider may ask you to check for
ketones in the morning. You can check
for the presence of ketones in your urine
or in a drop of blood by using a special
ketone urine strip or special ketone blood
test strip used also in your blood glucose
meter. A diabetes educator or your health
care provider can teach you how to check
for ketones. If ketones are present, you may
need to change the amount or type of food
that you eat or to change the times that you
eat your meals or snacks. Your health care
providers, including the registered dietitian,
will help you to know what to do.
Follow-Up
After you deliver your baby, gestational
diabetes usually goes away. Both your
blood glucose and your baby’s blood
glucose will be checked after the delivery.
Your baby may need to be observed
temporarily in a special unit to watch for
any episodes of low blood glucose. Since
having gestational diabetes can put you at
higher risk for developing type 2 diabetes,
it is recommended that you be screened for
diabetes 6-12 weeks after delivery and also
you should be followed-up with subsequent
screening for the development of diabetes
or pre-diabetes. Gestational diabetes doesn’t
cause diabetes in your baby. However,
since babies from mothers with gestational
diabetes tend to be overweight, they have
a greater risk of developing type 2 diabetes
in their teen or early adult years. Eating
healthy, staying active and maintaining
a healthy weight have been shown to be
successful strategies in reducing the chance
of developing type 2 diabetes.
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