If you’re a pregnant woman, probably one of the last things you want to hear is that you have gestational diabetes. Your thoughts might range from, “What did I do to cause this?” to “Will my baby be OK?” First, keep in mind that it’s perfectly normal to feel scared and worried. Second, while gestational diabetes (GDM) is indeed serious, remember that, with proper management, you can have a healthy baby.
Once you’re diagnosed
If you find out that you have GDM, be prepared to learn a lot about diabetes! You’ll likely be referred to a diabetes educator and/or a dietitian. You might also be referred to an endocrinologist, a doctor who specializes in diabetes and other endocrine disorders. In most cases, you’ll be seen by a member of your health-care team about every two weeks. Be prepared to start checking your blood glucose with a meter, following a meal plan, checking your urine for ketones, recording your food and glucose levels, and possibly starting on insulin. In other words, be prepared to do some homework! Your team is there to support you and make sure that you receive the right treatment.
There are a number of ways in which GDM is treated, and they all work together to help ensure that your blood glucose levels stay in a safe range throughout your pregnancy. Remember that the goal is to keep your blood glucose in a normal range; this is because, when blood glucose levels are too high, the extra glucose crosses the placenta to the baby. Too much glucose can cause your baby to be too large, and may cause other complications for both you and your baby during delivery and later on (such as Type 2 diabetes).
Nutrition and meal planning. The saying that “you’re eating for two” during your pregnancy is partly correct. You ARE eating for two, but you’ll need to pay careful attention to what, when, and how much you eat. A meal plan helps provide adequate nutrition for your baby, provides adequate calories and nutrition for you, helps to control blood glucose, and prevents ketone formation. Your meal plan should be tailored to you (hence the importance of seeing a dietitian) and will be controlled in carbohydrate, with an emphasis on portion control and timing.
You do need to eat carbohydrate during your pregnancy; in fact, about 40% to 45% of calories should come from carbohydrate. The amount of carbohydrate that you need depends on your pre-pregnancy weight and level of blood glucose control. Meal planning methods might include following the Plate Method or counting servings or grams of carbohydrate. In terms of weight gain, your obstetrician will discuss with you the recommended amount of weight to gain during pregnancy. If you are overweight, your weight gain target might be lower. A meal plan can help ensure that you gain the right amount of weight. Be prepared to keep food records and bring them to your appointments. Also, you may need to work closely with a dietitian during your pregnancy.
Blood glucose monitoring. In order to know what’s happening with your blood glucose levels, you’ll need to start checking your blood glucose with a meter, usually four times each day (before breakfast and one hour after the start of each meal). In general, blood glucose targets are less than 60 mg/dl to 95 mg/dl before breakfast, and less than 100 mg/dl to 129 mg/dl one hour after a meal. Keep a log of your glucose readings, as well. A diabetes educator should show you how to use a blood glucose meter and how to check your blood glucose using a lancing device. Practice checking your blood glucose while you are with the educator to make sure that you feel comfortable doing so and that you’re using your meter correctly (today’s meters are fast and easy to use!).
Urine ketone testing. Ketones are formed when fat is burned for fuel. If you have ketones in your urine during pregnancy, it may be a sign of what is called “starvation ketosis” — this means that you aren’t getting enough calories in your eating plan, and you may be losing weight, as well. (Starvation ketosis is not the same thing as diabetic ketoacidosis, a very serious condition that can occur in people with Type 1 diabetes and in those with Type 2 diabetes who take insulin).
In order to check for ketones, you’ll need to purchase ketone strips at your pharmacy. You’ll get a sample of urine in a clean container and dip the ketone strip into the urine. A pad on the strip will change color after a certain amount of time (follow the instructions on the container). You’ll then compare the color on the strip to the color on the container to determine the amount of ketones in your urine. The presence of ketones with a normal blood glucose levels usually means that you need to eat more; this is often done by eating a bedtime snack. Ketones along with a high blood glucose reading may indicate a need for insulin.
Physical activity. Yes, physical activity is an important part of the treatment plan! Physical activity helps with blood glucose control, can reduce insulin resistance, and can prevent excessive weight gain. Talk with your obstetrician about how much activity is safe for you to do, as well as at what level of intensity. Walking and swimming are good choices, but there are other options, too. There may be types of activities that you should avoid, as well, such as contact sports or scuba diving. Aiming for about 30 minutes each day is a good goal, ideally, after eating a meal (when your blood glucose will be at its highest).
More on treating GDM next week!