Gestational Diabetes: More Treatment Approaches

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If you’ve been reading about gestational diabetes over the past couple of weeks, you might be thinking that it seems like an awful lot of work to manage it. You’re right, it is. Remember that gestational diabetes is diabetes that occurs during pregnancy. If you already have diabetes, then you know the amount of effort it takes to try and control it. One of the positive aspects about gestational diabetes (GDM) is that it pretty much disappears after the baby is born. And of course, nothing tops the reward and joy of a happy, healthy baby!

Last week I wrote about the ways in which GDM is managed. Not surprisingly, healthy eating and physical activity top the charts. Monitoring is necessary, too, in the form of blood glucose checking and urine ketone testing. Here are the other approaches that are equally as important:

Medication. The hope is that a woman with GDM can manage her blood glucose levels by “lifestyle measures” (that is to say, meal planning and physical activity). But this isn’t the case for some women. Remember that the goal is to keep blood glucose levels within target range (and that range is pretty tight). It’s a lofty goal, and it may not be achievable without insulin injections.

Insulin is the best and safest treatment for GDM, and about 10% to 20% of women with the condition will need to take insulin. There is no risk to the fetus (insulin is a natural hormone). If it looks like you’ll need to start insulin, your doctor will determine the type of insulin needed (long-acting and/or fast-acting), the number of injections you’ll need (anywhere from 1–4 per day), and your insulin dose. Insulin doses generally increase during pregnancy due to insulin resistance. This is perfectly normal and nothing to worry about!

What about diabetes pills? Some doctors will prescribe metformin or glyburide instead of insulin. Insulin is the preferred medicine to use, but these diabetes pills may be used if taking insulin isn’t an option.

Fetal monitoring. Your doctor may want you to have additional tests during your pregnancy. One of these tests is an ultrasound, which is used to check the size of the fetus, the amount of amniotic fluid, and abdominal circumference. An ultrasound can determine if there is too much fat around the baby’s abdomen (called macrosomia). Another test checks for fetal movement (called “kick counts”). And you may have a nonstress test, which records the fetal heart rate.

Labor and delivery
Most women with GDM are able to deliver their baby vaginally; a C-section is not necessarily required unless the baby is too large. During labor and delivery, you and your baby are closely monitored. This monitoring includes keeping tabs on blood glucose levels, making sure that they stay within a specific range (usually 80 to 110 mg/dl). Intravenous dextrose and insulin may be given to ensure this. The baby’s heart rate is monitored, as well.

After delivery, the baby’s blood glucose is checked to ensure that it’s not too low. Your blood glucose will continue to be checked after delivery for about three days. Your doctor may encourage you to breastfeed your baby, which has a number of benefits, including:

• Helping to keep your baby at a healthy weight

• Reducing the risk of Type 2 diabetes later in life for both you and the baby

• Bolstering the baby’s immune system and lowering the chances of infection

Talk with your obstetrician about what would work best for you.

After delivery
Now that you have your bundle of joy, you might be wondering about your diabetes and what happens next. To make sure that your blood glucose levels are back to “normal,” you’ll have a glucose tolerance test at your six-week postpartum visit.

Keep in mind that even though GDM goes away (in most cases), you may be at risk for having GDM again during future pregnancies. You also have a risk of developing Type 2 diabetes down the road. In fact, about 50% of women who have GDM will get Type 2 diabetes 7 to 10 years later. This risk is increased if you are overweight or obese.

You can lower your risk after your pregnancy by focusing on reaching a healthy weight. That means following a healthful eating plan and getting plenty of exercise. That may seem easier said than done, but these are important steps to take to keep you as healthy as possible. Work with your dietitian or other members of your health-care team to help you reach a healthy weight. Or consider joining a weight-loss group or a commercial plan, such as Weight Watchers or Jenny Craig.

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