Gestational Diabetes: More Treatment Approaches

If you’ve been reading about gestational diabetes over the past couple[1] of weeks[2], 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[3] 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.

  1. past couple:
  2. of weeks:
  3. I wrote about:

Source URL:

Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

Disclaimer of Medical Advice: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information, which comes from qualified medical writers, does not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs.