Gestational diabetes (GDM) is diabetes (inability to handle carbohydrates adequately and thus blood sugar levels can remain elevated) that is first diagnosed during pregnancy, and often goes away once the baby is born.
Many women will have higher than normal blood glucose levels anyway during pregnancy, as the hormones that are released (and elevated) during pregnancy have a tendency to affect the release and sensitivity of insulin, which is the hormone responsible for getting glucose into the cells and out of the bloodstream
Why do we become insulin resistant in pregnancy?
Because our mini-human needs a constant supply of glucose to feed his or her growing brain, so the body, in its infinite wisdom, sacrifices mum’s needs to make sure baby gets everything needed for optimal growth and development.
Any woman can be diagnosed with GDM, but some are at higher risk than others, such as those with a history of:
- Obesity
- Diabetes (including with other family members)
- GDM in a previous pregnancy
- A diet high in refined sugars and minimal fresh, whole produce
- Rapid and/or excessive weight gain during pregnancy
Why is GDM a problem?
It may be tempting to just fob GDM off if you do not fit into any of the high-risk categories, however there are a small percentage of healthy women who also are diagnosed with GDM, and it can have risks, including:
- Bubba growing too big, which can increase the likelihood of a difficult birth
- Increased risk of obesity and diabetes for bubba later on in life
- Newborn death
- Congenital malformation
- Respiratory distress syndrome
Hardly risks you really want to take, right?
But what about the testing?
The thing is, there is no universal agreement on which test should be used and when, and what the appropriate cut-off values for blood glucose levels should be. Well that’s poop, isn’t it!?
The “standard” test (called the Glucose Tolerance Test, or GTT) involves consumption of a 50-75g glucose (sugar) drink (often referred to as “Glucola”) at around 24-30 weeks gestation (that’s medical-speak for pregnancy, friends). Most countries will test the mother’s fasting blood glucose levels. Some countries will then test levels again at 1hr post-Glucola, others at 2hrs post-Glucola. Results are then compared to values which change depending on where you are in the world. If you’re above these values, you’ll probably be advised to take another test. OR, perhaps you just have a trigger-happy doctor who decides to diagnose you with (and treat you for) GDM right then and there.
Issues with the GTT
(Other than the glaringly obvious inability for a consensus to be reached on ideal screening guidelines):
- There is quite a high rate of false positives using the GTT, which means you might be diagnosed with GDM following the GTT, but you don’t actually have GDM. This sucks because 1) You may be treated unnecessarily with medications and 2) You’ll most likely freak out and/or feel pretty guilty that you might be putting the health of your baby at risk
- 50-75g of glucose is equivalent to about 600-800mL of Coke (in sugar-speak OR 12-19 TEASPOONS OF SUGAR!!). What pregnant lady, in their right mind, is EVER going to consume this amount of sugar in one go, let alone on an empty stomach?! If your body is not used to consuming this quantity of sugar, how can we reasonably expect it to produce an appropriate amount of insulin in response AND have the necessary insulin sensitivity to get all of that sugar out of the bloodstream? Madness, I say!
- Have you tried this glucose drink? HOLY CRAP it is horrible! I had to have it during a physiology class at university (as all the other slackers had eaten too close to class time – never mind the fact I freak out with needles, even tiny ones). Anywho – I had the drink. My blood sugar levels were fine. Awesome. I didn’t have diabetes. What I did have, however, was a massive come-down about 3-4hrs later which felt like, what I imagine to be, coming off heroin. I was pale, shaky, clammy, sweaty and moody. Would I willingly do again? Heck no!
So what’s a preg-bot gal supposed to do?
Well, first of all, know that you do not HAVE to do anything you don’t want to do in pregnancy, including getting tested for GDM at all! However, if, like me, you would like to be screened but definitely do not want to slam your body with a massive dose of sugar-water, you have an option.
I’m pretty grateful for the support of my doctor and midwife for this – it’s important to have them on-board and on the same page as you. If they aren’t, find someone else who you are comfortable with (seriously – do you want someone who you aren’t completely comfortable with hanging out around your lady garden during labour? Didn’t think so!).
OK – your option – BLOOD GLUCOSE MONITORING
Yes! Just like the peeps who actually HAVE diabetes have to test their blood sugar levels. I like this method as it involves consuming WHOLE, REAL FOOD in its natural state, and seeing how my body handles it. The only thing I don’t like about it? 2 needles, instead of 1 (but to be fair, they are only little finger pricks – it actually wasn’t that bad at all. I’m embarrassed to admit I made my hubby administer one of them. Yes, I’m that bad with needles).
How to do it
(guidelines provided by my doc – again check with yours about guidelines and appropriate values):
- 3 days prior to testing your blood glucose levels, consume an extra 15g of carbohydrates per day (this is about 1 small banana, 1 medium apple, ½ cup sweet potato or potato, 1/3 cup cooked basmati rice, OR ½ cup cooked quinoa)
- Fast (don’t eat!) for 8hrs overnight before testing
- Test your fasting (on an empty stomach) blood sugar levels via finger-prick using a glucometer (see image above; ask your doc if you can borrow one)
- Have a large, carby brekkie (I had quinoa and banana porridge, which worked out to be ~50g carbs) then go for a walk
- 2 hours later, re-test your blood sugar levels via finger-prick
Your levels should be as follows:
- Fasting < 6.6mmol/L
- 2hrs post-carby brekkie <7.7mmol/L
Using this method, my results came back as 5.3mmol/L fasting and 4.6mmol/L 2hrs post-brekkie. Sweet as (without the extreme sweetness of “Glucola”)!
That’s it! How easy and how much more gentle on the body (and baby)?
I hope this helps. Please do not feel pressured into doing anything you do not want to do – your body, your baby, your choice. K? xx
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