Understanding Gestational Diabetes: Glucose Monitoring
Once you are diagnosed as having gestational diabetes, you and your health care providers will want to know more about your day-to-day blood sugar levels.
What is self blood glucose monitoring?Once you are diagnosed as having gestational diabetes, you and your health care providers will want to know more about your day-to-day blood sugar levels. It is important to know how your exercise habits and eating patterns affect your blood sugars. Also, as your pregnancy progresses, the placenta will release more of the hormones that work against insulin. Testing your blood sugar level at important times during the day will help determine if proper diet and weight gain have kept blood sugar levels normal or if extra insulin is needed to help keep the fetus protected.
Gestational diabetes, by itself, is not an indication to perform a cesarean delivery, but sometimes there are other reasons your doctor may elect to do a cesarean. For example, the baby may be too large to deliver vaginally, or the baby may be in distress and unable to withstand vaginal delivery. You should discuss the various possibilities for delivery with your obstetrician so there are no surprises.
Myth #: Im Thin I Cant Possibly Have Gestational Diabetes
Screening for gestational diabetes might seem like another unnecessary test, especially if youre otherwise healthy, but that doesnt mean youre in the clear. Some studies have shown up to 50% of women with gestational diabetes dont have any of the classic risk factors, like being overweight prior to becoming pregnant or a family history of diabetes.
While the screening tests arent perfect , its still worth being proactive given all that we know about mildly elevated blood sugar levels and risks to your baby. Even if youre not interested in the glucose drink, at the very least, using a glucometer to measure your blood sugar levels for a few weeks while you eat your usual diet teaches you a TON about food and your body. And if youre reading this in early pregnancy, ask to have an A1c added to your blood work.
Ehealth Medicine: Telehomecare And New Technologies For Glucose Monitoring And Healthy Behaviour Interventions
Use of new technologies and web-based platforms for BG monitoring in pregnant women with diabetes in Canada and worldwide is rapidly increasing. These initiatives allow for 2-way communication with women monitoring and transmitting their BG results in real time to health-care providers for feedback. Studies have demonstrated 38.0% to 82.7% reduction in face-to-face medical visits and decreased insulin use in pregnant women using telehomecare in conjunction with conventional care, without an increase in maternal or perinatal complications. While 4 studies of GDM women have demonstrated comparable glycemic control and pregnancy outcomes , other studies with type 1 diabetes and GDM have shown improved glycemic control and pregnancy outcomes in the group using web-based programs compared to standard care. Enhanced patient empowerment and greater satisfaction with the care received are also reported in groups using new monitoring technology . However, generalizability of those studies is questionable as these studies were small, conducted in very specific settings and used different types of technologies and e-platforms. Furthermore, acceptance of these interventions by marginalized population subgroups and in remote regions would also be important to determine. Finally, studies assessing cost effectiveness of these measures, both direct and indirect are needed.
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Importance Of A Balanced Diet
A balanced diet is essential for the control of blood glucose levels and for a healthy pregnancy. When there is gestational diabetes, certain modifications need to be made to the mothers diet, including to the amount of carbohydrates in each meal. A carbohydrate-controlled diet is the foundation of the treatment. It is essential not to eliminate carbohydrates completely but rather to distribute them throughout the day.
Medication Or Insulin May Not Work Immediately
Many ladies are confused to see higher or even worse levels the morning after starting medication and/or insulin.
Metformin and insulin cannot cause higher blood sugar levels. However, stress or concern over starting meds, alongside rapidly increasing insulin resistance may mean it takes a little while, or increased doses before the benefit is seen
Medication such as Metformin, can take a while to build up in your system before you see an improvement in blood sugar levels and doses may need to be increased before sufficient impact is made.
Slow release insulin will start working immediately , BUT it may take a while to get the dose right and doses may need continually increased until the benefit is seen on a daily basis. Insulin doses are started low to prevent hypos and are titrated as needed until the benefit is seen.
Its typical that insulin doses will have to be titrated as the pregnancy progresses. Its important to work closely with your diabetes team to ensure you increase doses as necessary. Please do not sit and wait for your team to call you, or for your next appointment if you are experiencing high fasting levels. After 3 or more high fasting levels, give your team a call to discuss insulin doses.
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Sleep Duration And Blood Glucose Control In Women With Gestational Diabetes Mellitus
Go to: To describe the relationship between objectively assessed sleep and blood glucose in a prospective cohort of women recently diagnosed with gestational diabetes mellitus . Women with GDM were enrolled immediately after attending a GDM education class. All patients were recruited during their first week of attempted dietary management of GDM. They were instructed on the use of a glucometer and on the principles of a GDM diet. Women wore an actigraph and completed a sleep log for 7 consecutive days. Glucose records were compared against the objective sleep data. Linear mixed model analysis was used to estimate the association of sleep duration on morning fasting and one-hour postprandial blood glucose concentrations. Thirty-seven participants provided data for 213 sleep-intervals that corresponded to at least one glucose reading. Sleep duration was negatively associated with fasting and one-hour postprandial blood glucose concentrations In analyses adjusted for age, gestational age and BMI, a one-hour increase in sleep time was associated with statistically significant reductions in fasting glucose as well as postprandial glucose concentrations . Short sleep durations are associated with worsened glucose control in women with gestational diabetes. Educating women on healthy sleep and screening for and treating sleep disorders during pregnancy may have a role in optimizing blood glucose control in gestational diabetes.Continue reading > >
Screening And Diagnosis Of Gdm
Early screening. Screening for diabetes in the first trimester should be considered for diagnosing overt diabetes in women who are at risk , including those with a history of previous GDM. The ability to predict abnormal results on glucose screening tests at 24 to 28 weeks and risk of continued dysglycemia postpartum are other, but less compelling, reasons cited to screen in the first trimester.
The test of choice for early screening should be based primarily on the ability to predict poor obstetrical outcomes, which may be modifiable by lifestyle or pharmacological intervention. There are 2 strategies for testing glucose levels in early pregnancyusing the nonpregnancy-recommended screening tests or using the typical 24- to 28-week gestational diabetes screening criteria . To apply nonpregnant FPG or A1C criteria in early pregnancy does not take into account that both decrease early in pregnancy and may lead to underdiagnosis in women with pre-existing diabetes. On the other hand, there has been no rigorous validation that criteria accepted for the diagnosis of GDM in the second or third trimester are appropriate for use in the first trimester.
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Elevated Fasting Blood Sugar In Pregnancy Linked To Harmful Outcomes For Mothers Babies
Issues persist even when drug treatments for gestational diabetes are given, U of A study shows.
Women with gestational diabetes who have elevated blood sugar levels before eating are at higher risk for complications than those whose blood sugar is only elevated after mealseven when their diabetes is treated, according to a new study.
Pregnant women diagnosed with diabetes who have elevated fasting blood sugar levels are more likely to face complications than those who have only elevated post-meal glucose levels, according to a new study by a University of Alberta research team.
“The women who had elevated fasting glucose, adjusted for all other risk factors, were almost three times more likely to have a big baby than women who had normal fasting glucose levels but elevated postprandial sugar levels,” said cardiology professor Padma Kaul, who is also an adjunct professor in the School of Public Health.
The women with high fasting blood sugars were also found to be at 1.5 times higher risk for high blood pressure during pregnancy, and had a higher likelihood of needing an induced labour, having a caesarean section or having a preterm birth.
Kaul said large babies are at risk for complications during birth and obesity later in life, and high blood pressure during pregnancy can place extra stress on the heart and kidneys of a mother.
My Struggle With My Fasting Blood Sugar 32 Weeks
I was diagnosed with GD early in pregnancy, around 18 weeks and have been able to control it with diet/exercise up until now. I am almost 33 weeks and my fasting sugar has been 95-97 these past few days. For the past 1.5 months, skipping a bedtime snack worked best for me, but my doctor became concerned that I was going too long without eating for the baby. When I would skip a bedtime snack, my fasting would be 78-88, but recently its been creeping up to mid/high 90s.
I tried all protein/fat snack and my blood is still around 97 when I wake up in the morning. Tonight Im going to try to incorporate a carb.
My stomach always measures normal when I goto the doctor and Iâve only gained around 12lbs. My numbers after meals are perfect, itâs just my damn fasting! I read so much about fasting blood and every doctor has different limits. My doctor would like it under 90, but she said if I average BELOW 95, I shouldnât need meds, but I see some women on here that are under 100 and are fine.
Im so scared to take medications while pregnant and donât want to take it if itâs not absolutely necessary. Help!
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Myth #: All Women With Gestational Diabetes Will Have Big Babies
Not so fast One of the big fears associated with gestational diabetes is the risk of having a large baby . Statistically its true. As a whole, we see more macrosomic babies among women with gestational diabetes. However you dont have to be a statistic. The chances of having a large baby correlates very strongly to blood sugar control during pregnancy.
So if you know what to do to keep your blood sugar under control, your risk of having a big baby goes way, way, way down. And if your blood sugar stays at pretty much normal levels, you are at no higher risk than a women without an official gestational diabetes .
I have yet to have a participant in my online Real Food for Gestational Diabetes Course have a macrosomic baby. Take that, statistics.
Prediabetes Flies Under The Radar
You can have prediabetes for years but have no clear symptoms, so it often goes undetected until serious health problems show up. Thats why its important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for prediabetes, which include:
- Being overweight
- Being 45 years or older
- Having a parent, brother, or sister with type 2 diabetes
- Being physically active less than 3 times a week
- Ever having gestational diabetes or giving birth to a baby who weighed more than 9 pounds
Race and ethnicity are also a factor: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.
Ready to find out your risk? Take the 1-minute prediabetes risk test and be sure to share the results with your doctor.
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Timing And Route Of Delivery
In gestational diabetes, shoulder dystocia is the complication most anticipated at the time of delivery. In one study,36 this complication occurred in 31 percent of neonates weighing more than 4,000 g who were delivered vaginally to unclassified mothers with diabetes. No prospective data support the use of cesarean delivery to avoid birth trauma in women who have gestational diabetes. One remaining limiting factor is the 13 percent error rate in estimating fetal weight by ultrasonography.37
A decision analysis38 that evaluated the cost and efficacy of a policy of elective cesarean delivery for an estimated fetal weight of 4,500 g in mothers with diabetes found that 443 cesarean deliveries would need to be performed to prevent one case of brachial plexus injury, at a cost of $930,000. A reasonable approach is to offer elective cesarean delivery to the patient with gestational diabetes and an estimated fetal weight of 4,500 g or more, based on the patient’s history and pelvimetry, and the patient and physician’s discussion about the risks and benefits. There are no indications to pursue delivery before 40 weeks of gestation in patients with good glycemic control unless other maternal or fetal indications are present.
What Are The Signs And Symptoms When Does It Develop
GD is typically diagnosed in the third trimester, though its not always obvious, experts say. The signs and symptoms arent very helpful, because it is only when blood sugar gets really high that you see excessive thirst and urination, said Gabbay. The majority of women have no symptoms.
According to ACOG, a health care professional will screen you earlier in your pregnancy by asking about your medical history to determine if you have risk factors for GD. If you do, youll get tested to determine your blood sugar levels. If you dont show signs of diabetes , youll undergo the standard glucose screening test.
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How To Control Fasting Blood Sugar During Pregnancy
This article was medically reviewed by Erik Kramer, DO, MPH and by wikiHow staff writer, Jessica Gibson. Dr. Erik Kramer is a Primary Care Physician at the University of Colorado, specializing in internal medicine, diabetes, and weight management. He received his Doctorate in Osteopathic Medicine from the Touro University Nevada College of Osteopathic Medicine in 2012. Dr. Kramer is a Diplomate of the American Board of Obesity Medicine and is board certified.There are 10 references cited in this article, which can be found at the bottom of the page. This article has been viewed 35,163 times.
If you have gestational diabetes or are at risk for developing it, your doctor will monitor your blood sugar. To determine how effectively your body processes sugar, they’ll check your blood sugar levels before you eat. If it’s above 95 milligrams per deciliter , you may need to make changes to your diet and everyday habits. Although this might seem overwhelming, there are lots of things you can do and medications you can take to control your blood sugar levels.
Treatment For Gestational Diabetes
Luckily, even conventional treatment suggests a healthy or balanced diet and exercise before resorting to insulin or medications. Unfortunately, the kind of diet conventional healthcare providers recommend may leave some room for improvement.
Conventional wisdom tells us that whole grains and dairy are healthy foods. In reality, both of these provide a large amount of carbohydrates and very little nutrition .
Because carbohydrates are so important during pregnancy many clinicians are wary of restricting pregnant womens carbohydrate intake. Its generally accepted that pregnant women should be no less than 175 carbohydrates each day. This guideline is followed for women with gestational diabetes as well.
The concern is that starvation ketosis or diabetic ketoacidosis can be harmful in pregnancy. However, research published in Diabetes shows that low-level pregnancy ketosis is common and does not carry the same risks including fetal brain development.
This makes sense when you think about the biological reason that women have slight insulin resistance. Pregnancy insulin resistance is the protection against dangerously low blood sugar.
Here is the difference between dangerous ketosis and normal ketosis:
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Study Design And Participants
All laboratory parameters were measured according to the standard laboratory methods at our certified Department of Medical and Chemical Laboratory Diagnostics . Briefly, the plasma glucose level was measured by the hexokinase method with a coefficient of variation of 1.3%. The levels of insulin and C-peptide were measured by chemiluminescence immune assays with CVs of 4% to 7% and 3% to 4%, respectively. HbA1c was assessed by high performance liquid chromatography .
The study was approved by the Ethics Committee of the Medical University of Vienna and performed in accordance with the Declaration of Helsinki. All participants gave the written informed consent.
Advice On How To Get Fasting Numbers Lower
My fasting numbers have been in the 113-119 range. Ive been eating snacks right before bed but cant seem to get them under control.
I think fasting number is the hardest to control – I couldnt get mine under control no matter what I did, until I got the right dosage of insulin.
Good luck, I hope some of the other moms here can give you advice that can help.
I have the same issue, mine range from 90-100.
I find that not having a snack has help. Endocrinologist said that is fine. So I fast for about 12 hours.
I drink a whole glass of water as soon as I get up and test 15 minutes later. I noticed when I don’t do this my numbers are between 100-110, but when I drink my water it is 85-94. I dont know if there is a scientific reason for this, but it works for me.
Did you doctor say that you could have water before your fasting number? Mine said I couldn’t even have water before checking. Just wondering because it seems like we all get different instructions. It makes me crazy.
I was told I could have water. I wake up at night a lot lately bc my mouth is constantly dry and I have to have water. I was told that drinking water was fine bc it doesn’t have calories, sugar, or carbs.
my fasting numbers were out of control until my doctor told me to drink a protein shake instead of an actual snack and that helped.
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