Diabetes and pregnancy

R

Rose031

Guest
Hello all. I'm not pregant, but my sister is. She just found out that she has developed diabetes as a complication, and I promised to get online and try to find out what I can about what she should do. She isn't getting much information from her doctor (which I think is a really big problem, but she has trouble trying to assert herself around him, totally other thread) Anyway, she is due mid-October and has already gained around 50 pounds or so. She is tired all the time and finds walking to the bathroom and back to bed all of the workout she can muster. Is this a complication of the diabetes? The doctor told her to watch her diet, but what exactly does that mean? She understands no candy, but does it go beyond that? Will it go away after the baby is born? Thank you for any information you can give me.
Rose (who is counting the days to seeing you in October
 
Diabetes during pregnancy

Hi Rose,

Note: This question would normally be beyond the realm of this forum, but I felt that due to its importance it should be addressed in its entirety. Exercise does play an important role in the management of this disorder so we weren’t totally off base by answering it!


Diabetes is a condition in which blood sugar or glucose levels are not regulated properly. It is related to the hormone insulin, which is responsible for controlling blood sugar levels. In Type I Diabetes (juvenile-onset or diabetes that develops before adulthood) the body does not produce enough insulin. In another form of diabetes, the insulin produced by the body is not used effectively. This is the case in both adult-onset diabetes and gestational diabetes.

Gestational diabetes, by definition, is diabetes that develops during pregnancy in a woman who did not have diabetes before she became pregnant. It is thought to result from metabolic changes brought on by the hormones of pregnancy and is only found in 1-5% of women who are tested for gestational diabetes during their pregnancies.

Although gestational diabetes is usually not a threat to the mother’s health, it should be taken as a warning sign that she is at a greater risk for developing adult-onset diabetes later in life. Also, gestational diabetes poses some real risks for the baby. However, when the problem is properly diagnosed and managed, the baby is put at no greater risk that it would have been had the mother not had the disorder.

The major risk for babies whose mothers have gestational diabetes is macrosomia or excessive birth weight. Macrosomia is defined as a birthweight of greater than 4500 grams or 9 pounds 14 ounces. Babies as big as this may have difficulty being born. Also the likelihood of a C-section is increased with these babies. Keeping blood sugar levels within the normal range is imperative in order to decrease the above risk.

Other problems that may develop as a result of gestational diabetes include hypoglycemia or low blood sugar shortly after birth. This may occur because the baby is used to getting high amounts of glucose across the placenta and once the umbilical cord is cut at birth, the source of this glucose is abruptly stopped. These babies are usually monitored after birth to prevent their blood sugar levels from becoming too low.

The key to managing gestational diabetes is to control mom’s blood sugar level. In most cases this can be done with careful diet planning, exercise and regular blood sugar testing. Home blood sugar testing may be recommended. Urine testing is not accurate as there is little correlation between urine sugar and blood sugar levels.

In almost all women who have the condition, diet, exercise and blood sugar monitoring can bring it under control. If diet and exercise do not seem to be controlling the condition, mom may require daily insulin injections.

Gestational diabetes almost always goes away after delivery. However, if mom has had gestational diabetes in one pregnancy, the likelihood that she will experience it in subsequent pregnancies is increased. Also as mentioned above, the likelihood that she will develop adult-onset diabetes in the future is increased. Therefore diet and exercise are especially important in the long term for moms who have had this condition during pregnancy.


I would suggest that your sister definitely be more assertive with her doctor regarding his management of her diabetes and also seek out the services of a registered dietitian to get her eating on track. IT IS EXTREMELY IMPORTANT THAT SHE GET HER DIET UNDER CONTROL!!! The American Diabetes Association says that “All women with gestational diabetes mellitus should receive nutritional counseling, by a registered dietitian when possible, consistent with the recommendations for calorie distribution proposed by the American Diabetes Association. Individualization of the diet depending on maternal weight and height is recommended. Diet therapy should include the provision of adequate calories and nutrients to meet the needs of pregnancy, and should be consistent with the maternal blood glucose goals that have been established. Intake of sucrose (sugar) and other caloric sweeteners should be limited.”

I cannot say whether her fatigue is related to the diabetes, which it very well could be, or just to her advancing pregnancy and her 50-pound weight gain. Please pass this information on to her quickly.

Please let me hear from you.
 

BLinda

Cathlete
Nutritionist/Dietitian

Rose-
While I was pregnant, I had a questionable case of GD. They kept repeating the tests until at 38 weeks I just told them to stop testing and act as if I did. Here is how that changed things for me- they immediately scheduled a diagnostic ultrasound, set up a meeting with a nutritionist and planned to do a fasting then post breakfast blood sugar level every appointment after that. I had my baby a few days later, so none of this materialized, and I still don't know if I actually had GD.
This is the level of care that I got from Nurse-Midwives who were in a free-standing birth center. I would expect at least this level of care from any doctor associated with a group practice or hospital. If insurance is a problem, she sould call the insurance/ HMO and get herself taken care of. I was with a very non-interventionist group, so expect that this is a minimum level of care.
Also, the 50 lbs may not be all weight gain. I have heard the it is very common with GD to carry an excess amount of amniotic fluid. Her Dr. should also be able to tell her this, as it could lead to complications at birth if the fetus is floating and her water breaks.
Sorry this is so long, I just wanted to share my experience. Linda
 

laurieb

Member
I had gestational diabetes

<center><font size="1" color="#ff0000">LAST EDITED ON Sep-10-99 AT 06:26PM (EST)</font></center>

With my first pregnancy I got gestational diabetes, they detected it late in my pregnancy 32 weeks and (don't be scared by the rest of this story) by this time it was too late. My original glucose test was misread and that it why I was diagnosed so late in my pregnancy. They had me start checking my blood sugar 8 times per day and sent me to a nurtritionist. I didn't make it to the nutritionist because my water broke at 33 weeks. I had a large premature baby (6lbs 3oz).
I was overweight before I got pregnant and drank mostly juice for thirst. The diabetes went away right after the delivery. But the diabetes slowed down the development of my son's lungs so he was hospitalized for a month. He is healthy and normal. Second time around I lost 20 pounds before I got pregnant, drank lots of water during my pregnancy, and did some light exercise (pregnancy workout tape and walking). They tested me constantly for diabetes but I never got it. Reflecting back on my pregnancies, the first time around I was tired and constantly thirsty. Second time around I felt great. The advise I would give your sister is too drink tons of water (no juice, pop, etc) and follow the diet for gestational diabetes. I bought a book "Managing Your Gestational Diabetes", it had a great diet in it that coincidentally followed weight watcher's very closely. If you want I can mail you or your sister this book. I don't have a need for it anymore ([email protected]). Anyways I hope this information is useful to your sister. I am concerned that your sister's doctor is not doing more to control her diabetes. I think the thing about gestational diabetes slowing down the baby's lung develop was discovered after I had my first (I could be wrong).
 

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