Gestational Diabetes

In late pregnancy, your body will block insulin to make sure some of the glucose in your diet stays in your blood and circulates to the baby.  Ideally, it’s the goldilocks model — you don’t leave too much glucose in your blood; your blood sugar is “just right.” If you keep too much glucose circulating in your blood to pass off to the baby, it would be a sign of Gestational Diabetes.  We screen all of our clients between 24-28 weeks to see how their body handles glucose.

This link includes information about who may get gestational diabetes, how we test for it, why we test for it, and what happens if you have high blood sugar.

Who May Have Gestational Diabetes?

There are some women who are just naturally at greater risk of gestational diabetes. Your risk increases if you

•  are over 35-years old,

• are overweight,

• ·have had a baby who weighs more than 9 lbs,

• re Latin American, Asian, or African, or

• have PCOS.  

What are the risks?

When you have gestational diabetes, the cells are already saturated with glucose, so no new nutrition can be moved into the mother’s cells.  So, in an odd way, too much sugar actually reduces nutrition for the mother while also over-feeding the baby.

When glucose stays in the blood, elevated blood sugars irritate the blood vessels the same way that a sugar scrub could irritate a tender area of skin if you scrubbed for an extended amount of time.  High blood sugar can damage the placenta, which can affect the baby.  

Possible risks to the baby include: too much glucose causing increased weight gain, shoulder dystocia or birth injury, difficulty breathing at birth, and unstable sugar in the immediate postpartum requiring medical care. If the inflammation affects the blood vessels in the placenta, the baby can be deprived of oxygen and nutrition which can lead to significant issues including jaundice, low calcium, and potentially stillbirth.

How do you test for gestational diabetes?

The standard of care is to test all pregnant women at 24-28 weeks. This first test involves having the woman drink 50 grams of glucose. (We will provide you the free bottle of “glucola” from Quest, or you can purchase a dehydrated food-sourced glucose from TheFreshTest.com)

Drink the glucose 45-minutes before your next appointment. That gives us 15 minutes to get settled in, then we draw your blood. (we have to draw it 1 hour after you eat).

We should get your results back within a day or 2. If your blood glucose was 140 or above, you either need an extended glucose test called a Glucose Tolerance Test, or you need continuous glucose monitoring.

Glucose Tolerance Testing: For that test, you’ll have your labs drawn at a Quest lab. They will give you a bottle of 100 gram glucose. Then they will draw your labs 3 times - one each hour after you drink it.

Continuous Glucose Monitoring: We can order a Freestyle Libre 3 Continuous Glucose Monitoring device for you to apply to your arm. You download the app. You record what you eat and drink in the app. The device will monitor the amount of glucose in your interstitial tissues. At your next prenatal appointment we will look at your nutrition and your glucose readings and devise a plan.

I have Gestational Diabetes - Now What?

If you’re reading this link, you probably have been told that your blood sugar is high enough that you either have “borderline gestational diabetes” or you actually have Gestational Diabetes. Our first goal is to try to manage your blood sugar with diet and exercise. If we can’t get it into a normal range, then we can refer you for medication.

Here's a link to American Diabetes Association including ranges of glucose. They define the targets as:

·    Fasting - before breakfast or before any meal should be 95

·    1 hour after a meal should be less than 135

·    2 hours after a meal should be 120 or less.

Goal 1: Let’s try to manage your blood sugar through diet and exercise if possible.

Your Management Plan will include:

1) Beginning immediately, monitor your blood glucose. We recommend a Continuous Glucose Monitor, but you can also use a glucometer. You’ll check your blood sugar first thing in the morning (fasting), and 1 hour after meals throughout the day until you are consistently and accurately managing appropriate blood sugar.

Purchase a glucometer with enough test strips to test your blood 4x per day for the next 2 weeks, then 2 x per day for the remainder of pregnancy. Here’s a link to one on Amazon. There are many to choose from, this is just an example. (If you prefer a glucose monitoring system like Freestyle Libre that you wear continuously, let us know. We can phone that in for you.)

Record what you eat and your glucose levels on a journal. Upload it weekly. Download this diet journal. If you prefer to use MyFitnessTracker, you can share it digitally with us.

2) Work with a Nutritionist to monitor glucose levels with diet and exercise.  

Please immediately set an appointment with a nutritionist. We have two that we recommend in Dallas. You can choose the one that fits your schedule the best:

Nikki Bisbee at Origin Wellness is a certified Nutritional Therapy Practitioner. She can help you manage your gestational diabetes through lifestyle adjustments. She also practices homeopathy so she may have other ways to help you feel healthy..  You can schedule an appointment with her HERE.

Another great option is Whitney. She’s a Registered Dietitian, Nutritionist & Diabetes Educator. She’s very knowledgable. You can review her website HERE.

Whitney Stuart has prepared “The Ultimate Guide to Mastering Gestational Diabetes” on her website. You can read that HERE

DIET:

• Remove processed foods and carbohydrates from your diet.

• Increase protein and healthy fats at every meal.

• Add a 20 gram protein snack after dinner nightly

SUPPLEMENTS:

• Diabenil (1-2 capsules 2x a day) is a product by Thorne that may promote healthy blood glucose management. We can put this in a FullScript cart for you to consider.

• Ovasitol (4000 mg 1x daily) stirred into water at bedtime.

EXERCISE:

• Begin walking for 30 minutes after your biggest meal 7-days a week

• Other low impact exercises can be added to help you expend the blood glucose

MONITOR YOUR PROGRESS:

• Attempt to adjust your nutrition based on your results.

• Share your diet journal with your midwife in your portal every week. IMPORTANT If your fasting blood glucose numbers are above 100 for 5 days in a row, please call us.

• Continue with daily glucose checks until your blood sugars are well controlled by diet. Then, you can reduce to checking 3 days a week.

We need to have your glucose well controlled by 30-32 weeks. If it remains high, we will need to consult with a physician.

We will also refer you for an ultrasound to make sure the baby is healthy and well nourished at 34-36 weeks.

If your fundal height is above the expected height, we will also refer you for an ultrasound. The Maternal Fetal Medicine Specialist we refer you to will measure the baby and check the function of the placenta to make sure the glucose isn’t causing harm to the placenta or over-feeding the baby. They will most likely recommend monthly ultrasounds until 36-weeks, and weekly scans in the last month to make sure you and baby are still healthy enough to birth out of hospital.

Summary - Day To Day

1.  Record your meals and record your blood glucose before breakfast and 1-hour after every meal.

2.  Eat a healthy, whole food diet with 80-100 grams of protein each day.

3.  Remove bread, pasta, and potatoes and "root vegetables" as well as processed sugars from your diet

4.  Eat a protein snack between meals and at bedtime.

5.  Include healthy fats like avocado, nuts and seeds in your diet for satiety.

6.  Begin walking or other light exercise after meals that seem to be the most challenging for your blood sugar. You may find it helps to do yoga or walk for 30 minutes each day.

7.  Take 4000 mg of Ovasitol every night. We will create an order in FullScript so you can order a high quality supplement asap.

RECOMMENDED RESOURCES: You can get Lilly Nichols' book Real food for Gestational Diabetes on Amazon.com. She has great information on how to use glucose.

Next Assessments

We will send you for an upper level ultrasound to measure the baby's growth. We will also add a glucose test to your 36-week labs.

I know this is a lot of information. We want you to feel confident that we will team up with you to have a safe, healthy birth. Managing your blood glucose is a big part of that picture.

We're here if you have any questions.

Best,

Margie Wallis, Midwife
Frisco Midwifery & Birth Center