The Truth About Gestational Diabetes {And Why It’s Not Your Fault!}

by Birth Without Fear on June 24, 2013

So you’ve had the Glucose Tolerance Test, or maybe you’ve been monitoring you’re blood sugar levels at home, and your blood sugar readings were high. You have been given a diagnosis of Gestational Diabetes. If your experience was anything like mine, an Obstetrician or midwife gave you a pamphlet on ‘Diabetes and Pregnancy’, referred you to a dietician and endocrinologist for management, and then sent on your way. And now you’re at home, and all the questions you didn’t think to ask are flooding in…  What the heck is it? And what does it mean? Will my baby be alright? Do I need a caesarean? Will I need to be on insulin? What can I eat? Do I have to stop eating CHOCOLATE?!?!?!

There is some debate against the use of routine testing to diagnose Gestational Diabetes, and also questioning about giving the diagnosis of Gestational Diabetes as a label on pregnant women. Dr. Sarah Buckley recommends avoiding routine testing for Gestational Diabetes for most women. Henci Goer and Dr Michael Odent are among many pregnancy and childbirth professionals who argue against diagnosing women with gestational diabetes, citing unnecessary stress and interventions as one of the risks of the Gestational Diabetes diagnosis. Nevertheless, whether you want to call it Gestational Diabetes or Pregnancy-Induced Insulin Resistance, or just high blood sugar levels in pregnancy, some women do have elevated blood sugar levels and need some extra help.

Gestational Diabetes Mellitus (GDM or GD) is described as a form of diabetes that develops during pregnancy, and usually goes away 4-6 weeks postpartum. In a pregnant woman without Gestational Diabetes, the body works ‘as usual’. You eat, your stomach breaks down your food, you start to digest it, and the glucose from the carbohydrates in your food enters the blood stream. The pancreas gets the signal to secrete more insulin into the blood stream to help the cells absorb the glucose and convert the glucose into energy. The blood glucose level increases straight after a meal but as the glucose is absorbed from the blood and into the cells, the blood glucose levels decrease. The blood glucose readings fluctuate as normal, but remain within the ‘prescribed levels’.

In a pregnant woman with Gestational Diabetes, the cells become ‘insulin resistant’. The pancreas makes ‘the usual’ amount of insulin to enable the cells to absorb the glucose, but because the cells have become ‘resistant’ to the insulin, the amount of insulin needed increases. When the pancreas makes as much insulin as it can, and the cells continue to struggle to absorb the glucose, this is Gestational Diabetes. The blood glucose levels in a woman with GDM rise as normal after a meal, but stay elevated due to the cell’s inability to absorb the glucose.

diabetes blood sugar test

So what can you do to prevent or stop insulin resistance and GDM from developing? There seems to be this myth floating around that fit and healthy women don’t get GDM, and unfit or unhealthy women are probably going to have GDM. It’s false. In pregnancy, insulin resistance is mostly caused by an increase in pregnancy hormones (hormones produced by the placenta). The hormones are thought to reduce the effect of insulin on the cell, as well as reducing the response of the cell to insulin. While keeping yourself healthy can reduce your risk, there is nothing that can stop your cells developing insulin resistance from the hormones made by the placenta. Although there appear to be some risk factors which could increase the chance developing Gestational Diabetes (for example, age, ethnicity, weight, personal or family history of diabetes,  or some hormone-related conditions such as PCOS), there are many women who develop insulin resistance and GDM who do not show any risk factors. In short, you just can’t control how your cells respond to your pregnancy hormones. There is a lot of research to suggest the most pregnant women will develop some insulin resistance during the pregnancy because of the increase in pregnancy hormones, but for many women the pancreas is able to produce enough insulin to maintain stable blood sugar levels and so it does not develop into diabetes.

There is also this idea that women with GDM can control it. Women are told “You just need to keep your diabetes under control.”, like it’s just that easy. Unfortunately, no one can explain how to control a cells response to the pregnancy hormones. You can’t control Gestational Diabetes. It happens sometimes. But telling a women that she should be able to control it really put unnecessary shame and blame on mothers who are frustrated and disappointed enough as it is. So if you’ve ever said this then, please, never say it again!

You can’t control Gestational Diabetes. It happens sometimes. But there are ways to help your body deal with it. Monitoring diet and engaging in regular exercise really can be the key for women who have low-to-medium level insulin resistance. The aim of monitoring your diet is to balance the amount of carbohydrate in your meals. The general consensus from dietitians and endocrinologists seems to be that having 3 meals and 2-3 snacks per day (but please follow the advice of your personal care provider). It does make sense that it’s easier on your body if you spread out the carbohydrates into 3 balanced meals and 2-3 snacks instead of packing them into three carb-heavy meals per day. Another way to manage high blood sugar levels can be regular exercise, like walking. Going for a walk 30 and 90 minutes after eating to can help lower blood sugar levels by using up the excess glucose in the blood stream. Every person responds differently though, so if you do have Gestational Diabetes, please work with your care provider in finding the management plan right for you.

Some women develop a high level of insulin resistance, despite eating balanced and spaced out meals and snacks, and exercising regularly. These women continue to have consistently elevated blood glucose levels. I was one of those women.

When my hormones peaked at 32 weeks, I would not be able to eat a chicken and salad sandwich of barely 30g of carbohydrates without my blood sugar spiking well above the ‘allowed’ limits. People kept telling me to “control” my diabetes. I thought I was doing something wrong because my blood sugar levels were so high, so I reduced my carbohydrate intake drastically. The dietician put me on insulin when I started losing weight (and I was only 140lbs at 32 weeks, so didn’t have much to lose!), I had no energy and I was and spilling ketones into my urine.

If, like me, you are doing all you can and you still need insulin, please be kind of yourself – it’s not your fault. Remember, you can’t control this. You have a medical condition. You are insulin resistant. Your body just needs some help. Injecting insulin is very easy (I found it virtually painless, and nowhere near as unpleasant as the finger-prick tests!). It helps your body by giving it the extra insulin it needs when your pancreas is producing as much insulin as possible but your body is still unable to lower your blood sugar level.

Despite the myths floating around, a diagnosis of Gestational Diabetes does NOT mean you will automatically have a big baby. It does NOT mean you automatically need to have a cesarean. It does NOT mean you cannot VBAC. It does not mean your baby will definitely need to go to the Special Care Nursery… You have options, and a gentle, calm and intervention-free vaginal birth with gestational diabetes is possible for most women.

diabetes insulin pen

References:

Australian Diabetes Council. (2013). What is Gestational Diabetes. Retrieved on February 28, 2013, from http://www.australiandiabetescouncil.com/About-Diabetes/Gestational-diabetes

Buckley, S. J. (2008). ‘Gestational Diabetes Testing’. In Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Retrieved on March 31, 2013, from http://www.fullcirclemidwifery.com/2009/02/gestational-diabetes-information/

Goer, H. (1996). Gestational Diabetes: The Emperor Has No Clothes. The Birth Gazette, 12(2). Retrieved on April 1, 2013, from http://www.gentlebirth.org/archives/gdhgoer.html

National Diabetes Service Scheme. (2013). Gestational Diabetes. Retrieved on February 20, 2013, from http://www.ndss.com.au/en/Diabetes-Information-Sheets/Gestational-diabetes/

National Diabetes Information Clearinghouse. (2013). What I need to know about Gestational Diabetes. Retrieved on March 1, 2013, from http://diabetes.niddk.nih.gov/dm/pubs/gestational/

National Institute for Health and Clinical Excellence [NICE]. (2008). Diabetes in pregnancy: Management of diabetes and its complications from pre-conception to the postnatal period. Clinical Guideline 63. Retrieved on April 1, 2013, from http://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf

Odent, M. (2004). Gestational Diabetes: A Diagnosis Still Looking For a Disease? Primal Health Research: A New Era in Health Research, 12(1). Retrieved on April 1, 2013, from http://www.bellybeginnings.com/Handouts/GestationalDiabetes-Odent.pdf

{ 16 comments… read them below or add one }

Sarah February 25, 2016 at 12:54 pm

I am 13 week pregnant and have been diagnosed with GD. I had it will my first pregnancy but was not diagnosed with it till I was between the 24 and 26 weeks of my pregnancy. I had hoped since I lost 20 + pounds since the first baby that I would get it this time. I was wrong. I am struggling with feelings that I have done this to myself. It is hard emotionally not to blame myself. This blog has helped me. I don’t know what the rest of my pregnancy will look like but I am hoping to be able to go forward and not blame myself for this any longer.

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Jenn April 14, 2016 at 8:38 am

Hi Sarah,
I am 19 weeks and at 17 weeks I took the 1 hour and it was elevated at a 179. My dr. skipped the 2 and 3 hour and went straight to endo and nutritionist. I had GD last time but I feel like It wasn’t this bad. I have been testing my sugar and limiting what I eat and it is still high. I have a long road ahead of me and I am already upset and angry about it. I too have lost weight and also since I got pregnant have lost 15lbs just but eating better and it has had 0 impact on anything. I get what you are feeling. IF you want someone to talk to, we can go through this together please email me! Jenn_21802@hotmail.com. Thanks! Best Wishes!

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Síle May 19, 2016 at 5:54 am

I was just diagnosed yesterday, at just under 6 weeks pregnant. I feel utterly upset and angry. I can’t even get excited about my baby and I feel like food is my enemy. I really needed to see that others have been angry too.

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Rainy April 6, 2016 at 4:56 am

Thanks for the this blog…. it make mum feel better during this emotionally hard time.

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Sara Richter May 7, 2016 at 6:33 pm

Thank you so very much for posting this! It truly has helped me feel better. I have PCOS (and definitely have insulin resistant issues) and was pre-diabetic for several years before getting pregnant (which I did through 2 years trying, 1 IUI later) and my levels on the 1 hour came back “elevated” so I just requested the endocrinologist referral to get some real help. Nothing else in my pregnancy has come up but I explained to my OB that really–due to my health history following this process could definitely help! I always want to figure out what my body is doing and WHY along with trying to work with it to not only produce a healthy baby but a healthy happy me. When I found out about the sugar levels and the possibility of having GD…I almost went into a food depression, wanting to refusing anything with carbs or sugar thinking it would help. But I forced myself not to because i knew my baby’s life depended on it. Now I just want to jump into figured out what foods and meals work with my body to help balance myself as much as possible.

I wish more people discussed this type of angle when discussing being pregnant. It’s all related and I feel more educated than just trying to fit into a certain window of definition for a lazy doctor (not mine–others i’ve heard.)

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Rachel May 19, 2016 at 7:14 pm

I was just diagnosed with GDM and this article was exactly what I needed to read right now. Thank you so much for writing this article!

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Catherine May 23, 2016 at 8:32 pm

Thank you for posting this. Everything you said were true. Thank God I had vbac though I almost need to have cs because of my big baby. I agree GDM adds stress to pregnant women like us. I was on strict diet and same with you, I was spilling ketones too. My UTI never left my body til my 8th month of pregnancy which also gives me added stress. I gotta be careful then next time since I have a family history of diabetes. Take care to every women not just with GDM but to all pregnant women in the world. It’s not easy being a mother. But everything is worthy after we saw our little one. 🙂

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Evelyn July 16, 2016 at 11:13 pm

Hi,

I just wanted to thank you for taking the time to share your experience, knowledge and information on GD. I am 32 weeks right now and 2 weeks ago found out I have it. Since then I have been feeling really overwhelmed with all the information, appointments, record keeping and additional information on all the possible outcomes of this. I have been focusing on having a calm and natural birth, and I am trying to do my best right now to continue to focus on that, because my baby right now is still growing at a normal rate and is healthy.

I sometimes feel that health care providers can cause unnecessary stress and anxiety on the women when they start talking about all the negative things that can come of GD instead of focusing on all the positive things you can do to work on it. I am in the care of a midwife and the Obstetrician I saw for this was pretty much telling me all the things that can possible go wrong and how a C section might be necessary and I started to feel anxious because that is not what I want. So….

For any of you women who are feeling, anxious, overwhelmed, angry , upset or worried you are not alone! I just want to say that something that has worked for me is hypnotherapy. I used it for when my 2nd son was born and it really works…it helps you to go into a deep state of relaxation and allows you to focus on what you want your outcome to be, not what all the people around you are telling you may or will or can happen. It is using the power of your mind! I don’t know if anybody has heard of hypnobirthing, but this is also another way to help you have a calm, peaceful birth if that is what you want. Google it. There are also Hypnosis recordings you can listen to, to help you with what you are going through right now. I am going to be using it to be able to conquer this for sure!!

here is a useful link for those who may be interested:
http://shinehypnosis.co.nz/preventing-and-managing-gestational-diabetes-with-hypnosis/

http://www.webmd.com/baby/features/hypnobirthing-calmer-natural-childbirth

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D July 28, 2016 at 10:29 pm

Except doctors use GD against women. Having an 11 lb baby means one must have had GD which means one must not have had prenatal care (even if one saw someone who practiced at the same hospital). So they keep the baby in the special care nursery when if the baby was in as bad shape as they said the baby would have been transfered to a hospital with a nicu already. The culture needs to change.

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houston dog obedience training August 4, 2016 at 1:25 am

I don’t ordinarily comment but I gotta say appreciate it for the post on this special one :
D.

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Kristen September 6, 2016 at 8:32 am

Thank you for this! Even being a nurse, I still have felt so much guilt and shame about this diagnosis! It’s crazy. I have maintained an active lifestyle throughout the entire pregnancy, only gaining 10 pounds by 32 weeks. Still my sugars are way too high, I’m on insulin and feel so frustrated like I’ve done something wrong. Being virtually ‘dumped’ by my midwife, and swept up in a barrage of appointments and specialists, weekly NST’s has been awful. The “HIGH” message on the glucometer certainly doesn’t help you feel like you’re doing a great job either! It’s nice to read this blog and feel understood. It’s so hard not to blame yourself!! I’m desperately hoping for a vaginal delivery in October, keeping my fingers crossed!

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Jennifer October 12, 2016 at 1:43 pm

Thank you for posting this. I’m was diagnosed with GD at about 15 weeks. It went through really worrisome and sad emotions the past 24 hours, but it’s posts like these that help me get myself together and fight on. Good luck to all.

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Rebecc October 26, 2016 at 12:05 pm

I wasn’t even tested until 25weeks for the glucola 1 hour test. How are people being diagnosed so early? was there another test my doc didn’t do?

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Nadya October 16, 2016 at 6:47 pm

Thank you for posting this, it was exactly what I need right now. I have PCOS and from the moment we started trying to conceive well over a year ago, I’ve been eating essentially a diabetic diet, walking every single day for 45-60 minutes, and taking care of myself with prenatals and anything else my doctor has recommended. I did everything right, and was still diagnosed with GD last week at 28w. I’m following the meal plan my dietician gave me, and she said I’m doing excellent, but despite that, my levels are still too high. I started exercising more – 30 minutes after every meal – and it isn’t helping. It’s so frustrating to know you are doing literally everything right and you still can’t protect your baby from your own body. Yes, I know there is nothing more I can do…I KNOW that. But it doesn’t stop me from feeling horrible about it. It’s like whatever joy I had in this pregnancy has been yanked away and replaced by the disappointment of seeing 7.8 on that stupid meter, despite just having come back from a one hour walk after having a very regimented lunch. It’s good to know there are others who have tried and tried to control it and just can’t, no matter what they do. I’m glad I’m not alone.

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Janice November 9, 2016 at 5:46 pm

I was just diagnosed with GD and immediately blamed myself and wondered what I did wrong. Both this post and Nadya’s comment made me feel better.

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Danielle November 30, 2016 at 2:41 pm

Diagnosed today at 31 weeks, and felt HORRIBLE. I went through 4 IUIs and 2 IVF rounds to get pregnant with #2 at 41 years old. GDM diagnosis was a crushing blow after the year we’ve had. But thank you for this. It helped to ease my fears, put control back into my mind, and feel better. I really appreciate your candor.

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