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 Gestation 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.
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.
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