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

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

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


Australian Diabetes Council. (2013). What is Gestational Diabetes. Retrieved on February 28, 2013, from

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

Goer, H. (1996). Gestational Diabetes: The Emperor Has No Clothes. The Birth Gazette, 12(2). Retrieved on April 1, 2013, from

National Diabetes Service Scheme. (2013). Gestational Diabetes. Retrieved on February 20, 2013, from

National Diabetes Information Clearinghouse. (2013). What I need to know about Gestational Diabetes. Retrieved on March 1, 2013, from

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

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

Gestational Diabetes: To Test Or Not To Test

Gestational Diabetes: To Test Or Not To Test

If you’ve been pregnant, chances are you’ve had to decide whether or not to take a ‘Gestational Diabetes’ test. You’ll usually be given a form to go have one of two ‘routine’ tests, the Glucose Challenge Test or the Glucose Tolerance Test, and that’s that. When I was pregnant I wasn’t really given any explanation about the test except that I would have a drink that was “like sweet, flat lemonade” (which it kind of is). I had no idea what Gestational Diabetes was. I didn’t think I had the option not to take the test, and I had no idea what ‘failing’ the test would mean. Unfortunately, it was only after I had ‘failed’ the test and was diagnosed with Gestational Diabetes that I researched more about the unreliability of the formal tests and the impact the diagnosis would have on my prenatal care.

The Glucose Challenge Test (GCT) is a relatively simple test: at 24-28 weeks gestation you drink a sweet drink with a high glucose load, usually around 50g of carbohydrate, and a blood sample is taken one hour later. Your blood glucose or blood sugar levels are tested and then compared to the ‘average’ levels. If your blood sugar levels are over the ‘average’, you are considered ‘at risk’ of Gestational Diabetes Mellitus (GDM), and will be sent for the Glucose Tolerance Test (GTT). This is a more involved test. You may be sent straight to this test if you are considered high risk of developing GDM. You must fast for approximately 10 hours, and then attend the pathology clinic for around 2 ½ hours. You will need to drink another sweet glucose drink – this one usually has around 75g of carbohydrate (the equivalent to eating 5 tablespoons of sugar or 3-4 pieces of white bread). A series of three blood tests will be taken – one before you have the glucose drink, another test one hour after you’ve had the drink, and another one hour after that. This series of blood tests are graphed and compared to the average levels. What the doctors are looking for is a normal fasting blood sugar level, a blood sugar peak at one hour, and then back within ‘normal’ range two hours after the drink.

gestational diabetes blood glucose meter

The ‘average’ and ‘cut-off’ levels seem to vary depending on where you live, however generally in the USA, UK, Australia  and New Zealand, women who have blood sugar levels above 8-9mmol/L (140-160 mg/dl) at two hours after drinking the 75g-glucose drink get the diagnosis of GDM.

Recommendations from some of the prominent College’s of Obstetrics and Gynaecology (ACOG, RAZNCOG and RCOG), state that every pregnant woman, regardless of risk or medical history, should be screened because the rate of GDM among expectant mothers is rising – although, that statement itself is ironic! They also claim that the GCT/GTT is essential: the potential ‘risks’ of GDM mean that women need to be under strict management during pregnant, labour and birth for optimal maternal and fetal outcomes. However, there are many medical and birth professionals who, after reviewing the data themselves, have decided to do away with routine testing for GDM.

When you think about the test, it’s not surprising that many women ‘fail’ or are considered ‘borderline’ or ‘pre-diabetes’. Most women are also asked to sit and not engage in any sort of activity for the entire two hour test, which is a factor that can lead to higher blood glucose levels. Pregnant women also naturally have some form of insulin resistance thanks to the pregnancy hormones. You drink the sweet glucose drink (a fast-release carbohydrate load that is larger than someone would have in an average meal) without any form of protein to slow the release of glucose. It’s easy to see why many have decided that the formal tests are not an accurate representation of the mothers ability to tolerate carbohydrates in everyday meals. Dr. Sarah Buckley, GP and obstetric professional, recommends against routine testing for GDM for most women. Ina May Gaskin, a Certified Professional Midwife and founder of The Farm Midwifery Center, also reports that up to seventy percent of women who repeat the test get a different result than on their initial test.

But… what are the options?

Well, a lot doctors and midwives won’t give you any. At a hospital appointment I once had, my partner and I sat and listened to a midwife argue for 15 minutes with a woman who refused the routine GDM test. Over the course of the conversation, the woman asserted herself, telling them she was 34 weeks pregnant, she checked her blood sugar at home periodically, she’d had a scan, everything was fine, and she didn’t want the test. The midwife belittled her, bringing her weight into the conversation. Tried to scare her by predicting the size of the baby. Insinuate that she was uneducated and naive and she didn’t understand the risks. She even tried to pull the “You’re jeopardising the safety of your baby, it’ll be on your head if something happens” card. I’m not sure what became of the woman, but she was just one woman in what I imagine is a sea of pregnant women trying to assert themselves in this medicalised and interventionist culture of birth at the moment.

gestational diabetes glucose meter and strips

The mother in my story knew a great option. One that WAS reflective of real life – periodic home blood sugar tests. If you are comfortable with refusing the GCT/GTT, but still feel the need to have some kind monitoring, then this is one of your options. It is logical and obvious that testing two hours at home after eating your lunch and doing whatever you normally do afterwards, would give you a good idea about whether or not your body is having trouble. These results are usually compared to the ‘average’ results – usually aiming for less than 5.5mmol/L (100mg/dl) while fasting, and less than 6.7mmol/L (120mg/dl) two hours after meals. This could give you an idea of whether you need to readjust your diet or consider medical management.  And, going by the stories I have read and the women I have talked to, this seems to be the option many homebirth midwives give their clients. However, it can be a hassle if you forget, or if you’re in the habit of frequent eating, because for accurate results you need to eat your meal and then nothing but water for two hours. This is because other food or drink could raise your blood sugar levels and give an inaccurate reading of your body’s ability to handle the carbohydrate load of your meal.

Another option some professionals give is to keep the formal test, but swap the drink for something else with an equivalent carbohydrate load. This attempts to mimic a real-life situation, and is thought to be more accurate than a test based on the glucose in the sweet drink. However, this is not recommended by some medical professionals because eating a meal takes more time than the 5-10 minute limit you are given when drinking the glucose drink. Also, different types of foods have slower or faster releasing glucose, so the results can’t really be compared to the ‘average’ results after the glucose drink.

If you choose to forgo the routine testing for less invasive tests or none at all, educating yourself is important. Be aware of the quality of your carbohydrates and how to eat well-balanced meals that include low-GI (glycemic index) carbohydrates. This is a good way to keep your body healthy, diabetes or not. Dr Michael Odent explains this practice quite well in his article ‘Gestational Diabetes: A Diagnosis Still Looking For a Disease?’ (linked below). Alongside a balanced diet, Buckley, Gaskin and Odent all recommend regular low impact exercise throughout pregnancy to help the body lower blood glucose levels naturally.

Keep reading: The Truth About Gestational Diabetes {And Why It’s Not Your Fault}



American College of Obstetricians and Gynaecology, The [ACOG]. (2011). Screening and diagnosis of gestational diabetes mellitus. Committee Opinion No. 504. 751–3. Retrieved on March 31, 2013, from

Australasian Diabetes in Pregnancy Society, The [ADPS]. (2002). Gestational Diabetes Mellitus – management guidelines. Retrieved on March 31, 2013, from

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

Goer, H. (1996). Gestational Diabetes: The Emperor Has No Clothes. The Birth Gazette, 12(2). Retrieved on April 1, 2013, from

Gaskin, I. M. (2003). Ina May’s Guide to Childbirth. United States: Bantam.

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

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

Royal Australian and New Zealand College of Obstetricians and Gynaecologists, The [RANZCOG]. (2011). Diagnosis of Gestational Diabetes Mellitus. Retrieved on March 31, 2013, from

Royal College of Obstetricians and Gynaecologists, The [RCOG]. (2011.) Diagnosis and Treatment of Gestational Diabetes. Scientific Impact Paper 23. Retrieved April 1, 2013, from

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