Diabetes in pregnancy! Every pregnant woman has a fear while they are pregnant. Many have more than one fear, but as a prenatal provider for nearly 10 years, I find there is always one fear that stands out more than the others.
For me, it was developing gestational diabetes.
I have a family history of both my mother and father being diabetic until they had gastric bypass surgeries that helped to cure them. A family history of diabetes significantly increases your personal risk of developing diabetes and if you are diagnosed with gestational diabetes your risk of developing diabetes in your lifetime greatly increases.
Growing up, the faces of diabetes were Julia Roberts in Steel Magnolias drinking juice with shaky hands in a salon cape and Willford Brimley, the beloved star of Cocoon and Quaker oatmeal commercials advertising diabetes supplies with his particular way of saying diabetes. Now it wears the faces of seemingly healthy pregnant women that have to transfer their care to a diabetes clinic for the rest of their pregnancy.
Having gestational diabetes increases the risks of developing preeclampsia, high blood pressure, growing big babies that are hard to push out, C-sections, fetal cardiac, respiratory and blood sugar metabolism issues.
Diabetes at the very least is inconvenient; measuring blood sugars, taking medications with side effects, and hearing friends and family constantly judge your nutritional decisions.
But advanced diabetes is disabling- causing vision changes, wound healing delays and can lead to kidney failure. Haunting my pregnancy were images of patients on dialysis connected to machines in a complicated web of tubing tethering them down daily- keeping them from family weddings, fulfilling jobs or taking vacations since they had to come in so often and for hours at a time.
Diabetes develops from insulin resistance
Diabetes develops from insulin resistance. What does that mean? Insulin is produced by the pancreas. It is the key that unlocks the cells to allow sugar inside. Without insulin, sugar just floats around in the bloodstream while the cells think they are starving. This causes increased appetite and cravings for sugar which further compounds the problem.
Eventually, the pancreatic cells are no longer able to produce insulin and then exogenous insulin must be injected into the body.
Gestational diabetes develops when the increased metabolic demands of pregnancy are too much for the body to continually supply insulin.
Not only overweight women develop it.
An increased BMI carries a higher risk of GDM because of the increased metabolic demands but thin women also have pancreatic cells that become exhausted and don’t efficiently produce insulin too.
Who hasn’t heard of the pregnancy rite of passage of craving pickles and ice cream? Many women who have heavily restricted their diets before pregnancy find relief in indulging while pregnant. I have a friend who joked about what the teachers must think about her sending her daughter to preschool with recycled plastic pint containers from her daily gelato consumption.
Taking care of yourself can still feel indulgent and rewarding.
Here is how you do it: Eat the damn cookie but limit the sweet treat to once or twice a week not once or twice a day. And when you do have that cup of ice cream or brownie, eat it with a handful of almonds. Why?
Fiber is in almonds and fiber is the antidote to sugar. Nature is proof of this phenomenon. Does an orange juice grow in a cup hanging from a tree? No, the orange grows with a fiber filled fruit and it’s sweet juice. Thus, eating an orange will not spike your blood sugar in the same way as a glass of OJ.
Have pizza but eat it with a side of veggies. Because they have fiber, keeping in mind that sugar isn’t only in sweets. The body breaks down refined carbohydrates into sugars that are absorbed the same way as candy. The fiber in vegetables helps to delay this process preventing the spike that eventually leads to a crash that in turn leads to more sugar and carb cravings.
Exercise like insulin also helps to bring sugar into the cells. It’s like the WD40 that lines the keyhole helping the insulin key glide in to unlock the channels.
Your take home TL;DR (too long; didn’t read) message is to eat your ice cream but with the pickles too.
You will be tested at the beginning of pregnancy if you have increased risk factors for developing diabetes: BMI > 30, immediate family history or prediabetes diagnosis. This is done using a fasting blood sugar test.
Everyone will be screened for diabetes with a HgbA1C at the beginning of pregnancy. Then for gestational diabetes between 20 and 24 weeks with the GTT.
Hemoglobin A1C is a measure of your average blood sugar levels over the last 3 months.
You don’t need to be fasting for the 1 hour GTT test. But its not the best idea to binge on doughnuts in the days preceding the test.
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