16. Gestational Diabetes
Hey there, sisters! It's great to reconnect in this space! Today, I'm delving into the important subject of Gestational Diabetes. It's a topic that's gaining traction as more women undergo early pregnancy testing, leading to shifts in the criteria for what's considered "acceptable" glucose levels. Consequently, many women find themselves labeled as high-risk due to numbers that fall outside these evolving guidelines.
My aim here is to provide you with factual insights that will spark your own critical thinking and prompt further independent research, especially if you're in a position where advocating for yourself is crucial. I'm not here to sway your opinion one way or another; the decision ultimately rests with you, based on the knowledge you gather from credible sources. My role is simply to equip you with accurate information and reliable resources.
This is another opportunity for me to emphasize the importance of the BRAIN acronym in decision-making.
If you're interested, I've dedicated an entire blog post to the concept of:
Informed Choice and Asserting Your Rights
Check it out for a deeper dive into this crucial aspect of decision-making.
If you’re not familiar with BRAIN, here’s a quick rundown!
B: Benefits
How will this help my pregnancy?
How will this help my baby?
How will this help my birth
How will this help me?
R: Risks
How will this affect my pregnancy?
How will this affect my baby?
How will this affect my birth?
How will this affect me?
A: Alternatives
What other options do I have?
(Because there are ALWAYS other options.)
I: Intuition
What does my gut say?
What does God say?
N: Need Time
“I need more time to think this decision through.”
“I need a private moment to talk to my family.”
“I would like to wait for now.”
“I do not consent.”
I’ll open with this quote from Gail Hart:
“Gestational Diabetes is a syndrome with no risks to the mother or the baby, and with no symptoms, other than the increased chance of growing a larger than average baby.”
The issue of Gestational Diabetes during pregnancy remains contentious, with various theories circulating. Some attribute its occurrence to the weight of the pregnant woman, while others suggest it strikes randomly. Meanwhile, there are those who question its existence altogether. It's a complex puzzle with numerous variables, and the underlying causes remain elusive, leaving many unanswered questions about its origins.
What is Gestational Diabetes?
In straightforward terms, Gestational Diabetes is a form of diabetes that emerges during pregnancy, representing a type of diabetes typically diagnosed for the first time during gestation.
The inception of this understanding dates back to 1979 when the decision was made to classify diabetes diagnosed during pregnancy as Gestational Diabetes, officially recognizing it as a medical condition. This classification frames it as a form of glucose intolerance specific to pregnancy. By having an "official" designation as Gestational Diabetes, insurance coverage becomes available for its treatment. Moreover, the formal recognition encourages both women and healthcare providers to approach it with the seriousness it warrants.
Unlike Type 1 and Type 2 Diabetes, Gestational Diabetes typically doesn't manifest clear signs and symptoms nor does it usually result in long-term damage. Its diagnosis relies primarily on laboratory values, which have evolved over time and can vary between different healthcare practices across the country.
During pregnancy, it's common for blood sugar levels to be slightly elevated since the pregnant body metabolizes sugars at a slower pace. This often leads to fluctuations in blood sugar, particularly noticeable in the morning. These fluctuations are closely linked to what's commonly referred to as "Morning Sickness."
It's worth highlighting that women who have been diagnosed with genuine diabetes may encounter fertility challenges.
Even the American College of Obstetricians and Gynecologists (ACOG) has established criteria stating that low-risk women do not require screening for Gestational Diabetes.
Under 25 years old
Not “morbidly obese”
No family history
Not a high risk ethnic group
The Difference Between Types of Diabetes
Type 1 Diabetes: Also known as insulin-dependent or juvenile-onset diabetes, Type 1 diabetes occurs when the body's immune system mistakenly attacks and destroys insulin-producing cells in the pancreas. As a result, the body produces little to no insulin, leading to high blood sugar levels. Type 1 diabetes typically develops in childhood or adolescence but can occur at any age. Management involves insulin therapy, blood sugar monitoring, and lifestyle adjustments.
Type 2 Diabetes: Type 2 diabetes is characterized by insulin resistance, where the body's cells do not respond effectively to insulin, or insufficient insulin production. This results in elevated blood sugar levels. Type 2 diabetes is often associated with obesity, physical inactivity, and genetic predisposition. It typically develops in adults, although it is increasingly diagnosed in children and adolescents due to rising obesity rates. Management involves lifestyle modifications such as diet and exercise, oral medications, and sometimes insulin therapy.
Gestational Diabetes: Gestational Diabetes, characterized by high blood sugar levels during pregnancy, usually resolves after childbirth. However, women with a history of Gestational Diabetes face an increased risk of developing Type 2 Diabetes later in life. This condition can lead to complications during pregnancy and delivery, as well as elevate the child's risk of obesity and Type 2 Diabetes in the future. Management typically involves dietary adjustments, exercise, and sometimes insulin therapy to regulate blood sugar levels. Physiologically, Gestational Diabetes involves insulin resistance, particularly with weight gain and elevated placental hormone levels directing more nutrients to the baby. During the third trimester, insulin levels may triple. Despite blood sugar levels typically being lower in normal pregnancies, the risk factors for Gestational Diabetes mirror those of Type 2 Diabetes, highlighting the importance of vigilance in monitoring and managing glucose levels during pregnancy as it may signal an underlying issue with glucose metabolism.
How Common is Gestational Diabetes?
The prevalence of Gestational Diabetes varies depending on factors such as diagnostic criteria, screening methods, and cutoff values. Currently, Gestational Diabetes is the most common complication of pregnancy. Approximately 1 in 7 pregnant women will be diagnosed with Gestational Diabetes.
Testing
Testing for Gestational Diabetes can indeed be inconsistent and sometimes unpleasant. Typically, screening for Gestational Diabetes occurs around the 28th week of pregnancy on average. However, the timing and method of testing can vary based on healthcare provider protocols and individual risk factors.
The Glucose Tolerance Test (GTT)
One of the primary challenges associated with the Glucose Tolerance Test (GTT) lies in the fact that the thresholds used to diagnose Gestational Diabetes are set lower than those for non-pregnant women. This discrepancy raises questions about the rationale behind this practice. Considering that pregnant women inherently have higher baseline blood sugar levels due to the physiological changes of pregnancy, it seems counterintuitive to establish lower thresholds for diagnosis. This approach can be perplexing for expectant mothers who may wonder why their blood sugar levels are being compared to those of non-pregnant individuals.
The diagnostic criteria for Gestational Diabetes lack standardization, presenting a significant challenge for expectant mothers. Moreover, the Glucola drink used in the Glucose Tolerance Test contains food dyes, preservatives, and substantial amounts of sugar. This composition can be problematic, especially for individuals who adhere to a consistently low-sugar and low-carb diet. In such cases, their bodies may respond abnormally to the Glucola due to the pancreas not being accustomed to processing large quantities of insulin.
That being said, there's a notable prevalence of both false positives and false negatives in the diagnostic process. Conversely, individuals who regularly consume high amounts of pure sugar and carbohydrates may already have elevated insulin levels. The Glucose Tolerance Test (GTT) procedure involves fasting for 6-8 hours to obtain a baseline fasting glucose level. Subsequently, a 50g glucola drink, containing more sugar than many individuals consume in a day, is ingested, followed by a blood draw one hour later to assess sugar metabolism. If the blood sugar level exceeds 140 at the one-hour mark, the woman is advised to undergo the 3-hour GTT test. Failing this subsequent test results in a diagnosis of Gestational Diabetes.
If a woman fails the test without exhibiting any symptoms, it's important to note that there's likely no actual risk present because Gestational Diabetes isn't necessarily the culprit. In such cases, it's probable that the woman has completely normal glucose metabolism during pregnancy. It's crucial to avoid instilling fear during childbirth, as it can adversely impact the birthing experience. Moreover, if a healthcare provider exhibits fear, it can inadvertently instill apprehension in the expectant mother. It's vital to recognize that low-calorie diets pose significant risks during pregnancy, potentially leading to complications such as Pre-Eclampsia and preterm birth. Additionally, it's worth remembering that regardless of the woman's diet, the baby's size will be determined by various factors beyond dietary intake.
Alternative Testing
I won't delve into each of these individually, but you can easily find more information by conducting a Google search or exploring your favorite home birth or natural birth Facebook group. There's a wealth of knowledge available if you're willing to invest the time to explore it!
Fresh Test
28 Jelly Beans (only used for the 50g test)
Sugary foods equaling the amount in the glucola drink
Eat a Real Meal & Test with a Glucometer
You can eat a real breakfast of eggs, protein, pancakes, and some syrup. After an hour has passed since your meal, test your blood sugar.
Fasting Levels
True Diabetic: 145-300 (or higher)
105 or below: 99% you don’t have Gestational Diabetes
Hemoglobin A1C Test
Only accurate in the first trimester
Add this to your first-trimester pregnancy labs
Very indicative of Gestational Diabetes later in pregnancy
It’s not a perfect test
It does not test insulin levels
A study conducted in Seattle has revealed a correlation between Vitamin C Serum levels and blood glucose levels, suggesting a potential impact on the development of Gestational Diabetes.
If You Have Gestational Diabetes, What Does That Mean for Your Pregnancy, Labor, and Baby?
The evidence indicates that maintaining normal blood sugar levels leads to favorable outcomes, mitigating any heightened risks. By effectively managing blood sugar levels, individuals gain the opportunity to proactively make lifestyle choices that promote overall health and well-being.
What is the Healthiest Way to Manage Gestational Diabetes?
Opt for a diet rich in lower glycemic index foods and lower carbohydrates to significantly reduce your likelihood of requiring insulin by up to 50%. Surprisingly, the conventional dietary recommendations for individuals with Gestational Diabetes may exacerbate blood sugar levels. Adopting a high-carbohydrate diet in this context appears counterintuitive and may not align with optimal management strategies.
Real Diabetes Symptoms
Our bodies often provide clear signals when something isn't functioning optimally. According to Gail Hart's theory, Gestational Diabetes may not pose as high a risk as commonly perceived, especially if the diagnosis is solely based on a failed Glucose Tolerance Test (GTT). In instances where a woman experiences glucose-related challenges during pregnancy, it's possible that she was already diabetic before becoming pregnant, but remained unaware until the additional strain of pregnancy revealed the underlying condition.
Excessive weight loss or weight gain
Excessive thirst
Cannot ever quench thirst
In a normal situation, excessive thirst does not lead to increased urination
Poly-Uria (peeing a ton)
In a higher volume and increased frequency
Glycosuria (sugar in your urine)
Ketones + Sugar
Cardiovascular Symptoms
High Blood Pressure
Fundal Height is Large for Dates
Large Baby for Dates
Large in a strange way
Baby is filled with fluid
Hydramnios (increased Amniotic Fluid)
All Lab Values Will be Out of Range
Fasting Glucose
1 hour
3 hour
How Can You Prevent Gestational Diabetes?
Sometimes, the development of Gestational Diabetes is entirely beyond your control. It might simply be that your pancreas isn't adequately adapted to the demands of this pregnancy. Additionally, it's possible that you were pre-diabetic before conceiving, without realizing it. However, there are proactive lifestyle choices you can make to help manage your condition. Prioritize sufficient protein intake, aiming for 80-100+ grams per day, particularly during the first trimester. Be mindful of your carbohydrate consumption, especially refined carbs, and consider incorporating nuts into your diet as they don't spike blood sugar levels. Limiting excessive fruit intake can also mitigate your risk and help manage weight gain. Regular physical activity, such as exercise for 30-60 minutes two to three times a week, can significantly reduce insulin resistance. Lastly, ensure you're getting plenty of magnesium and Vitamin D to support overall health and wellbeing during pregnancy.
It's perplexing that individuals who barely fail the Glucose Tolerance Test (GTT) are categorized in the same group as those who significantly fail the test, all labeled as having Gestational Diabetes. This lack of differentiation fails to account for the varying degrees of severity within the condition. As a result, the management and treatment approach for Gestational Diabetes remain uniform, regardless of the extent of glucose intolerance. This standardized approach overlooks the potential nuances in care required for individuals with differing levels of glucose intolerance during pregnancy.
“A temperature of 100.5 is a fever, right? But should we treat the woman with a temperature of 100.5 the same as we treat a woman with a temperature of 105?” This is the mentality surrounding the treatment of Gestational Diabetes. Anyone who fails the GTT, regardless of how many points they are about the limit, are treated the same way in pregnancy, even if they are, in fact, not diabetic in that pregnancy.”
Resources:
Podcasts:
Stay Wild & Free,
-Brandy
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