So–you may be a known diabetic, or just found out you didn’t pass the glucose test, so you are now labeled GESTATIONAL DIABETIC(which means we don’t have any sign that you were pregnant before the pregnancy). Let’s all hope it goes away after the baby is born! But be warned that being a ‘gestational diabetic’ puts you at risk for diabetes down the road!
You will need to be checked again at your 6 week post partum visit to make sure you are not still diabetic!
Because we have some of the fluffiest people in Canada living in our area–we screen everybody at about 26-28 weeks If you have risk factors, then we screen at your first visit.
The Society of Obstetricians in Canada recommends screening everybody—there are some centres in Saskatchewan and Ontario that do not do this.
You can be diabetic even if you are healthy beforehand–that darn placenta just can work 100% against you–no matter how healthy you eat, how much you exercise —- the “elephant in the room” is that PLACENTA!!! The placenta makes hormones that can make you diabetic. BUT if you are diagnosed with diabetes early in the pregnancy–you can CALL it gestational diabetes—but you are very likely TYPE 2 diabetic.
The preferred approach to test for diabetes in pregnancy is to begin with a 50 g glucose challenge test (that sickly sweet orange drink).
You do not have to FAST for the 50 gram test–but this is NOT the morning to hit House of Pancakes and load up on syrup! Have some ham and eggs—much better!
If you fail this 50 gram test, you will have to do the 2 hour test, with a 75 g oral glucose drink. THIS one you FAST for!
IF YOUR ONE HOUR BASIC SCREEN IS ≥ 7.8 mmol/liter ( ≥ 140 mg/dl) YOU JUST FAILED AND NEED THE TWO HOUR TEST.
TWO HOUR TEST:
You are considered diabetic if you have ONE NUMBER ABNORMAL:
fasting ≥5.3 mmol/L (95mg/dl)
( ≥ is read as greater than OR EQUAL TO)
1 hour ≥10.6 mmol/L
2 hours ≥9.0 mmol/L)
GOALS OF DIET AND MEDICATION ARE SUGARS THAT ARE:
fasting < (less than)5.3mmol/L,(95 mg/dl)
I hour postprandial (after eating) <7.5 mmol/l(140 mg/dl)
and 2 hours postprandial <6.7 mmol/L.(<120mg/dl))
The Diabetes Association has released new guidelines for diagnosing diabetes in pregnancy. They tell us we can go straight to a 75 gram sugar test BUT THEY HAVE DIFFERENT PASSING NUMBERS!
A diagnosis of GDM is made if one plasma glucose value is abnormal:
fasting ≥5.1 mmol/L,
1 hour ≥10.0 mmol/L,
2 hours ≥8.5 mmol/L).
If trying to get pregnant, we like to see sugars well controlled before you get pregnant–high sugars do increase risk of congenital heart disease in baby–so we like to see the “three month marker” test of Hemoglobin A1C of less than 7–preferably less than 6.5, and when pregnant we like to see if under 6.5 –and love it when under 6.1
What are the complications of being diabetic in pregnancy?
- higher birth weight baby, so more trouble getting shoulders delivered, and higher chance of C. Section
- C. Section on fluffy women don’t heal as well, and it is not unusual to spend weeks having your wound packed–while you are trying to care for a newborn
- increase in death for baby–uncontrolled diabetes has a higher death rate, and stillborn rate. This is NOT a higher risk if you are DIET CONTROLLED!!! Diet controlled is same risk of a normal pregnancy—-so try really hard to do your BEST with diet—there’s no “do-overs” for making this baby.
- problems with the sugar control in the baby after birth
- a mom who is at risk for continued diabetes after delivery (you need to be checked after delivery to make sure you don’t need to continue with medications etc.
- diabetes is bad for your heart and your brain–heart attacks and strokes–we NEED you around to get this baby through life!
If women with GDM (gestational diabetes mellitus), do not achieve sugar targets within 2 weeks from diet alone, insulin therapy should be initiated. Sometimes, if there is just a problem with fasting sugars, or sugars are still high wtih decent diet, the option of the pill Glyburide is one I discuss. Although not generally done here, there is plenty of literature about its use in pregnancy. I used it quite a lot when practicing in the USA. I will use it when a woman refuses insulin.
Glyburide is safe and effective in controlling glucose levels in >80% of patients with GDM, and does not cross the placenta.
Women who are older, who are diagnosed earlier than 25 weeks, and have higher fasting and postprandial glucose values on their OGTT (oral glucose tolerance test–that 75 gram drink and 2 hour test), are less likely to respond to glyburide. I find it best when the morning sugar alone is the highest.
The use of Glyburide can lead to increase compliance with care–women are more accepting of a pill than a needle! If, however, you are told you need insulin–you need insulin—time to put on the grown-up panties, and do what you can to keep this pregnancy going well. It’s a tiny needle—-and YES–you CAN do it!!
You don’t have to give your shot in the same place every time. This is an example of a”grid” system. You can think of your belly like this–just move along every day, and you won’t hit the same area for at least another month.
HEMOGLOBIN A1C (HGB A1C)
Hgb A1C is a blood test that shows the average blood glucose level over the previous two to three months. It does not matter if you fast for this test—it is a way to see how your sugars are, even if you have been really good for a day or two before you are tested.
If your sugars have been high we will know! We may test this monthly if we have trouble with control.
Miserable thing–but there are no good cereals, no good cookies, no good cakes, and no good rice or pasta–and no good juices or sodas. I hear –well eat BROWN rice—there is VERY little difference between white and brown rice. A serving of rice is HALF A CUP (leveled off)—like WHO eats just that—-they bring 4 cup servings in most restaurants!
There are no good juices–well maybe tomato juice — and although milk is fine–CHOCOLATE milk is NOT! Almond milk or coconut or cashew milk will not spike your sugar the same as cow milk, by the way.
Calories per day are typically divided over three meals, and two to four snacks, but there is a lot of talk now about INTERMITTENT FASTING–and to me, it makes good sense NOT TO eat all the time and keep making your pancreas fight the constant carbohydrate intake.
Some experts feel that current recommendation of 40% carbs is one of the reasons we have this obesity epidemic–and suggest getting only 30-40 grams of carbohydrates a day and the rest is protein and fats.
You are welcome to read about this or listen to Dr. Jason Fung–a Toronto doctor who is really shaking up the status quo.
You eat as many veggies as you can—-use vinaigrettes for dressing. Best veggies are those that ground ABOVE GROUND.
You need to pay attention to labels, and to the GLYCEMIC INDEX of foods. Some foods will really push up your blood sugar. You also need to pay attention to GLYCEMIC LOAD.
4 grams of sugar is same as 1 teaspoon of sugar.
The glycemic load is calculated by multiplying the grams of a carbohydrate in a serving by that food’s glycemic index, then divide by 100.
A glycemic load of 10 or below is considered low.
A glycemic load of 20 or above is considered high.
A glycemic INDEX–GI is rated:
0-55 is low 56-69 is medium 70 and over is high
Two foods with the same amount of carbohydrates can have different glycemic index (GI)numbers. Also, if you are cooking pasta–the longer you cook it, the higher the glycemic index (GI).
Very ripe fruits tend to have a higher glycemic index. That’s why you use very ripe bananas in banana bread!
You want to avoid foods with high GI, and high GL (glycemic load).
HOW TO DO THE MATH–and we tend to eat the same foods so you can keep a log in a book or on your smart phone under notes app.
There are free apps that will tell you the GI of most foods (and you have to try to use food that is not processed–that means put in a can, or a box, or a bottle).
As long as you know the glycemic index of a food and the grams of available carbohydrates (total carbohydrate minus fiber) in that food, you can figure out that food’s glycemic load.
GLYCEMIC LOAD = Glycemic index x Grams of carbohydrates / 100
1/2-cup serving of raw carrots, which have about 8.6 grams of available carbohydrates and a glycemic index of 45.
AVAILABLE carbs is number of carbs per serving MINUS number of grams of fiber per serving.
45 (G.I.)x 8.6 (# of available carbs per 1/2 cup serving) = 387 / 100 = 3.9 glycemic load
YAAAAHHH stuff your face on carrots!!! Please–SHOOT me!!
So ONE CUP of red kidney beans has 37 grams of carbs and 9 grams of fiber–
so AVAILABLE carbs is 28 grams. Now that sounds like a lot. The G.I. (from charts available on the internet or on apps you can get) is 27.
The G.L. (glcemic load) is:
27(glycemic index) x 28 (number of carbs in one cup)/100= 7.56
Half a cup is 27 x 14(half of 28)/100 = 3.78 — a really LOW glycemic load!
Want to calculate the glycemic load of instant white rice instead?
Well, a portion size of around 2/3 cup of white rice has about 36 grams of available carbohydrates and a glycemic index of 72. Here’s the math:
72 (GI) x 36 (carb content) = 2,592 / 100 = 26 glycemic load—–NOT GOOD!!!!
If you HAVE to have rice, then make it a brown rice BUT consider mixing in Quinoa, lentils, chia seeds. millet–or other grains etc— make it more tasty. COOLING the rice actually will slightly lower the GI, since the sugars in the rice will “crystallize” and become less digestible—at least that is what dieticians (they’re the experts!!) are telling us.
The glycemic load uses a specific calculation. So as long as you know the glycemic index of a food and the grams of available carbohydrates (total carbohydrate minus fiber) in that food, you can figure out that food’s glycemic load. Here’s the calculation:
Glycemic index x Grams of carbohydrates / 100
KRAFT DINNER each box is supposed to have THREE SERVINGS hahahahahahahahaha—yeah right
ONE SERVING IS 1/3 cup (level) unprepared has 27G of carbs in 52 grams– and 1Gram of fiber so subtract 1—-so 26 grams of available carbs per serving—we’ll forget the cheese for now and just do the macaroni.
From printed charts we know the GLYCEMIC INDEX of macaroni is 50 per 100 grams–so we will use
50 (the GI) x 26 (grams of carbs per serving-which is ONE THIRD OF THE BOX!)=1300 then divide by 100 = 13 GLYCEMIC LOAD This is medium GLYCEMIC LOAD—now—let’s get REAL—-you are going to eat at least half the box!
So– half a box has 54 grams of carbs, so now
GI (50) x 54 /100 = 27 HIGH GLYCEMIC LOAD
Oh –now add on the cheese!!!—look!!—just FORGET this meal as an option!
SERIOUSLY!! Look at doing zucchini pasta–it holds up well to thick sauces. Spaghetti squash is an option but it is a bit watery in my opinion.
Remember that even though bottled spaghetti sauces look healthy (they are red so tomatoes and tomatoes are healthy)–there is a bucketload of sugar in them—that’s why they burn in the pot so easily–the corn syrup caramelizes!!! Just read the ingredients on your next bottle—-there will be a maltOSE or a fructOSE or a sucrOSE–some OSE (code word for SUGAR)!! MAKE YOUR OWN SAUCE!!
ENOUGH!!!!!! GET AN APP ALREADY!!!!! OR remember—no bread, no cookies or cakes or cracker or cereals. No pasta. No candy, chocolate….basically–if it looks delicious…DON’T EAT IT!!!!
WHAT TO EXPECT during pregnancy if you have diabetes.
If your get your sugars controlled with diet alone, then no special testing needs to be done–you are at no higher risk than a normal pregnant woman.
IF you need insulin or meds, then things are done!
At about 32-34 weeks we start doing NST (non stress tests). This is where you are put on a monitor to graph out the baby heart beat for about 20-30 minutes. We look for the heartbeat to go up when the baby moves. We may do NST weekly or twice a week–depending on your medical situation.
For instance, diabetics are way more prone to high blood pressure in pregnancy–so if we have you on insulin AND we have to start blood pressure pills, you will get tested more than someone who has normal blood pressure.
If there is excessive fluid around your baby (polyhydramnios–poly=too much hydra= water amnio= fetus sac), you may get more testing done.
Your risk is highest if your average sugars are over 180 mg/dl (10 mmol/l), and your Hgb A1C is over 8%.
We try to aim for a normal vaginal birth, but diabetics do have a higher chance of a C. Section due to size of baby, and increased risk of other complications such as high blood pressure, too much fluid, etc.
We are not here to give you a hard time—but we are not your best friend—we are your doctors/practitioners–and you might not like what we say—but DON’T SHOOT THE MESSENGER! PLEASE!!!!