How to Manage Gestational Diabetes

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What to do when your little bundle of joy now comes with an unexpected surprise—gestational diabetes. 

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Gestational diabetes is the elevation in blood sugar diagnosed during pregnancy that had not been seen before. During the course of pregnancy, all women should undergo an oral glucose tolerance test (OGTT). This test usually takes place around 28 weeks for women without a history of diabetes, but may take place earlier if there were issues with blood sugar control during a previous pregnancy. If you pass—all is well. If you fail—there is work to be done. What does that work entail? The usual work of diabetes management.

Blood glucose targets during pregnancy are a little tighter than are sometimes recommended in non-pregnant persons. It is desirable to have fasting blood sugar numbers less than 95mg/dL, less than 130mg/dL one hour after meals, and less than 120mg/dL two hours after meals. When you hear these numbers the inevitable panic may set in. How am I going to get to these numbers? What happens if the numbers are higher? Is my baby going to be alright…?

Take a deep breath - in through your nose and out through your mouth. 

Now let’s talk. 

Getting to the desired numbers may be easier than you think. Diet and exercise, and sometimes medication, are the keys to your successful arrival.

Diet

It is recommended that during pregnancy women consume 175 gm of carbohydrate daily. I know what you are thinking—I don’t eat that much food in a day. This amount of carbohydrate is important for the growth and development of a fetus, appropriate weight gain and glycemic control. 

So you can have a decent amount of carbs, but this does not give license to overeat. These carbs must be divided throughout the course of the day—15- 30 grams for breakfast, a 15-gram snack, 30 grams for lunch, a second 15-gram snack, 30 grams for dinner, and a 15- to 30-gram bedtime snack. 

If this whole carbohydrate thing sounds a bit overwhelming, oftentimes the services/assistance of a dietician may be available. Ask your doctor for a referral and check with your insurance provider about coverage.

Exercise

You have heard it often–and it is true–30 minutes of exercise 5 days a week still remains a mainstay during pregnancy. These 150 minutes can be achieved in any combination: 10 minutes after each of the 3 daily meals; 30 minutes before work or anytime during the day Monday-Friday; 45 minutes 3 times a week.

Medications

Medications, including metformin or insulin therapy, may be required if blood sugars are not adequately controlled. For women with a previous diagnosis of type 1 or type 2 diabetes, management of blood sugars will likely require adjusting current medications, but diet and exercise should always be incorporated.

The best ways to manage blood sugar during pregnancy are to take an active interest in your care, develop healthy habits and discuss any concerns that you may have with your health care provider. 

For more information on managing gestational diabetes, see American Diabetes Association: Diabetes Care-Standards of Diabetes Care 2019 and Academy of Nutrition and Dietetics Gestational Diabetes Evidence-Based Nutrition Practice Guideline