Managing Gestational Diabetes
Towards the end of your second trimester (24-28 weeks) you may be offered a glucose tolerance test to find out if you have gestational diabetes or not. In the UK, screening is offered if you fall into a certain ‘risk’ category. In other countries all pregnancies will be screened for gestational diabetes. Symptoms of gestational diabetes (GD) include thirst, frequent peeing and tiredness. Don’t you think these symptoms sound very similar to someone in their late 2nd or third trimester?
Gestational diabetes is a complication of pregnancy that can
- increase baby’s growth (macrosomia) which may affect birth outcomes
- increase blood pressure leading to early interventions
- increase baby’s chances of diabetes later on in life
What is Gestational Diabetes?
The NHS have a simple definition of gestational diabetes: “Gestational Diabetes is high blood sugar that develops through pregnancy and usually disappears after giving birth.”
According to the NIH (National Institutes of Health), they define it as follows: ‘Gestational diabetes is diabetes diagnosed for the first time during pregnancy. Diabetes is a medical condition in which the body either does not make enough insulin or cannot use insulin correctly. Insulin is a hormone that is necessary for providing cells with energy to function. Insulin helps sugar (glucose) move from the bloodstream into the cells. When glucose cannot enter the cells, it builds up in the blood (hyperglycemia)’
Oftentimes having a diabetes test may be the first time a woman has this test, and could have had type 2 diabetes for years without even realising it. If your insulin levels have not returned to normal postnatally, then it can be assumed you had undiagnosed type 2 diabetes.
If you would like a more in-depth understanding of gestational diabetes (GD), The Midwives Cauldron have 2 outstanding podcasts that are easy to listen to and understand. Listen here for gestational diabetes from the pregnancy perspective and here for understanding gestational diabetes from the baby’s perspective.
What Causes Gestational Diabetes?
The short answer is we don’t know what causes GD! Our hormonal system works exceptionally hard to maintain our blood sugar levels, especially after eating a sugar or carbohydrate rich meal. However, a woman’s metabolism changes during pregnancy making it more demanding to control and correct blood sugar levels. The placenta is thought to be responsible for the increased resistance to insulin which may lead one to wonder if there is a natural insulin resistance, maybe it’s there for a reason.
Am I at Risk of Gestational Diabetes?
Researchers don’t have an answer as to why some woman get gestational diabetes and others don’t, but there may be some contributing factors:
- Excess weight
- Low activity levels
- Close family history
- Ethnicity (South Asian, Black, African-Caribbean, Middle Eastern)
- Previous GD
- Baby weighing more than 10 lbs (4.5 kg)
- High BMI*
*If you have been labeled with a high BMI, I highly recommend investing in Dr Sara Wickham’s book, ‘Plus Size Pregnancy” for a balanced, evidence based look at the issues, assumptions and science behind BMI and pregnancy. It’s an empowering and liberating read.
How Does Gestational Diabetes Affect my Baby?
Your unborn baby gets more energy than he/she needs to grow and develop. As with all humans any extra energy in the body will be stored as fat. Macrosomia is the term given to a big baby who is over 8 lbs 13 oz (4 kg). The problem with a big baby is that there is a slight increase in baby’s shoulders becoming stuck (shoulder dystocia) during the birth process. Doctors and midwives will know how to manage shoulder dystocia by changing the mother’s position. It’s also important to realise shoulder dystocia doesn’t only happen with suspected big babies, smaller babies can also experience this complication. From what I have personally seen and explored is that baby is often in a sub-optimal position, and/or the mum has been labouring on her back, restricting the movement of the sacrum. 94% of large babies do not have this shoulder dystocia BUT, and this is a big but, measuring babies is not a very accurate science- up to 15% difference either way. The most accurate way to measure the weight of a baby is to weigh it once it is born.
A baby born to a mother with uncontrolled gestational diabetes may have low blood sugar levels at birth. There is also an increased risk of jaundice developing along with breathing problems, especially if baby was born too early. These complications would likely prevent an uninterrupted golden hour with baby needing testing and monitoring. Later in life there is an increased chance of developing diabetes.
Do I have to have an Induction if I Have Gestational Diabetes?
Many women will be told they have to have an early induction. I have even heard of medical professionals telling women they need an early induction as the rate of stillbirth increases. Miscarriage and stillbirth can tragically happen in any pregnancy, and the rates with gestational diabetes is still extremely low – 5.7 in 1000 – that’s 0.57%. However, if you had to ask for evidence proving the benefits of an early induction, there would be none as research shows no improved outcomes.
Any treatment plans should be an offer not an order or command. The choice should always be yours to make. (Read Take Control of YOUR Birth to help you make informed choices) At the end of the day, you are the one who will be living with your choices and outcomes. You may see the risk as really small, and happy to decline an induction (or any intervention), or you may think that risk is too high for you and decide to proceed with the recommended plan of action.
If you have been diagnosed with GD, and have managed to control your blood sugar levels, your risks of complications reduces considerably.
Can I Reverse Gestational Diabetes?
Gestational diabetes cannot be reversed, but it can be managed through diet and exercise during pregnancy. I do want to clarify that GESTATIONAL DIABETES IS NOT YOUR FAULT!! It is not caused by poor eating or being overweight, but by your placenta increasing resistance to insulin. You may have certain risk factors, but that doesn’t necessarily mean you will develop gestational diabetes. A woman with no risk factors may develop gestational diabetes too – in fact 25-50% cases occur in women with no risk factors.
Eating Strategies for Gestational Diabetes
Eating for Gestational Diabetes
Receiving a GD diagnosis can be very stressful and confusing. If you have been to the diabetes clinic you may have been advised on how many carbohydrates to consume in a day, though not know how to actually count those out. Maybe you think you'll just cut out all carbs from your diet and you'll be fine. But what about hidden sugars? How do you make meals that won't spike your blood sugar levels? If you remove the carbs how do you deal with the hunger?How do you even read food labels and make good choices?
Tracking blood sugar by trial and error
After eating your meal, blood sugar readings will you give you a good indication what foods are better for your unique body, and which foods are less helpful. For example some people find eating any type of fruit spikes their blood sugar, while others can manage low GI fruit (berries,citrus,melon).
Notice how sleep and exercise affect you. Does sleeping 8 hours help more than 7 hours? What about walking after a meal-or is exercising before a meal more helpful?
Also, how does stress impact you and your blood sugar levels. Keeping a journal and noting down these small changes may play a bigger role than you thought.
Prioritising vegetables, protein & fat
Any carbohydrates in non-starchy veggies will be mostly fibre and will help to maintain blood sugar levels. Try shifting your focus from a carb rich meal to a protein rich meal eg Pasta bake ~ roast chicken, broccoli, red cabbage and sweet potato
Adding a protein and fat at each meal will also stabilise blood sugars as well as give you and your baby the necessary calories and essential micro-nutrients.
Look for hidden sugars
Become a master of reading food labels. The ingredient list can show hidden sugars in ingredients like: glucose, fructose, concentrated fruit juice, molasses, corn syrup, sugar, maltodextrin, dextrose, maltose, lactose etc. Cereals and sauces are exceptionally high in sugars.
Be aware that the more refined a food, the more fibre has been removed to make it quicker and/or easier to cook. When you see oats, you think it’s a healthy alternative to cereal. Steel-cut/pinhead oats are long cooking, high in fibre. Rolled oats have slightly less fibre and are quicker to cook. Instant packet oats have pretty much all fibre removed with added sugar to compensate for the lack of flavour.
Fruit juices can also be thought of as a healthy option, especially when compared to sodas. A small glass of orange juice could be equivalent to 5 oranges. Mother nature has made an orange just right for your body. The fibre in an orange will make you feel full just after one, but with the oj, the fibre is removed, and sugars will causes havoc with your blood sugar levels.
Give Carbs a friend
Including protein and/or a fat with carbohydrates will slow down the release of sugar into your bloodstream.
You can also consider:
- lowering the amount of carbs you eat and increase veg and protein
- having a carb free meal at dinner to help that fasting blood sugar
- eating carbs last
- substituting simple carbohydrates (white bread, rice, pasta) with complex carbs like quinoa, brown/wild rice, lentil pastas; or veggies (think zoodles, cauliflower rice)
Blood sugar balancing breakfast
Morning blood sugar levels can be the hardest reading to control. Swapping out a carbohydrate rich breakfast for a savory, protein rich alternative can help control high blood sugar levels.
Breakfast
Controlling fasting blood sugars may be the most difficult to control. There is a surge of placental hormones flowing through your body in the early hours of the morning making your body more resistant to insulin. Waking with a high blood sugar and then eating a high carbohydrate breakfast makes it even more tricky to lower.
Opt for:
- a low carbohydrate breakfast: eg. yoghurt,nuts and seed, low GI fruit
- a savory breakfast: eg. eggs, sausage, turkey bacon, fried tomatoes
- adjusting your normal breakfast: eg. 2 slices of toast with peanut butter and jam. Adjust: 1 slice of sourdough toast with poached egg
Snacks
Snacks are important to prevent you getting hungry and to maintain your blood sugar levels. Food prep can truly help so you don’t reach for the biscuit tin.
Low Carb snack: Combine with high protein and fat eg. hard boiled egg, cucumber, cheese, hummus, melon
Medium carb snack: with protein and fat. This snack is best eaten when blood sugars are low. eg. cheese and crackers; muffin with mixed nuts; apple and nut butter
Late night snack: This is a fantastic snack to add if you wake with high blood sugars. Eat your snack within an hour of going to sleep to prevent more than 10 hours of no food:
- yoghurt, seeds, berries
- veggie with dip
- roasted chickpeas
- hard boiled egg
- dark chocolate and nuts
- cinnamon and chia seed pudding
- left over dinner
Other Nutritional Considerations
There are other factors that are worth considering too:
- Gut microbiome: Probiotics and eating probiotic rich foods play a role in influencing the metabolism of pregnancy hormones. Research is coming out showing that probiotics have marked improvement on insulin sensitivity, oxidative stress, triglycerides and inflammatory markers. Eating gut supporting foods, and taking a probiotic if needed could help in controlling GD. Examples of foods to support the gut: fermented foods like kimchi, sauerkraut; bone broths, chia seeds
- Vitamin D: New evidence is emerging that women who have insufficient levels of Vit D have a higher risk of developing GD. Those women who take vitamin D supplements in their first and second trimester had better outcomes with their glucose tolerance test (GTT) and better blood sugar management. Most people are deficient in Vit D. Those living in hot climates protect their skin and eyes from the sun, while those of us living in cooler countries don’t get enough sunshine. Supplementing with Vit D3 and eating fatty fish, dairy, fortified foods helps.
- Magnesium: Most of us are deficient in this incredible micro nutrient. Randomised control trial studies have shown supplementing with magnesium reduces fasting glucose levels and insulin levels, as well as improved oxidative stress markers. Foods high in magnesium include dark leafy greens, dark chocolate, seeds and nuts. Think peanut butter and dark chocolate together-heaven!
- Insulin Reducing Supplements: Cinnamon is known to help stabilise insulin levels by reducing insulin resistance and increasing insulin sensitivity. Cinnamon can be added to porridge, soups, lattes, vegetables, broths which adds depth of flavour, aroma and is very warming. Apple cider vinegar stabilises blood sugar levels and can be incorporated in salad dressings, taken as a shot first thing in the morning before eating any foods.
