| Let's Talk About... |
| Insulin Resistance and Gestational Diabetes |
| http://home.comcast.net/~creationsunltd/aboutgdm.htm |
What is it? Some women get diabetes (di-uh-b-tees) when pregnant. This is called gestational (jes-ta-shun-ull) diabetes mellitus (GDM). This is a form of carbohydrate intolerance, or inability to process carbohydrates efficiently. GDM is most often seen the second half of pregnancy, and usually goes away after your baby is born. Over 50 % of women develop Type 2 diabetes in the years following their pregnancy, unless they make specific lifestyle choices that can help them prevent the development of diabetes later in life. |
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| Insulin resistance is a condition that many women with gestational diabetes have. Insulin resistance is when your cells do not utilize insulin, and actually over time resist insulin, while insulin is trying to help glucose enter your cells. Eventually, more insulin is produced. Glucose is forced into muscles and adipose tissues, thus contributing to obesity and weight gain. Your pancreas works overtime trying to make enough insulin to meet your body's needs. Eventually an individual can develop Type 2 diabetes, one of two major forms of diabetes. Diabetes is when your body has difficulty using sugar and making insulin (in-suh-lun). Insulin resistance can occur up to ten years before diabetes is diagnosed, and with dietary and lifestyle changes, it appears insulin resistance can be improved and diabetes can be prevented or improved. | |||||||||||||||||||||||||
| Much of what you eat and drink is changed into sugar (glucose). Sugar gives us energy, and therefore has value for us. With diabetes, you do not make enough insulin or the insulin does not work efficiently. Sugar builds up in the blood without insulin to facilitate its use in your body. Once the screening tests tell us you have gestational diabetes the goal for the remainder of the pregnancy is to keep your blood sugar within a normal range. It is very important for your baby to have the right amount of sugar. Too high or too low sugar levels can affect your baby and how he/she grows and develops. Too high a sugar level, or too low a sugar level can affect the cells and tissues of your body, exhaust your body's hormone systems. Consistently high blood sugar levels can affect mental functions and eyes. The goal of management during pregnancy is to help keep your blood sugar at a lower level to prevent further complications such as macrosomia or a large infant at birth. Keeping your blood sugar normal also helps to prevent other complications caused by a too high blood sugar. | |||||||||||||||||||||||||
Common contributing factors to GDM: Gestational diabetes is caused by the hormones made by the placenta (pluh-sen-tuh). The placenta is the organ in your uterus that connects you to your baby. It is also called "afterbirth" and produces hormones that help your baby to grow and develop. In some women these hormones may change the way insulin works. You may be more likely to get gestational diabetes if you are over 30 years old, have abdominal body fat, or a high body mass index (BMI). Overweight women commonly develop diabetes during pregnancy. How to determine your Body Mass Index: http://nutrition.ucdavis.edu/www/bmi.htm |
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| A large baby (weighing > 9# at birth) is commonly seen in women who develop gestational diabetes. A previous stillbirth (a baby that has died before birth) or having family members with diabetes might contribute to you developing GDM. A history of PolyCystic Ovarian Syndrome (PCOS) might also contribute to the development of GDM. | |||||||||||||||||||||||||
| Pregnancy is similar to diabetes, because the hormones that lead to fetal growth and development do so my mobilizing your nutritional resources, primarily glucose (sugar) and making them available to your baby. Insulin sensitivity decreases in the last trimester of pregnancy, and glucose levels are higher, even with higher insulin levels. So, the increased mobilization of glucose and the decreased sensitivity to insulin places some women at risk of developing diabetes. It is thought that women who develop diabetes secrete less insulin to deal with this additional sugar load. Approximately 4 % of pregnant women develop GDM (gestational diabetes mellitus). | |||||||||||||||||||||||||
Common signs and symptoms: You may be very tired, thirsty, hungry, or urinate (pee) often. Blurred vision may be another sign. Your baby may have too much fluid around him/her while you are pregnant. You may have a lot of weight early in your pregnancy, or have a desire for more sugar, or eat more carbohydrates. There may be no observable signs that you have gestational diabetes. Sometimes GDM is only determined by a blood test and specific screening done by your health care provider |
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What you can do to help keep your blood sugar within normal ranges: Carefully watch the foods you eat during your pregnancy. Make healthy choices of foods, as encouraged by your health care provider. Exercise of some sort seems to help your body process insulin and glucose more efficiently. Even walking for 30 minutes a day can be beneficial. Your provider might ask you to check your urine for sugar, and even do self finger sticks to check your sugars. You will be encouraged to follow a specific diet, and your provider will want to check your blood sugars every few weeks to be sure they are staying within a normal range for you. It is important you eat frequently, but make healthy food choices. After your pregnancy, continue with the healthy food choices you have made, and ask for an annual test of your blood sugar to be sure it is staying within a normal range. Learn more about your pregnancy and gestational diabetes. You are the one that can make choices about how to care for yourself. Ask your caregiver any questions you have about your care. |
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| Discuss your treatment options with your health care provider. Work with him/her to decide which approach can be used to treat your gestational diabetes. Do some research yourself about the condition, and make learn more about the effects of diabetes. Your provider might also have you see a nutritionist who can help you make healthy food choices. You always have the right to refuse treatment, but you need to understand GDM and diabetes so that you can make informed choices about your care. | |||||||||||||||||||||||||
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Pat Sonnenstuhl, ARNP, CNM webmidwife1@comcast.net |
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| GDM, Insulin Resistance and Healthy Eating Handouts | |||||||||||||||||||||||||
| http://home.comcast.net/~creationsunltd/overview.htm | |||||||||||||||||||||||||
| Pregnancy Information | |||||||||||||||||||||||||
| http://home.comcast.net/~webmidwife1/preginfo.htm | |||||||||||||||||||||||||
| Creations Unlimited | |||||||||||||||||||||||||
| http://home.comcast.net/~creationsunltd/ |