Gestational Diabetes Mellitus

What is Gestational Diabetes Mellitus?

Gestational diabetes is a type of diabetes that starts during pregnancy. If you have diabetes, your body isn’t able to use the sugar (glucose) in your blood as well as it should. This causes the level of sugar in your blood to become higher than normal.

Gestational diabetes affects from 1% to 3% of all pregnant women. It usually develops in the second trimester (sometimes as early as the 20th week of pregnancy). Most often, gestational diabetes goes away after the baby is born.

How can gestational diabetes affect me and my baby?

High blood sugar levels can be unhealthy for both you and your baby. If the diabetes isn’t treated, your baby may be more likely to have problems at birth. For example, your baby may have a low blood sugar level, jaundice, or your baby may weigh much more than normal.

Gestational diabetes can also affect your health. For instance, if your baby is very large, you may have a more difficult delivery or you may need a cesarean section. Gestational diabetes also increases your risk of developing preeclampsia, which is a condition that can be serious if left untreated.

Diagnosis & Tests

What tests will I need to have during my pregnancy?

Your doctor will ask you to have regular blood tests to check your blood sugar level. These tests will let your doctor know if your diet and exercise are keeping your blood sugar level normal. A normal blood sugar level is less than 105 mg per dL when you haven’t eaten for a number of hours before the test (fasting) and less than 120 mg per dL 2 hours after a meal.

Treatment

What can I do if I have gestational diabetes?

You will need to follow a diet suggested by your doctor, exercise regularly and have frequent blood tests to check your blood sugar level. You may also need to take a medicine called insulin to control your blood sugar level.

You may be asked to see a specialist if you have to start taking insulin.

What changes should I make in my diet?

Your doctor may ask you to change some of the foods you eat and see a registered dietitian to help you plan your meals. It’s important to eat well-balanced meals. You may need to eat less at each meal, depending on how much weight you gain during your pregnancy. Your doctor or dietitian will talk to you about this.

Avoid eating foods that contain a lot of simple sugar, such as cake, cookies, candy or ice cream. Instead, eat foods that contain natural sugars, such as fruits.

If you get hungry between meals, eat foods that are healthy for you, such as raisins, carrot sticks or a piece of fruit. Whole-grain pasta, whole-grain breads and rice are also good for both you and your baby.

Why is exercise important?

Your doctor will suggest that you exercise regularly at a level that is safe for you and the baby. Exercise will help keep your blood sugar level normal, and it can also make you feel better. Walking is usually the easiest type of exercise when you are pregnant, but swimming or other exercises you enjoy are also beneficial. Ask your doctor to recommend some activities that would be safe for you.

If you’re not used to exercising, begin by exercising for 5 or 10 minutes every day. As you get stronger, you can increase your exercise time to 30 minutes or more per session. The longer you exercise and the more often you exercise, the more in control you will be of your blood sugar.

You do need to be careful about how you exercise. Don’t exercise too hard or get too hot while exercising. Ask your doctor what activities are safe for you. Depending on your age, your pulse shouldn’t go higher than 140 to 160 beats per minute during exercise. If you become dizzy or have back pain or other pain while exercising, stop exercising immediately and call your doctor. If you have uterine contractions (labor pains), vaginal bleeding or your water breaks, call your doctor right away.

What happens after my baby is born?

You may not need to have blood tests to check your blood sugar while you’re in the hospital after your baby is born. However, it may be several weeks after your baby’s birth before your gestational diabetes goes away. To make sure it has gone away, your doctor will ask you to have a special blood test 1 or 2 months after you have your baby.

Even if the gestational diabetes goes away after the baby’s birth, it increases your risk for diabetes in your next pregnancy and also later in life. It is important that you continue to exercise, watch your weight and eat a healthy diet after pregnancy. If you do these things, you may avoid diabetes when you’re older.

Questions to Ask Your Doctor

• I’m pregnant. Am I at risk for gestational diabetes?
• Is screening for gestational diabetes a standard part of my prenatal care?
• What tests do I need?
• Does gestational diabetes put my baby at risk for any health problems?
• Can I control gestational diabetes through lifestyle changes alone?
• What changes should I make to my diet and exercise?
• Will I need insulin? For how long?
• What follow-up tests or care will I need after I deliver my baby?

Gestational Diabetes Mellitus, Diagnosis

Gestational diabetes (gestational diabetes mellitus) is a short-term (temporary) form of diabetes that can happen during pregnancy. It goes away after you give birth. It may be caused by one or both of these problems:

• Your pancreas does not make enough of a hormone called insulin.
• Your body does not respond in a normal way to insulin that it makes.

Insulin lets sugars (glucose) go into cells in the body. This gives you energy. If you have diabetes, sugars cannot get into cells. This causes high blood sugar (hyperglycemia).

If you get gestational diabetes, you are:

• More likely to get it if you get pregnant again.
• More likely to develop type 2 diabetes in the future.

If gestational diabetes is treated, it may not hurt you or your baby. Your doctor will set treatment goals for you. In general, you should have these blood sugar levels:

• After not eating for a long time (fasting): 95 mg/dL (5.3 mmol/L).
• After meals (postprandial):
  • One hour after a meal: at or below 140 mg/dL (7.8 mmol/L).
  • Two hours after a meal: at or below 120 mg/dL (6.7 mmol/L).
• A1c (hemoglobin A1c) level: 6–6.5%.

Follow these instructions at home:

Questions to ask your doctor

You may want to ask these questions:

• Do I need to meet with a diabetes educator?
• What equipment will I need to care for myself at home?
• What medicines do I need? When should I take them?
• How often do I need to check my blood sugar?
• What number can I call if I have questions?
• When is my next doctor’s visit?

General instructions

• Take over-the-counter and prescription medicines only as told by your doctor.
• Stay at a healthy weight during pregnancy.
• Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

• Your blood sugar is at or above 240 mg/dL (13.3 mmol/L).
• Your blood sugar is at or above 200 mg/dL (11.1 mmol/L) and you have ketones in your pee (urine).
• You have been sick or have had a fever for 2 days or more and you are not getting better.
• You have any of these problems for more than 6 hours:
  • You cannot eat or drink.
  • You feel sick to your stomach (nauseous).
  • You throw up (vomit).
  • You have watery poop (diarrhea).

Get help right away if:

• Your blood sugar is lower than 54 mg/dL (3 mmol/L).
• You get confused.
• You have trouble:
  • Thinking clearly.
  • Breathing.
• Your baby moves less than normal.
• You have any of these:
  • Moderate or large ketone levels in your pee.
  • Blood coming from your vagina.
  • Unusual fluid coming from your vagina.
  • Early contractions. These may feel like tightness in your belly.

Summary

• Gestational diabetes is a short-term form of diabetes. It can happen while you are pregnant. It goes away after you give birth.
• If gestational diabetes is treated, it may not hurt you or your baby. Your doctor will set treatment goals for you.
• Keep all follow-up visits as told by your doctor. This is important.

Gestational Diabetes Mellitus, Self Care

When you have gestational diabetes (gestational diabetes mellitus), you must make sure your blood sugar (glucose) stays in a healthy range. You can do this with:

• Nutrition.
• Exercise.
• Lifestyle changes.
• Medicines or insulin, if needed.
• Support from your doctors and others.

If you get treated for this condition, it may not hurt you or your unborn baby (fetus). If you do not get treated for this condition, it may cause problems that can hurt you or your unborn baby.

If you get gestational diabetes, you are:

• More likely to get it if you get pregnant again.
• More likely to develop type 2 diabetes in the future.

How to stay aware of blood sugar

• Check your blood sugar every day while you are pregnant. Check it as often as told.
• Call your doctor if your blood sugar is above your goal numbers for two tests in a row.

Your doctor will set personal treatment goals for you. Generally, you should have these blood sugar levels:

• Before meals, or after not eating for a long time (fastingor preprandial): at or below 95 mg/dL (5.3 mmol/L).
• After meals (postprandial):
  • One hour after a meal: at or below 140 mg/dL (7.8 mmol/L).
  • Two hours after a meal: at or below 120 mg/dL (6.7 mmol/L).
• A1c (hemoglobin A1c) level: 6–6.5%.

How to manage high and low blood sugar

Signs of high blood sugar

High blood sugar is called hyperglycemia. Know the early signs of high blood sugar. Signs may include:

• Feeling:
  • Thirsty.
  • Hungry.
  • Very tired.
• Needing to pee (urinate) more than usual.
• Blurry vision.

Signs of low blood sugar

Low blood sugar is called hypoglycemia. This is when blood sugar is at or below 70 mg/dL (3.9 mmol/L). Signs may include:

• Feeling:
  • Hungry.
  • Worried or nervous (anxious).
  • Sweaty and clammy.
  • Confused.
  • Dizzy.
  • Sleepy.
  • Sick to your stomach (nauseous).
• Having:
  • A fast heartbeat.
  • A headache.
  • A change in your vision.
  • Tingling or no feeling (numbness) around your mouth, lips, or tongue.
  • Jerky movements that you cannot control (seizure).
• Having trouble with:
  • Moving (coordination).
  • Sleeping.
  • Passing out (fainting).
  • Getting upset easily (irritability).

Treating low blood sugar

To treat low blood sugar, eat or drink something sugary right away. If you can think clearly and swallow safely, follow the 15:15 rule:

• Take 15 grams of a fast-acting carb (carbohydrate).Some fast-acting carbs are:
  • 1 tube of glucose gel.
  • 3 sugar tablets (glucose pills).
  • 6–8 pieces of hard candy.
  • 4 oz (120 mL) of fruit juice.
  • 4 oz (120 mL) of regular ( notdiet) soda.
• Check your blood sugar 15 minutes after you take the carb.
• If your blood sugar is still at or below 70 mg/dL (3.9 mmol/L), take 15 grams of a carb again.
• If your blood sugar does not go above 70 mg/dL (3.9 mmol/L) after 3 tries, get help right away.
• After your blood sugar goes back to normal, eat a meal or a snack within 1 hour.

Treating very low blood sugar

If your blood sugar is at or below 54 mg/dL (3 mmol/L), you have very low blood sugar (severe hypoglycemia). This is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

If you have very low blood sugar and you cannot eat or drink, you may need a glucagon shot (injection). A family member or friend should learn how to check your blood sugar and how to give you a glucagon shot. Ask your doctor if you need to have a glucagon shot kit at home.

Follow these instructions at home:

Medicine

• Take your insulin and diabetes medicines as told.
• If your doctor says you should take more or less insulin or medicines, do this exactly as told.
• Do notrun out of insulin or medicines.

Food

• Make healthy food choices. These include:
  • Chicken, fish, egg whites, and beans.
  • Oats, whole wheat, bulgur, brown rice, quinoa, and millet.
  • Fresh fruits and vegetables.
  • Low-fat dairy products.
  • Nuts, avocado, olive oil, and canola oil.
• Meet with a food specialist (dietitian). He or she can help you make an eating plan that is right for you.
• Follow instructions from your doctor about what you cannot eat or drink.
• Drink enough fluid to keep your pee (urine) pale yellow.
• Eat healthy snacks between healthy meals.
• Keep track of carbs that you eat. Do this by reading food labels and learning food serving sizes.

Follow your sick day plan when you cannot eat or drink normally. Make this plan with your doctor so it is ready to use.

Activity

• Exercise for 30 or more minutes a day, or as much as your doctor recommends.
• Talk with your doctor before you start a new exercise or activity. Your doctor may need to tell you to change:
  • How much insulin or medicines you take.
  • How much food you eat.

Lifestyle

• Do notdrink alcohol.
• Do notuse any tobacco products. These include cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your doctor.
• Learn how to deal with stress. If you need help with this, ask your doctor.

Body care

• Stay up to date with your shots (immunizations).
• Brush your teeth and gums two times a day. Floss one or more times a day.
• Go to the dentist one or more times every 6 months.
• Stay at a healthy weight while you are pregnant.

General instructions

• Take over-the-counter and prescription medicines only as told by your doctor.
• Ask your doctor about risks of high blood pressure in pregnancy (preeclampsia and eclampsia).
• Share your diabetes care plan with:
  • Your work or school.
  • People you live with.
• Check your pee for ketones:
  • When you are sick.
  • As told by your doctor.
• Carry a card or wear jewelry that says you have diabetes.
• Keep all follow-up visits as told by your doctor. This is important.

Care after giving birth

• Have your blood sugar checked 4–12 weeks after you give birth.
• Get checked for diabetes one or more times during 3 years.

Questions to ask your doctor

• Do I need to meet with a diabetes educator?
• Where can I find a support group for people with gestational diabetes?

Where to find more information

To learn more about diabetes, visit:

• American Diabetes Association: www.diabetes.org
• Centers for Disease Control and Prevention (CDC): www.cdc.gov

Summary

• Check your blood sugar (glucose) every day while you are pregnant. Check it as often as told.
• Take your insulin and diabetes medicines as told.
• Keep all follow-up visits as told by your doctor. This is important.
• Have your blood sugar checked 4–12 weeks after you give birth.