Gestational Diabetes

Gestational Diabetes affects around 1 in 20 pregnant women and is diagnosed between 24 and 28 weeks. In most cases, it can be controlled with diet and exercise and goes away after the baby is born. I asked Jenny to tell us about her experience with Gestational Diabetes

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Even as a nurse myself, and feeling I was pretty well informed, it wasn’t until I was 28wks pregnant that I heard of gestational diabetes (GDM), it’s really worrying to first hear of a condition as it’s suspected and especially in pregnancy.

GDM is a condition where the hormones produced during pregnancy stop insulin working properly and so the amount of glucose in your blood is too high and action is required to keep it within normal limits (more info here: http://www.nhs.uk/conditions/gestational-diabetes/Pages/Introduction.aspx)

Unlike many, the glucose tolerance test didn’t bother me (taking swigs of near soda stream concentrate was a rare guilty pleasure so it actually made me feel nostalgic!) and I bumped into a pregnant friend there who fitted the picture of a GDM pregnancy – bump measuring big, and huffing and puffing about in the summer heat, while I’d had ongoing worries about how tiny my bump was.

Low and behold, the results came back and my friend was clear and I was the one that had it… suddenly worry, guilt and tears all came at once along with a v steep learning curve. Here’s a list of my key learning points:

  • speedy advice and support from dietician/specialist nurses/midwives all helped hugely, but still found walking round the supermarket trying to work out what to buy for the next few days was overwhelming.
  • You have to get use to pricking your fingers I was having to test my blood sugar level four times a day – pre and 1hr post breakfast, an hour post lunch and an hour post tea with the aim of the readings being between 3-7mmols/litre of sugar in my blood.
  • The monitors are very easy to navigate and it was noticeable in the 3yrs between my pregnancies how they became even more effective meaning less blood was required – I alternated fingers working from    left hand to right using each side of finger to ensure they didn’t get sore.
  • The advice around food varies from person to person as everyone is at a different starting point with what their typical diet is (so how big a change is required) and how strong their insulin intolerance is.
  • Most important advice was Not to avoid carbs…they’re essential, but read up the labels and carefully consider carb/sugar ratio – the higher the actual sugar level the less you can have.
  • Morning = high hormone levels & lowest tolerance of carbs. V low/no carb brekkie could be (after 1hr post blood sugar) followed by a cereal bar
  • Carb tolerance varies from person to person – I could do small portions of pasta but rice was really tricky. I tried to have around 15g carbs in the morning (breakfast & snack), 20-30g with lunch & 30-40g with my tea (sometimes split between a pm snack too).
  • Berries and cream after the last blood sugar of the day = equally life saving if you normally live by your sweet tooth!
  • A half hour walk after lunch helped with lowering sugar -ensuring I was active every day was much easier first pregnancy!
  • Mumsnet typically have an active GDM thread – often running to 100’s of posts, but worth reading through as can over an hour read a few women’s posts from diagnosis to birth!
  • If you have a high reading, jot down what you ate/portion size to help you suss out where you went wrong. One high reading wont = insulin/meds, but a pattern of poor control will mean they need into give you more support or that you do need medication to ensure you can continue a healthy diet inc carbs.
  • Got really stressed about eating out – but being sensible with choices (no pizza/pasta/Wagamamas!) meant my sugars were often at their best after these meals (Ooo, and making it walking distance = exercise pre-reading!)
  • GDM doesn’t mean a big baby. very few are macrosomal (medical term for big) but seems the only thing many people claim to know about it. Even had a senior Paeds Dr say this to me when I was diagnosed, even though my bump was measuring small – at full term my daughter weighed 2.1kg (4lbs 10oz).
  • If induction is talked about, ask for evidence/reasons around risks… “that’s what we do” shouldn’t be reason enough and doesn’t help you make an informed choice.
  • Read up on and undertake colostrum harvesting (https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/video/hand-expression/). Babies of GDM mum’s are likely to experience low blood sugars (hypoglycaemia), so having a few syringes of this can help boost their sugars when needed, give you skills to hand express a bit of milk to encourage them to latch/establish breastfeeding. I wasn’t shown how to do this and it’s only now having had much more training on breastfeeding that I realise how important this is.
  • Don’t lie to your team…your lab blood sugar (HbA1c) will show if your control has been bad and your urine will have ketones if you’ve not had enough carbs – they will know, best to have an honest discussion!
  • Don’t let it stop you enjoying the pregnancy- yes some mindfulness and care are required, and yes you may have even more unsolicited advice thrown at you (nod, smile and work out of worth trying/considering or throwing in your brains trash can!), but you’re still doing the most amazing thing and it will be over as soon as baby is born.
  • …dreaming of naughty treats (Big Macs/chips/choc brownies) are great visualisations/motivations for labour…just imagine during contractions each strong breath is inflating a brownie!!

Fingers crossed it won’t be something you experience, but if you do I hope this has been useful.