gestational diabetes

I Failed My Glucose Test-Understanding Gestational Diabetes

Before you proceed, please understand that this article does not replace the advice and direction of your provider. It is important to speak with your provider about any problems or concerns that you may have.

With 10% of all U.S pregnancies developing gestational diabetes (GDM), it’s no surprise that mamas have lots of questions on the subject. Even if this is your third time being pregnant and you’ve developed GDM before, you still may have questions and concerns. With the many pamphlets you’ll get handed, and medical jargon thrown, you’re probably thinking, “WTH is going on right now? What does this all mean?” Here, you’ll get plenty of information and resources to understanding gestational diabetes. Let’s break it down.

Diabetes… What is it?

Diabetes is a chronic (this means it lasts a long time ya’ll. Like 3 months or more) condition where your body is unable to make enough insulin to turn the glucose (sugar) from your food, into energy. When this happens, this extra sugar, that was unable to be broken down, builds up in your bloodstream. 

(Centers for Disease Control and Prevention, 2020) 

There are different types of diabetes, but the 3 most common types are: Type 1 diabetes, Type 2 diabetes, and Gestational diabetes.

Type 1: This type of diabetes is when the pancreas either doesn’t make any insulin or it barely makes any at all. In this instance the body can’t use the blood sugar for energy. For type 1 diabetes, insulin medication is needed.

Type 2 diabetes: This is the most common form. With type 2 diabetes, the body is able to produce insulin, but it doesn’t use it properly. Your pancreas goes into overdrive trying to make more insulin but is unable to keep up with the demand. This is insulin resistance. This type of diabetes can be controlled with diet and exercise, but in some instances, insulin is needed (Centers for Disease Control and Prevention, 2020).

In this article, we’ll be focusing on understanding Gestational Diabetes (GDM). I’ll start with what it is.

What is Gestational Diabetes?

Gestational Diabetes is a type of diabetes that develops in pregnant women who don’t already have diabetes. During pregnancy, the insulin that the body produces is not able to convert the blood glucose (sugar) into energy. This causes the mother to have high blood sugar and unfortunately can cause other issues within the pregnancy. Almost 10% of all pregnancies in the United States are affected by gestational diabetes. So here me when I tell you, you are not alone!
So what does this mean for you and your pregnancy? Let’s answer a few frequently asked questions. Soon, you’ll be on your way to understanding GDM and how to manage it.

Understanding gestational diabetes

Why did this happen? Did I do something to cause this?

Mama, please do not blame this on yourself. In pregnancy, all women have some form of insulin resistance, but it usually doesn’t happen until late pregnancy. For some women, they have insulin resistance before they get pregnant. I’ll break it down: Insulin is a hormone. When you get pregnant, the placenta produces a hormone in your body that tries to interfere with insulin’s job. In most cases, insulin starts working harder and can produce enough to manage your blood sugar and keep it at a normal level. Unfortunately, for that 10% (like me) it just can’t compete, and in turn, cannot use the insulin effectively to control your blood sugars. This leads to gestational diabetes (Johns Hopkins Medicine, 2020).

How do I know if I have gestational diabetes?

Gestational diabetes usually shows its sneaky head later in pregnancy around 24 weeks gestation. Your obstetrician–gynecologist (OBGYN) will test your blood sugar between 24-28 weeks, as well as get a full medical history. So what is the test like, you ask? Imagine that someone made a pitcher of Kool-aid and used an entire bag of sugar, and you were asked to drink a cup of it 🤢. It is then followed by blood work(Ladies, go for the lemon-lime flavor. Trust me).

Glucose Screening Test (1 hour Glucose Test)

The mother is asked to drink glucose (that awfully made kool-aid I mentioned) and then waits one hour in the office for blood to be drawn. The purpose of this test is to evaluate how your body processes sugar. For this test, you do not need to fast before coming in. A normal result would be 140 mg/dL. If your numbers are normal, you do not have gestational diabetes (U.S National Library of Medicine, 2018).

Glucose Tolerance Test (3 hour Glucose Test)

This test is needed if you failed your 1 hour glucose test. This test requires that you fast for 8-14 hours before you come in to the office. Your provider will give you instructions on the length of time they want you to fast. Once there, you’ll have your blood drawn to get your fasting blood sugar level. After that you will drink the “kool-aid” and each hour after that for 3 hours you will have your blood drawn again. More than one result being above the parameters is a fail (U.S National Library of Medicine, 2018).

Fasting>95 mg/dL
1 hour>180 mg/dL
2 hour>155 mg/dL
3 hour>140 mg/dL
Note: mg/dL means milligrams per deciliterResults and parameters may differ
(U.S National Library of Medicine, 2018) 

If you’ve had GDM in a prior pregnancy or if you have other risk factors, it is possible that your OBGYN will want to get you tested earlier in your pregnancy.

What does this diagnosis mean? Is it dangerous?

Having gestational diabetes is serious and can be dangerous if not controlled.

Mom

  • Preeclampsia: In some cases, GDM can lead to high blood pressure during your pregnancy. During pregnancy a mom may have protein in her urine. This is most commonly accompanied with swelling of the extremities (hands and feet) that doesn’t go away with rest. Preeclampsia is a serious medical condition that must be monitored closely. It can lead to preterm labor and seizures in the mother.
  • Needed Cesarean section: Babies born to mothers with GDM are usually larger in size, especially around the shoulders. That can lead to not being able to deliver vaginally, as the shoulders will not fit through the birth canal. Although not all mothers that have GDM require a c-section, this is something that needs to be thoroughly discussed with your provider so that you have a happy, healthy, and safe delivery of your newborn.
  • Hypoglycemia: In some cases of GDM, a mother requires insulin and/or other medications throughout her pregnancy to control her blood sugar. If not properly monitored, the blood sugar could get too low, and if not treated quickly, it could become fatal.
  • Also: Heavy bleeding after delivery, severe tears during delivery, and labor difficulties (The American College of Obstetricians and Gynocologists, 2017).

Baby

  • Macrosomia: This is a condition where the baby is remarkably larger than normal. So why does this happen? Well, the baby receives all of is nutrients from the mother’s blood stream via the placenta. If the mother’s blood sugar is high, the baby’s pancreas will begin to produce more insulin to try to use all of the extra glucose. Because there is too much glucose, it is then stored as fat.
    You see, the fetus’s pancreas is already working and creating its own insulin, even if a mom has GDM. With the extra blood sugar and extra insulin, the baby has no other choice than to convert it into fat, which then becomes excessive. Their shoulders are usually bigger, so babies born to mothers with GDM have a higher risk of experiencing birth trauma during a vaginal delivery due to their shoulders.
  • Hypoglycemia: This happens after the baby is born. A nurse will check the newborns blood sugar level after delivery to make sure baby is able to now regulate on their own. Why is this important? If mama had high blood sugars throughout her pregnancy, this would cause the baby’s pancreas to keep producing more insulin. Once delivered, the baby will still have all of the extra insulin in their system, but will no longer have the high blood sugar they were once receiving from mom. The excessive insulin would cause the baby’s blood sugar to become very low. In some cases, if the newborn’s blood sugar is too low, the facility will require them to receive glucose intravenously (by IV).
    Make sure to talk with your provider about the policies in place so that you are informed of what’s happening if it should come to that. In many cases skin to skin immediately after birth and breastfeeding will help to raise the newborn’s blood sugar just fine so no other measures need to be taken. If your baby does require some form of supplement, and you would rather they not receive formula, ask what your options are. If you colostrum hasn’t come it yet, ask if human milk supplementation is possible. Regardless, be informed of your options so that you’re not stressed all at once trying to figure things out.
Understanding gestational diabetes

How do I manage this?

With the diagnosis of GDM you will be seeing your provider more frequently to help monitor your baby’s health and growth. They will also be monitoring your blood sugar. Here are a few things to expect:

More frequent doctor visits: You may or may not be referred to Maternal Fetal Medicine (MFM). This is a high risk provider. Regardless of who you see, expect to come in to the office more often for ultrasounds to monitor the baby’s growth.

Understanding gestational diabetes

You will have to monitor your blood sugar throughout your pregnancy by testing your sugar levels daily. Expect to meet with a Diabetes Educator to talk to you about monitoring your sugar levels and eating a diet low in carbs to help keep your levels within a normal range. For many, diet and exercise will be the key to maintaining normal blood sugar levels in your pregnancy. For some, you may need to take medication to help maintain normal blood sugar levels. Don’t worry, you and your provider will go over all of your options.

Is there any way I can prevent this?

There are a few things you can do before you get pregnant, to help prevent gestational diabetes. If you are overweight, it’s a good idea to start some form of regular physical activity and lose weight before you get pregnant.

Do NOT try to lose weight once you are pregnant. You’re expected to gain a good amount of weight during your pregnancy. Discuss with your provider, about ways to exercise safely to maintain a healthy weight.

understanding gestational diabetes

If I have gestational diabetes, does this mean I’ll always have diabetes?

Gestational diabetes does not mean you have type 1 or type 2 diabetes. It also doesn’t mean you’ll always have it. After you deliver your baby and placenta, your blood sugar levels usually return to normal. Having GDM does put you at risk for developing Type 2 diabetes later on in life. The CDC states that 50% of women that develop gestational diabetes during pregnancy, will develop type 2 diabetes later on. This is why your provider will want to check you blood sugar around 6-12 weeks after your delivery to make sure your levels have gone back to normal. You’ll also want to go back every 1-3 years to check.

Will this affect my child as they grow up?

Children that were born of mother’s that developed GDM are at a higher risk of childhood obesity. They also have a higher risk of developing diabetes later in life. It’s important to let your child’s pediatrician know that you had gestational diabetes during your pregnancy so that their blood sugar levels can be monitored throughout childhood.

Will this affect my ability to breastfeed?

Having gestational diabetes should not impair your ability to breastfeed. The circumstances surrounding your delivery, however, could have an affect on a smooth start to breastfeeding. For instance, if you have a cesarean section, you may have a delay with skin to skin and initiating breastfeeding until you get back to recovery. Talk with your provider beforehand and see if they’re able to support skin to skin in the operating room. As long as there are no complications, you should be in the recovery room shortly and will have baby on your chest immediately.

The best part is, there are still many benefits to breastfeeding even if moms developed gestational diabetes. One great benefit is that it is shown to improve glucose metabolism- While studies have shown that breastfeeding after developing GDM, studies are inconclusive on whether or not they reduce the risk of developing type 2 diabetes.

Although gestational diabetes doesn’t seem to cause any issues with breastfeeding, studies have shown that moms that developed GDM are less likely to breastfeed, and those that do, only breastfeed for short periods (Much et al., 2014). This likely has to do with the higher rate of neonatal and delivery complications. For instance, a newborn that was delivered to a mother with GDM may need a Neonatal Intensive Care Unit (NICU) stay. Infants that need to visit the NICU are more likely to be supplemented with formula and unfortunately, mothers sometimes don’t know alternatives to formula or ways to maintain their milk supply while their baby is in NICU. As mentioned in Things I wish I knew I discuss the importance of pumping when your baby is not nursing from the breast to maintain your milk supply.

understanding gestational diabetes

On a final note…

Being diagnosed with gestational diabetes can be a hard pill to swallow. Know that there are many other women out there, just like you and there’s so much support and resources for you and your baby. Don’t be afraid to ask questions. Follow the guidance of your care team and again, ask questions! The best thing you can do is be informed.


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References and Other Resources

The American College of Obstetricians and Gynocologists. (2017, November). Gestational diabetes. value is what Coveo indexes and uses as the title in Search Results.–> ACOG. https://www.acog.org/patient-resources/faqs/pregnancy/gestational-diabetes

Centers for Disease Control and Prevention. (2020, February 27). Gestational diabetes and pregnancyhttps://www.cdc.gov/pregnancy/diabetes-gestational.html

Johns Hopkins Medicine. (2020). Gestational diabetes mellitus (GDM)https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/gestational-diabetes

Much, D., Beyerlein, A., Roßbauer, M., Hummel, S., & Ziegler, A. (2014). Beneficial effects of breastfeeding in women with gestational diabetes mellitus. Molecular Metabolism3(3), 284-292. https://doi.org/10.1016/j.molmet.2014.01.002

U.S National Library of Medicine. (2018, April 19). Glucose screening tests during pregnancy: MedlinePlus medical encyclopedia. MedlinePlus – Health Information from the National Library of Medicine. https://medlineplus.gov/ency/article/007562.htm

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