By Dr Sabita Prasad

 

Gestational diabetes is diabetes that is found for the first time when a woman is pregnant. Diabetes means that your blood glucose (also called blood sugar) is too high. Your body uses glucose for energy. But too much glucose in your blood can be harmful. When you are pregnant, too much glucose is not good for your baby. This article focuses on women with gestational diabetes. If you have type 1 or type 2 diabetes and are considering pregnancy, consult your healthcare team before you get pregnant.
 
What causes gestational diabetes?
Changing hormones and weight gain are part of a healthy pregnancy. But both changes make it hard for your body to keep up with its need for a hormone called insulin. When that happens, your body doesn’t get the energy it needs from the food you eat.
 
What is my risk of gestational diabetes?
To learn your risk for gestational diabetes, check each item that applies to you. Talk with your doctor about your risk at your first prenatal visit.
 
* I have a parent, brother, or sister with diabetes. (Family History)
* I am 25 years old or older.
* I am overweight. (Obesity)
* I have had gestational diabetes before or I have given birth to at least one baby weighing more than 9pounds.
 * I have been told that I have “pre-diabetes,” a condition in which blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes.
* Glycosuria
Other names for it are “impaired glucose tolerance” and “impaired fasting glucose.”
* Have had a still birth.
* Have high blood pressure.
If you checked in any of these risk factors, ask your healthcare team about testing for gestational diabetes.
  You are at high risk if you are very overweight, having had gestational diabetes before, have a strong family history of diabetes, or have glucose in your urine.
 You are at average risk if you checked one or more of the risk factors.
 You are at low risk if you did not check any of the risk factors.
 
What are the symptoms?

 
Usually there are no symptoms or if any are mild.
You may have:
* Fatigue
*Increased thirst
* Increased urination
* Weight loss despite appetite
* Frequent infections of bladder, genitals
 
When will I be checked for gestational diabetes?
Your doctor will decide when you need to be checked for diabetes depending on your risk factors.
 If you are at high risk, your blood glucose level may be checked at your first prenatal visit. If your test results are normal, you will be checked again sometime between weeks 24 and 28 of your pregnancy.
 If you have an average risk for gestational diabetes, you will be tested sometime between weeks 24 and 28 of pregnancy.
 If you are at low risk, your doctor may decide that you do not need to be checked.
 
How is gestational diabetes diagnosed?
Your healthcare team will check your blood glucose level. Depending on your risk and your test results, you may have one or more of the following tests.
 
* Fasting blood glucose or random blood glucose test
Your doctor may check your blood glucose level using a test called a fasting blood glucose test. Before this test, your doctor will ask you to fast, which means having nothing to eat or drink except water for at least 8 hours. Or your doctor may check your blood glucose at any time during the day. This is called a random blood glucose test.
These tests can find gestational diabetes in some women, but other tests are needed to be sure diabetes is not missed.
 
* Screening glucose challenge test (GVT) Or 50gm glucose test
For this test, you will drink a sugary beverage and have your blood glucose level checked an hour later. This test can be done at any time of the day. If the results are above normal, you may need further tests.
 
*Oral glucose tolerance test (100gm glucose test) or GTT
If you have this test, your healthcare provider will give you special instructions to follow. For at least 3 days before the test, you should eat normally. Then you will fast for at least8 hours before the test. The healthcare team will check your blood glucose level before the test. Then you will drink a sugary beverage. The staff will check your blood glucose levels 1 hour, 2 hours and 3 hours later. If your levels are above normal at least twice during the test, you have gestational diabetes.
How will gestational diabetes affect my baby?
Untreated or uncontrolled gestational diabetes can mean problems for your baby, such as:
* Being born very large and with extra fat; this can make delivery difficult and more dangerous for your baby
* Low blood glucose right after birth
* Breathing problems
 
If you have gestational diabetes, your healthcare team may recommend some extra tests to check on your baby, such as:
* An ultrasound exam, to see how your baby is growing
* “Kick counts” to check your baby’s activity (the time between the baby’s movements) or special “stress” tests.
 Working closely with your healthcare team will help you give birth to a healthy baby. Both you and your baby are at increased risk for type 2 diabetes for the rest of your lives.
 
How will gestational diabetes affect me?

Often, women with gestational diabetes have no symptoms.
However, gestational diabetes may
* Increase your risk of high blood pressure during pregnancy
* Increase your risk of a large baby and the need for caesarean section at delivery.
 The good news is your gestational diabetes will probably go away after your baby is born. However, you will be more likely to get type 2 diabetes later in your life. You may also get gestational diabetes again if you get pregnant again.
Some women wonder whether breastfeeding is OK after they have had gestational diabetes. Breastfeeding is recommended for most babies, including those whose mothers had gestational diabetes. Gestational diabetes is serious, even if you have no symptoms. Taking care of yourself helps keep your baby healthy.
 
How is gestational diabetes treated?
Treating gestational diabetes means taking steps to keep your blood glucose levels in a target range. You will learn how to control your blood glucose using the following:
* A meal plan
* Physical activity
* Insulin (if needed)
 
Meal Plan
We can design a meal plan to help you choose foods that are healthy for you and your baby. Using a meal plan will help to keep your blood glucose in your target range. The plan will provide guidelines on which foods to eat, how much to eat, and when to eat. Choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.
 
You may be advised to
 * Limit sweets
 * Eat three small meals and one to three snacks every day
 * Be careful about when and how much carbohydrate-rich food you eat; your meal plan will tell you when to eat carbohydrates and how much to eat at each meal and snack
 * Include fibre in your meals in the form of fruits, vegetables, and whole-grain crackers, cereals and bread
 
Physical activity
Physical activity, such as walking and swimming, can help you reach your blood glucose targets. Talk with your healthcare team about the type of activity that is best for you. If you are already active, tell your healthcare team what you do.
 
Insulin
Some women with gestational diabetes need insulin, in addition to a meal plan and physical activity, to reach their blood glucose targets. If necessary, your healthcare team will show you how to give yourself insulin. Insulin is not harmful for your baby. It cannot move from your bloodstream to the baby’s.

How will I know whether my blood glucose levels are on target?
It’s advised to use a blood glucose meter to check your levels on your own. And note the below:
* Learn how to prick your finger to obtain a drop of blood
* Know what your target range is
* And when to check your blood glucose
 

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You may be asked to check your blood glucose
* When you wake up
* Just before meals
* 1 or 2 hours after breakfast/1 or 2 hours after lunch
* 1 or 2 hours after dinner
 
The following chart shows blood glucose targets for most women with gestational diabetes. Talk with your healthcare team about whether these targets are right for you.
 
Each time you check your blood glucose, write down the results in a record book. Take the book with you when you visit your doctor. If your results are often out of range, your doctor will suggest ways you can reach your targets.
 
Will I need to do other tests on my own?
Your doctor can train you how to test for ketones (KEE-tones) in your morning urine or in your blood. High levels of ketones are a sign that your body is using your body fat for energy instead of the food you eat.
Using fat for energy is not recommended during pregnancy. Ketones may be harmful for your baby.
If your ketone levels are high, your doctor may suggest that you change the type or amount of food you eat. Or you may need to change your meal times or snack times.
 
After I have my baby, how can I find out whether my diabetes is gone?
You will probably have a blood glucose test 6 to 12 weeks after your baby is born to see whether you still have diabetes. For most women, gestational diabetes goes away after pregnancy. You are, however, at risk of having gestational diabetes during future pregnancies or getting type 2 diabetes later.
 
How can I prevent or delay getting type 2 diabetes later in life?
You can do a lot to prevent or delay type 2 diabetes.
 *Reach and maintain a reasonable weight.
* Even if you stay above your ideal weight, losing 5 to 7% of your body weight is enough to make a big difference.
* Be physically active for 30 minutes most days.
* Walk, swim, exercise, or go dancing.
 * Follow a healthy eating plan.
Eat more grains, fruits, and vegetables. Cut down on fat and calories. A dietician can help you design a meal plan.
 
Even after your delivery, it is advised to check your blood glucose levels regularly. Women who have had gestational diabetes should continue to be tested for diabetes or pre-diabetes every 1 to 2 years. Diagnosing diabetes or pre-diabetes early can help prevent complications such as heart disease later. Your child’s risk for type 2 diabetes may be lower if you breast feed your baby and if your child maintains a healthy weight.
 
* The author is (Specialist Gynaecologist) at ASTER Medical Centre, Al Hilal.


Above-normal results for the oral glucose
tolerance test*
Fasting    95 or higher
At 1 hour    180 or higher
At 2 hours    155 or higher
At 3 hours    140 or higher
Note: Some labs use other numbers for this test.
*These numbers are for a test using a drink with 100g of glucose.

Blood glucose targets for most women with gestational diabetes
On awakening    not above 95
1 hour after a meal    not above 140
2 hours after a meal    155 or higher
At 3 hours    not above 120


Study says Omega 6 fats may pose dangers

By Renee Elder
 

New research is challenging widely held beliefs about the dietary benefits of unsaturated fats, showing that some types long considered healthy, such as corn and safflower oil, may actually harm people with heart problems.
The new results stem from a study published in 1978 that examined links between diet and heart disease. A re-examination of the original research, including some data not part of the previous analysis, found that eating fats identified as omega 6s was linked to higher death rates among research subjects, all men with a history of heart attacks.
“What we found didn’t go along with the dietary advice that has been given out for the past half century,” said Daisy Zamora, a nutrition epidemiologist with the University of North Carolina’s Gillings School of Health in Chapel Hill, who was involved in the latest research.
The study was published earlier this month in the British Medical Journal.
Saturated fats, found in butter, red meats, cheeses and other animal-based products, have been known to build up in arteries, hamper blood flow and cause cardiovascular problems. In the 35 years since publication of the landmark Sydney Diet Heart Study, Americans have been urged to replace saturated fats with unsaturated fats derived from vegetables, nuts and fish.
Unsaturated fats are divided into two categories — omega 6 and omega 3.
Omega 6 fats come from a wide range of vegetable oils, such as safflower, sunflower and corn oil, and are used heavily by the food industry because they are widely available and inexpensive, said Elisabetta Politi, nutrition director at the Duke Diet and Fitness Center.
She said the new study findings should be considered as useful information by anyone considering day-to-day food choices, but added that she would need to see more research before advising people to stop eating omega 6 fats.
“I think it’s better to focus on trying to include more omega 3s, such as salmon or flax seed, in your diet,” Politi added.
The original study involved nearly 500 men age 30 to 59 with a previous history of heart disease. Half the group was instructed to use linoleic acid, found in safflower oil, to replace animal and dairy fats in their diets. The other half were not told to change their eating habits at all.
The study did not examine intake of omega 6 and omega 3 fats separately for either group.
According to Zamora, the amount of linoleic acid in American diets has tripled over the past century.
She agrees with Politi that without some additional studies “it would be a jump to say that this is what caused the rise in cardiovascular disease. Yet this is the conclusion we keep going back to.”
Zamora said the team re-analysing the heart-study findings confirmed that substituting saturated fats with omega 6 oil does in fact lower cholesterol levels.
“But our findings also suggest that, even though this happens, the risk of death from cardiovascular disease still increased as much as if they had kept on eating saturated fats,” she said.
The new analysis showed that the group substituting omega 6 fats had a 17% higher risk of dying than the control group during the course of the study, which ran from 1966 to 1973. — The News & Observer/MCT