Sunday, 24 February 2013

Gestational Diabetes in Pregnancy

Being told you have gestational diabetes can be scary. All of a sudden you're told you have a serious medical condition that you didn't before and you feel scared and alone and don't know who to turn for advice. I even remember thinking "But I don't eat that much sugar, how can I be diabetic?" You start to worry about your baby, what does it mean, what will happen, is my baby at risk, will my baby be born with it, am I now diabetic, do I need to inject myself? Questions buzz around your head and you feel very scared, but you might have a few days before you see anyone about it. 

So I hope this post will answer some of your questions until you see a specialist. If you have any worries or questions then make sure you write them down to take with you to your first appointment otherwise you might not remember them. I hope this post will help put your mind at ease and help explain your condition to you. The answers have been taken from what I was told and have learnt since I was diagnosed with gestational diabetes at 29wks pregnant with my 4th and also with help from the Diabetes UK website. 

What is Gestational Diabetes?
Gestational Diabetes Mellitus is a type of diabetes which only occurs during pregnancy. It usually appears during the second or third trimester, although occasionally it can occur in the first trimester but in those cases the condition was probably present before the pregnancy. Diabetes is a condition where the amount of glucose in your body is too high because the body can't use it properly. This is because your pancreas doesn't produce any insulin (Type 1 diabetes) or not enough (Type 2 and gestational diabetes) to help the glucose enter your body's cells. Insulin is a hormone produced by the pancreas that allows glucose to enter the body's cells where it is used as fuel for energy so we can work, play and generally live our lives and it is vital for life. Glucose comes from digesting carbohydrates and is also produced by the liver. Carbohydrates comes from many different kinds of food and drinks; including starchy foods such as bread, potatoes, chapatis, fruit, some diary products, sugar and other sweet foods. If you have diabetes or gestational diabetes, your body can't make proper use of this glucose so it builds up in the blood and isn't able to be used as fuel. Gestational diabetes happens because the body cannot produce enough insulin to meet the extra demands of pregnancy.

How do I know if I'm at risk of developing gestational diabetes?
At your booking appointment you will be asked questions to assess if you have any risk factors which make you more susceptible for gestational diabetes. These include;
  • Obesity
  • A family history of Type 2 diabetes (usually a close family member such as mother, father, brother, sister etc)
  • An unexplained stillbirth or neonatal death in a previous pregnancy and/or
  • A very large infant in a previous pregnancy (4.5kg (9lb 14oz) or more)
  • You have had gestational diabetes before 
  • Your family origin is South Asian, Black Caribbean or Middle Eastern
How do they test for Gestational Diabetes?
If you are considered to be at risk for gestational diabetes then you will be offered a Glucose Tolerance Test. The test is simple as a fasting blood test is taken before you are given a sugary drink (such as lucozade). Two hours after your sugary drink another blood test is taken and the results are compared to see how your body coped with the influx of sugar. If your body produced enough insulin then your body will have reduced your blood glucose level by converting the glucose into energy, if your body didn't cope with the influx of sugar then you will have a high blood sugar level and will be diagnosed with gestational diabetes. 

I failed the glucose tolerance test so what happens now?
If you fail the glucose tolerance test then you will be diagnosed as having gestational diabetes and you will be referred to a dietician who can help you reduce your glucose levels by changing your diet and being aware of what you can eat. Sometimes a change in diet is all you need but around 10-20% of sufferers require tablets or insulin injections to treat your gestational diabetes. You will have an appointment with a specialist medical team who are trained in diabetes and gestational diabetes who can answer any questions you might have and will monitor your blood sugar levels throughout your pregnancy ensuring that both you and your baby are safe. 

What are the risks to my baby?
In most cases, gestational diabetes is discovered during the second trimester of pregnancy which means that the baby's major organs are fairly well developed at this stage and there is a lower risk to the baby than for women with Type 1 or Type 2 diabetes. Babies of women who had blood glucose problems which were undiagnosed before pregnancy, have a higher risk of malformations. The degree of risk depends on how long blood glucose levels have been high and how high the levels have been. Once the baby is born it will need to have it's blood sugar levels checked regularly and may appear sleepy. This is because your baby has been getting some of your excess sugar via the placenta and the baby's body has been producing insulin to deal with this excess sugar. Once the baby is born, it stops getting your excess sugar but is still producing insulin so the baby will be monitored to ensure it stops producing excess insulin.

Am I now diabetic or will it go away?
If you have true gestational diabetes then it will go away once the baby is born. You blood will be tested about 6wks after the baby is born to check that your body is producing enough insulin to cope with your blood sugars. If you took medication during your pregnancy (either tablets or insulin injections) then once the baby is born you can stop taking them. However, in some cases a pregnant woman is diagnosed with gestational diabetes when in actual fact she has developed Type 2 diabetes and this means that the diabetes doesn't disappear when the baby is born. Being diagnosed with gestational diabetes means you have a higher risk of developing Type 2 diabetes in the future. In rare cases women who suffered gestational diabetes will go on to develop Type 1 diabetes. In those rare cases it usually means that the women had a slow developing form of Type 1 which is unmasked during pregnancy.  I was unlucky enough to develop Type 2 diabetes a year and a half after the birth of my daughter. Gestational diabetes can be a warning that are at risk of developing diabetes and is a warning that you should take seriously and make changes to your lifestyle, such as losing weight if you are obese to help reduce your risk.

Will I get gestational diabetes again if I have another pregnancy?
Although the risk of you developing gestational diabetes is now higher than someone who has never been diagnosed with gestational diabetes, it doesn't mean you will get it again. I know friends who have suffered from gestational diabetes but not with any of their other ones. Losing weight can help reduce the risk as well. If you have previously had gestational diabetes then you will be offered a glucose tolerance test at 16-18 weeks which will be repeated at 28 weeks if the results of the early one were normal. 

Will my baby be born with diabetes?
Absolutely not! Your baby will have a higher risk of developing diabetes than a child whose mother didn't suffer from gestational diabetes, but that is only because you have an increased risk of developing it. But the child born during the mother's gestational diabetes has only the same risk of it's siblings.

My Story

When I was 29 weeks pregnant with my 4th child I had to have a Glucose Tolerance Test. However I wasn't worried as I'd had one with each of my 3 previous pregnancies and I passed so I fully expected to pass this time. Sadly however, I failed this one and I was diagnosed as having Gestational Diabetes. 

Because of my diagnosis, I had to attend a special clinic every two weeks where my blood sugar readings (that I took myself using a blood glucose meter and recorded in a book and meant I had to prick my finger several times a day) were studied, my blood was tested, the baby was checked and my sugar levels were checked as well as my health. 

The clinic consisted of a consultant obstetrician, a diabetic nurse and a dietician if needed. We would discuss my diet and my blood sugar results and as I was injecting myself with insulin my doses were adjusted based on my readings. At first being told I had to prick my finger to make it bleed as well as injecting myself in my thighs was pretty scary, but I soon got used to it and thankfully they didn't hurt too much. 

There was talk of me having an elective c-section, but in the end I was induced at 38 weeks (after having a membrane sweep at 37wks to try and get my labour started naturally). Now having had a previous section with my 2nd I was under the impression that I couldn't be induced as it can put extra strain on the caesarean scar, but because it had been almost 5yrs since my section and I had had a VBAC (virginal birth after caesarean) the consultant was confident that I would be ok. The reason I wasn't allowed to go full term is because the baby receives some of your excess insulin through the placenta and this means babies of mothers with gestational diabetes or diabetes can be larger than normal babies. 

When my daughter was born she was a little sleepy because of the excess sugar and the midwife's had to test her blood sugars regularly, but I found lots of kangaroo care (skin to skin contact) and waking her regularly to breastfeed her helped a lot (it also helped stabilise my sugars as well as hers). She was also a little red as well because she had too many red blood cells attacking her glucose, but within a few hours her sugars stabilised and the redness faded and she was discharged the following day.

Three years later and she shows no signs of my gestational diabetes having affected her, but sadly my diabetes returned a year and a half later as Type 2 diabetes. 


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