Managing Gestational Diabetes: A Beginner’s Guide

Managing Gestational Diabetes: A Beginner’s Guide

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According to The Centers for Disease Control and Prevention (CDC) every year 2% to 10% of pregnancies in the United States are affected by gestational diabetes.

Gestational diabetes (or GDM) is a type of diabetes that is diagnosed during pregnancy. During pregnancy, your body goes through a lot of hormonal changes that cause insulin resistance, which means that your body is not using insulin effectively. All pregnant people have some insulin resistance during late pregnancy, but if the pancreas cannot make enough insulin to compensate for the level of insulin resistance, gestational diabetes develops. In some cases, people aren’t aware that they have insulin resistance before becoming pregnant. This increases the risk for developing gestational diabetes.

Understanding the Risk Factors

According to the CDC, the factors that increase the risk of developing gestational diabetes include:

  1. Older than 25
  2. Entering pregnancy at a higher weight and/or not being physically active
  3. Family history of type 2 diabetes
  4. Being a member of some ethnic groups such as: Hispanic/Latino, Black/African American, American Indian, and Asian American
  5. History of gestational diabetes in a previous pregnancy
  6. Having delivered a baby weighing more than nine pounds (four kilograms)
  7. Previous history of insulin resistance (PCOS or prediabetes)
  8. High blood pressure (greater than 140/90 mmHg) or heart disease

Typically GDM does not have any symptoms. The medical history and risk factors can let your doctor know if you need to be tested for GDM at your first prenatal visit. For most people, an Oral Glucose Tolerance Test (OGTT) will be performed at weeks 24 to 28 of pregnancy. 

If GDM was identified, you will develop a plan with your doctor to ensure that you and your baby stay healthy during pregnancy. There are potential complications for both the parent and the baby with unmanaged blood sugar. The parent has an increased risk for cesarean section, preeclampsia, and developing type 2 diabetes after pregnancy. The baby is at risk of macrosomia (large baby), premature birth, complications at birth, low blood sugar at birth, and developing type 2 diabetes later in life. 

Managing Gestational Diabetes

The good news is that you can successfully manage gestational diabetes and reduce the risk of complications by incorporating lifestyle changes. Your plan to manage GDM includes healthy eating, exercise, monitoring your blood sugars multiple times a day with the glucometer, managing stress, attending appointments with your medical team, and taking medication (if necessary).

Food Matters 

Think of what you put into your body like gusts of wind to your blood sugars. Certain foods will have a stronger force and elevate your blood sugar, whereas others may elevate it slightly or not all. Food can be categorized as mostly fats, carbohydrates, or protein.

Carbohydrates (a.k.a carbs) cause the blood sugar to elevate. They are broken down into sugar (glucose) and enter the bloodstream, so your body can use it for energy. With GDM, your body does not process sugar effectively. For this reason, consuming too many carbs can cause elevated blood sugars. 

Your food choices have an effect on your blood sugar. To help you manage GDM, incorporate a healthful eating pattern:

Keep your meals on a schedule and distribute your carbs. The current recommendations on meal planning for gestational diabetes is to consume smaller and more frequent meals. Three meals and three small snacks are usually recommended to distribute your carbs throughout the day and obtain the calories you need to support a healthy pregnancy and the growth of your baby. A large meal can increase the risk of elevating your blood sugar. Keeping your meals on a consistent schedule can prevent consuming a large amount of carbs at a single meal.

Make the right food combination on your plate. Combine lean protein, plant-based fats, and non-starchy vegetables with your carbs to help slow the absorption of sugar into the bloodstream and reduce risk of spikes in blood sugar. Start by filling half of your plate with non-starchy vegetables such as broccoli, asparagus, cauliflower, spinach, and carrots. Divide the other half in two and fill one fourth of your plate with fish, chicken, or lean meat. Complete your plate by adding healthy sources of carbs such as sweet potato, beans, brown rice, quinoa, or buckwheat. Use olive oil for cooking or making a salad dressing. 

Eat healthy without compromising flavor. Celebrate your food with herbs and spices. Healthy eating also means consuming those foods you enjoy and are part of your culture and traditions. Keep portion sizes in mind to help you maintain your blood sugar in a healthy range. Choose herbs and spices to enhance the flavor in your meals and help you reduce the amount of salt. Add fresh cilantro, tarragon, or chives to your salads and vegetable soups. Sprinkle some cayenne pepper and squeeze citrus fruits such as lemon or lime on your fruits and vegetables.

Being in control. Take a pause before reaching for food and ask yourself, “am I actually hungry?” If the answer is “no”, emotions may be driving the urge to eat. At this point, finding a distraction such as going for a walk, taking a deep breath, drinking water, or calling a friend could be helpful. Do you know that we can easily mistake thirst for hunger? Next time, drink some water and wait to see if you feel better.

Make a healthy choice your first choice. Here are some healthy swaps.

If you’re craving ______,

try eating ______.

Sweet

Fruit

Salty

Nuts and seeds

Sour

Greek yogurt and chia seeds

Chewy

Dried fruit without added sugar

Crunchy

Baby carrots or jicama

Bitter

Dark chocolate


Exercise and Blood Sugar

Think of physical activity as one of the more useful items in your toolbox for managing blood sugar. Exercise makes your body more sensitive to insulin, the opposite to insulin resistance. The American College of Obstetrics and Gynecologist (ACOG) recommends 20 to 30 minutes of moderate activity three to seven days a week throughout pregnancy.

Note: If you are new to exercise or want to try a new activity, speak to your doctor first before beginning an exercise program. If you are taking insulin and other oral medications to lower blood sugar, make sure you know the risk for low blood sugars with exercise. 

Exercise is great at any time of the day. According to a study by the journal, Frontiers in Endocrinology, glucose levels tend to peak within 90 minutes of a meal. Therefore, if you are experiencing higher blood sugar after a meal, physical activity can do the trick. Try engaging in a 15- to 20-minute brisk walk. 

Find it challenging to get started or stay motivated? Try the following exercise tips:

Start small. Studies have shown that 5 to 10 minutes of exercise, if done consistently, every day can add up to big results. Sometimes setting the bar too high may be tough to reach. If a 30-minute routine is challenging, start with 10-minute increments throughout the day. Here are some easy examples of a 10-minute exercise routine: 

  1. Walking
  2. Dancing in your living room
  3. Cleaning your home
  4. Doing some light yard work
  5. Standing up and moving during a TV show

Find a buddy. Let your neighbors or a friend know about your exercise goals and invite them to exercise with you. Having someone to exercise with makes it much fun and will keep you motivated. Working out with others may be challenging during COVID-19. Go for a walk with a friend and make sure to wear a face mask and practice social distancing. 

Keep it fresh. Anything we do over and over every day may get boring at some point, no matter how motivated we are. Find several activities you enjoy or would like to try. When you get bored with one, switch it up! You can try a dance class for some days and then switch to yoga. 

Reward yourself. Rewards can help motivate you to achieve your exercise goals. Small rewards go a long way. Offer a small reward if you reach your goal for the week. For instance, if you met your goal of walking four days this week, treat yourself with a new pair of walking shoes or exercise clothes. 

What Comes After Your Baby is Born

You may be wondering what happens with gestational diabetes after you’ve delivered your baby. In most cases, your blood sugar returns to normal after giving birth. However, having gestational diabetes puts you at a higher risk for developing type 2 diabetes in the future. 

The only way to check if you still have diabetes after pregnancy is by getting tested. It is very important that you return to your OB-GYN for your postpartum visit.  A test will determine if you still have diabetes. Your doctor will check how your body responds to a large load of sugar at your first postpartum visit or four to 12 weeks after delivery.  

A diagnosis of gestational diabetes carries a lifetime risk of progression of type 2 diabetes of 60%. Even if gestational diabetes goes away, you have an increased risk of developing type 2 diabetes within five to 10 years. Focusing on lifestyle factors can help you delay or prevent developing type 2 diabetes in the future. 

For those who are classified as overweight, research shows that you can reduce the chances of developing type 2 diabetes by losing five to seven percent of your weight and keeping it off. Engaging in at least 30 minutes of physical activity five days a week can help you achieve this. Eating a healthful eating pattern by keeping in mind portion sizes and food choices is part of your long-term plan to prevent type 2 diabetes. Ask your doctor to refer you to a program to prevent type 2 diabetes (if needed). 

Reducing Your Risk for Future Pregnancies

After giving birth, if your blood sugars return to normal, you may be at risk of having GDM in subsequent pregnancies. Planning your next pregnancy is important to prevent gestational diabetes. Achieving a healthy weight, consuming a healthy diet, and being active will help you prevent GDM in the future. 

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Coach Sandra Gonzalez, RD, CDCES and Coach Melinda Washington, RD, CDCES
Mar 29, 2021

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