Islets of Hope for persons with diabetes
Article by Lahle Wolfe, Founder, Islets of Hope.
For article use and reprint permission please contact:
Join Baby On Board, a support list created especially for women with gestational diabetes or who have type 1 or 2 diabetes and are pregnant.
Resource links for women with gestational diabetes
American Academy of Family Physicians: Management of gestational diabetes mellitus.
BD Diabetes offfers a free award-winning brochure on gestational diabetes (20 pages) Download .pdf file
Canadian Diabetes Association: Gestational diabetes; preventing complications in pregnancy.
Diabetes UK: Pregnancy and diabetes. Offers a (paid subscription below) magazine specifically for women with GD.
DLife.com: Everything you need to know about gestational diabetes.
Family Doctor: Gestational Diabetes: What it means for me and baby.
Mayo Clinic: Gestational diabetes.
NIH: Are you at risk for gestational diabetes? Download free .pdf brochure.
VeryBestBaby.com: Pregnancy diabetes.
WebMd Health: Gestational diabetes.
Types 1 and 2 Diabetes and Pregnancy
back to main "Diabetes Information"
What is gestational diabetes (GD)?
Gestational diabetes is a form of type 2 diabetes that only occurs during pregnancy. It is present in about 15% of all pregnancies and is usually detected at 24-28 weeks of pregnancy. With GD diabetes, the woman’s pancreas does produce insulin but it is insufficient to maintain normal blood glucose. A woman’s body is capable of producing about three times the normal amount of insulin during pregnancy but sometimes the demands of pregnancy and certain lifestyle factors cause insulin resistance. Insulin resistance simply means that the body stops responding to the effects of insulin. When the pancreas cannot produce enough insulin to keep blood glucose (also referred to as “blood sugar”) levels in normal ranges, the result is serious potential medical risks to both mother and baby.
When blood glucose levels become too high they need to be managed with lifestyle changes (diet and exercise) and possibly daily injections of insulin. GD is not a form of type 1 diabetes (even if a person requires insulin during the pregnancy) where the beta islets cells in the pancreas are destroyed.
Why did I develop GD?
GD has the potential to develop in all pregnancies. While certain factors seem to put some women at higher risk, research seems to indicate a strong connection between hormones produced during pregnancy that impact the way insulin works in the body. As a pregnancy progresses the placenta produces more estrogen, a hormonal contributor to the development of insulin resistance. Women who are pregnant often produce more than three times the usual amount of insulin as a normal part of being pregnant because estrogen makes cells resistant to the effects of insulin. It is when the body cannot make enough insulin to keep up with the demands of pregnancy that blood sugar levels may become too high, and a woman is diagnosed with GD.
What are the symptoms of GD?
Usually symptoms of GD are present but not always easily recognized as GD and your doctor may screen you for GD even if you have no symptoms. The test for GD (an oral glucose tolerance test) is necessary because two of the main symptoms of GD (excessive thirst and frequent urination) are also common symptoms of a normal pregnancy. GD usually develops during the 5th or 6th month of pregnancy (between 24 and 28 weeks) when certain hormones produced by the placenta can cause insulin resistance to develop. Symptoms of GD are similar to type 2 diabetes and include: increased thirst (polydipsia), frequent urination (polyuria), weight loss despite increased appetite (this is a sign of abnormally high blood sugar levels), fatigue, nausea and/or vomiting, blurry vision, infections of the bladder, vagina or skin (especially yeast infections), confusion, feeling dizzy, shaky or weak.
Who is at risk?
Women at risk for developing GD include those with a family history of diabetes, impaired glucose tolerance (prediabetes), have previously had GD during a pregnancy, women who are overweight, have had a previous stillbirth or delivered a baby over 9 pounds, are over the age of 25, or who have a large amount of amniotic fluid.
GD affects approximately 5% of all pregnant women, but a higher incidence of GD is seen in certain populations (7-9%) including Hispanics, African Americans, Native Americans, South or East Asians, Pacific Islanders, and Indigenous Australians. Another group of women at higher risk for developing GD are those with polycystic ovarian syndrome (PCOS), and those with thyroid disorders.
How can I tell if I have GD?
Your doctor will order an oral glucose tolerance test (OGTT, also simply called GTT). Most doctors routinely prescribe this test to all pregnant women as they may not have obvious symptoms of GD because some of the symptoms of GD (frequent urination, fatigue) are common to many pregnancies. Some women may fail a GTT the first time and yet do fine on a subsequent GTT. If you have a GTT that suggests diabetes you may wish to have a repeat test. But even if you do fine on a repeat GTT test you should take the first test results as a caution and be sure to follow a healthy diet and exercise plan as recommended by your doctor.
What is the diagnostic criteria for GD?
There are several diagnostic indicators that your doctor may use for determining if you have gestational diabetes. These tests include:
Fasting plasma glucose test (FPG)
A sample of blood is taken from the vein after the woman has not had anything to eat or drink (except water) for eight to 10 hours. The blood is tested for the amount of glucose (sugar) that is present in the sample. If the glucose level is higher than 140 milligrams per deciliter (mg/dL) then the woman may be diagnosed with gestational diabetes. The fasting plasma test and random plasma test are often administered as the first tests to check for gestational diabetes. However, these tests may not detect gestational diabetes in all women. Most doctors rely on additional tests to confirm the diagnosis. If you have a morning fasting blood sugar of 140 mg/dL or higher (during pregnancy) you will be diagnosed with GD.
Random plasma glucose test (RPGT)
A sample of blood is taken from the vein and tested for the amount of glucose present in the blood. This is not done after fasting so the glucose in the blood may be high. However, the level should not be over 200 mg/dL. If the level is higher than 200 mg/dL, the woman is considered to have gestational diabetes.
Glucose challenge test
This is a screening test that measures the amount of glucose in the blood. For this test, the woman drinks a sugary beverage and the blood is checked an hour later. This test may be performed at any time during the day. If the glucose level is over 140 mg/dL, the results are considered positive or abnormal. Not all women with a positive screening test have diabetes.
American Diabetes Association Guidelines for
Oral glucose tolerance test (OGTT)
The OGTT is usually done between the second and third trimester of pregnancy when the greatest amount of insulin resistance occurs. This test is more sensitive than the FPG test and can often detect milder cases of diabetes. It measures glucose levels four or five times over a three-hour period. Prior to the test, the woman must not eat or drink anything but water for eight to ten hours.
Before starting the test, a blood sample is taken to provide a fasting glucose level. The woman drinks a 100 grams of glucose (a sugary beverage) and blood samples are taken every hour for three hours. Some doctors only use a 2-hour glucose test (in this case only 75 grams of glucose are taken).
American Diabetes Association Guidelines for
Your doctor may order one or more of the following glucose (blood sugar) tests to diagnose gestational diabetes:
Be reassured that having a high glucose level on the glucose challenge test does not necessarily mean GD. The oral glucose tolerance test must show abnormal levels of glucose on two separate occasions. And not all diagnosis of GD will result in insulin shot therapy.
When a woman is diagnosed with GD additional tests will probably be ordered to see how the baby is doing. This includes an ultrasound to check for growth and development, and a “kick count” test to ensure the baby is active.
Women with GD may also have glucose in their urine (this can be determined by dipping a Diastix into urine at home or the doctor’s office). If they are hyperglycemic (blood glucose levels are too high) they may also show ketones in their urine. Ketones are spilled into the urine when blood sugars are too high because the body cannot use glucose as a source of fuel so it begins to burn fat. The burning of fat instead of blood glucose throws out ketones which can be detected by dipping a ketone test strip into urine at home or in the doctor’s office. Both urine glucose and ketone test strips are available over the counter at any pharmacy. The cost is usually less than $10 per item, and typically health insurance will cover the cost of these strips when your doctor makes a diagnosis of GD.
How is GD treated?
Often GD can be treated with lifestyle changes including following a healthy meal plan and exercise. If blood glucose cannot be controlled through lifestyle management, insulin via daily injections may be required (called “shot therapy”). Untreated GD puts both the baby and mother at risk for serious health problems during the pregnancy, at birth, and later on in life for both mother and baby. If you have GD, please take it seriously and work with your doctor to keep your blood glucose levels in target ranges.
Do I have to take insulin? Can’t I take oral medication instead?
When lifestyle changes are not sufficient to maintain tight blood glucose control, insulin may be required. Insulin will not cross the placenta to the baby as can oral antidiabetes medications. Insulin, injected daily, will help control blood glucose levels and protect the health of you and your baby. Some doctors may prescribe oral insulin sensitizing drugs like Glucophage during pregnancy. Be sure to discuss all the risk factors involved before making a decision to take oral medication instead of using insulin.
After the baby is born, will I still have diabetes?
Although it is rare, some women who develop GD will continue to be type 2 diabetic for life. Any woman who develops GD has a 40-60% increased risk for developing type 2 diabetes later in life. The American Diabetes Association (ADA) reports that 40% of women who are overweight prior to pregnancy and develop GD will also have onset of type 2 diabetes within four years after pregnancy. This risk is lower for women who maintain a normal weight prior and during pregnancy, and can be reduced for those overweight with GD by changes in lifestyle, including maintaining a health weight, following a low-fat, carbohydrate-controlled meal plan, and regular exercise.
Every woman who has had gestational diabetes should have an annual blood test to check for hyperglycemia (high levels of blood glucose). Since 20 to 50 percent of women with GD will develop diabetes later in life, it is important to be aware of the symptoms of type 2 diabetes. Women with GD during one pregnancy have a 50% chance of developing GD with subsequent pregnancies.
Will my baby have diabetes?
Having GD does not cause a baby to be born with type 1 diabetes. However, a baby born to a mother with GD is at risk for childhood obesity and at higher risk for developing type 2 diabetes in the future. It is important that these children adopt a healthy lifestyle early in life to help prevent diabetes onset in the future.
What are some of the concerns for women associated with GD?
GD carries an increased risk for developing preeclampsia (toxemia). This is a potentially serious condition in which high blood pressure (hypertension) occurs during pregnancy. Dangerous levels of fluid build up, swelling the arms and legs. Preeclampsia is a serious condition for both the mother and the fetus and, in many cases, the woman must be placed on bed rest until delivery, sometimes even in the hospital.
What are the concerns for my baby if I have GD?
GD can cause problems for both mother and baby during the pregnancy, at deliver, and later in life. Since GD typically occurs during the second or third trimester, the critical fetal development time during first trimester is usually unaffected. This means the baby has usually fully formed and is in the growing stage. Still, untreated GD results in increased risk for stillbirth and a two- to three-fold risk of a condition called “macrosomia.” Macrosomia is when a baby is larger than normal for a full-term pregnancy (a birth weight of over 9 lbs 14 ounces). This condition occurs due to high blood sugar levels in the mother. When the mother’s blood sugar (glucose) is too high, the extra glucose passes through the placenta to the baby. The baby’s pancreas begins to produce more insulin in response to the high blood glucose levels. Because the baby is getting more glucose nutrition then needed, it will also store extra glucose as fat. Eventually, macrosomia may result.
Another serious problem related to high blood sugar in women with GD is that the baby has responded to high blood sugars by producing high levels of insulin. As soon as the baby is born, he/she no longer is receiving the extra glucose from the mother so the high levels of circulating insulin still in the baby can cause hypoglycemia (when blood sugar falls too low). A baby born to a mother with GD will be checked for hypoglycemia and may require treatment with an IV solution of glucose until insulin and glucose levels have stabilized.
Babies that are large may have to be delivered by c-section (women with macrosomia babies are 3-4 times more likely to require a c-section), or have to schedule an early delivery if the baby is growing too large. Babies that grow too big can face a problem during delivery called shoulder dystocia. This happens when the baby’s shoulders are too large to move through the birth canal. This is a potentially life-threatening situation.
Babies born early are at a higher risk for respiratory problems because the lungs are one of the last organs to develop; babies born to mothers with GD are at an increased risk for premature delivery.
Other risks for babies born to mothers with GD include an increased risk for jaundice, hypocalcemia (low level of calcium in the blood), and polycythemia (an increased level of red blood cells).
Keeping your blood sugar in target range will help you and your baby.
Page Updated 08/03/2006