Taking Charge of Your Health

With gestational diabetes there generally
aren’t any symptoms. However, there are patients who are at greater risk. So a a woman whose
parents have had type 2 diabetes, or who is obese, or who has had a very large baby, or
who is spilling sugar in her urine, or who has polycystic ovarian syndrome or who’s had
gestational diabetes before, those are all high risk conditions and those women we would
test for glucose tolerance as soon as we saw them in pregnancy. I mentioned that having
gestational diabetes greatly increases your risk of having type 2 diabetes and sometimes
women will develop that type 2 diabetes between pregnancies and we want to know if that’s
happened. Now for the average patient, we’ll test them with a blood glucose testing when
they get to be about twenty-four to twenty-eight weeks pregnant. And that’s because the hormonal
changes of pregnancy are exerting their effects. They’re increasing the resistance to the action
of insulin. And so if we’re going to see glucose intolerance or gestational diabetes, it’ll
be evident by twenty-four to twenty-eight weeks. The other point is if we test the patients
and we find they have an abnormal test and we treat them, we can prevent some of the
adverse outcomes, which for gestational diabetes one of the biggest concerns is having a baby
that’s over ten pounds that can be very difficult to deliver and have a traumatic birth. The
other reason we want to avoid the babies getting too big and too fat is cause if they are too
big and too fat at delivery, they’re more likely to grow up to be fatter as children
and adults and they’re also more likely to grow up to have diabetes themselves. So the
testing that we do includes, at about twenty-four to twenty-eight weeks, having the mother drink
a sugary liquid and then measuring her glucose one hour later. If that’s elevated, that screening
test is positive, then we go on and we do a full three-hour oral glucose tolerance test.
And if that’s abnormal, then we begin treatment. And for most patients, treatment is going
to be diet, making sure that the patient has a balanced diet and doesn’t eat concentrated
sweets, candies, soda pop that’s sweetened with sugar. Eats a balanced diet where most
of the carbohydrates come from complex carbohydrate sources and we also encourage the moms to
exercise. Brisk walking every day will help to reduce her glucose levels and reduce the
chances that she’ll need to go on to additional therapy. And some patients, and it varies
from patient to patient, but overall about twenty to thirty percent of patients, despite
following the diet, will have glucose levels that are too high and we know that because
we also have the patients monitor their glucose levels using a glucose meter usually about
four times a day – when they get up in the morning and then after each meal. And if those
levels are too high, if the pattern of those tests demonstrates they’re too high, which
could be dangerous for the baby and lead to that baby being too big, then we would start
additional therapy. It might be an oral hypoglycemic, a pill, or it might be insulin.

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