Diabetes

Gestational Diabetes

What Is Gestational Diabetes?

Gestational diabetes sometimes develops when a woman is pregnant. It’s when the blood glucose level (blood sugar level) of the mother goes too high during pregnancy.

Having an elevated blood glucose level during pregnancy can cause problems for your baby—if it’s left untreated. Fortunately, doctors are vigilant about checking for gestational diabetes so that it can be identified and effectively managed. A pro-active treatment plan helps you have a good pregnancy and protects the health of your baby.

Gestational Diabetes Symptoms

Gestational diabetes doesn’t often cause noticeable symptoms for the mother. Because there aren’t often symptoms, it’s very important to be tested for a high blood glucose level when you’re pregnant. (Your doctor will most likely test you for gestational diabetes sometime between the 24^thand 28^th week.

Gestational Diabetes Causes and Risk Factors

Gestational diabetes develops when your body isn’t able to produce enough of the hormone insulin during pregnancy. Insulin is necessary to transport glucose—what your body uses for energy—into the cells. Without enough insulin, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps gestational diabetes.

The elevated blood glucose level in gestational diabetes is caused by hormones released by the placenta during pregnancy. The placenta produces a hormone called the human placental lactogen (HPL), also known as human chorionic somatomammotropic (HCS). It’s similar to growth hormone (so it helps the baby grow), but it actually modifies the mother’s metabolism and how she processes carbohydrates and lipids. HPL actually raises the mother’s blood glucose level and makes her body less sensitive to insulin—less able to use it properly. If the body doesn’t use insulin as it should, the blood glucose level goes up. The HPL hormone elevates the blood glucose level so that the baby gets enough nutrients from the extra glucose in the blood.

At 15 weeks, another hormone that affects the mother’s blood glucose level increases production: human placental growth hormone. This hormone helps regulate the mother’s blood glucose level, again to make sure that the baby gets enough nutrients. It can, however, cause the blood glucose level in the mother to go too high.

It’s normal for women’s blood glucose levels to go up a bit during pregnancy because of the extra hormones produced by the placenta. However, sometimes, the blood glucose level is too elevated.

The medical community isn’t sure why some women develop gestational diabetes, although there are several risk factors that make it more likely that you will develop it:

• Age: Women over the age of 25 are more likely to get gestational diabetes.
• Weight: Women who are overweight (have a body mass index—or BMI—that’s above 25) are more at risk for gestational diabetes.
• Race/ethnicity: Gestational diabetes is more common within certain ethnic groups. African-Americans, Native Americans, Asian Americans, Hispanic people, and Pacific Islanders are more likely to have gestational diabetes.
• Family history: If someone else in your family has or had diabetes (type 1, type 2, or gestational diabetes), you’re at higher risk.
• Pre-diabetes: This is a “pre-diagnosis” of diabetes. It means that your blood glucose levels are elevated, but they aren’t high enough to be considered diabetes yet. If you’ve been told that you have pre-diabetes, you’re more likely to develop gestational diabetes.
• Previous pregnancies with gestational diabetes: If you developed gestational diabetes during another pregnancy, you’re more at risk for developing it again.

Hyperglycemia

Hyperglycemia means high (hyper) glucose (gly) in the blood (emia). Your body needs glucose to properly function. Your cells rely on glucose for energy. Hyperglycemia is a defining characteristic of diabetes—when the blood glucose level is too high because the body isn’t properly using or doesn’t make the hormone insulin.

You get glucose from the foods you eat. Carbohydrates, such as fruit, milk, potatoes, bread, and rice, are the biggest source of glucose in a typical diet. Your body breaks down carbohydrates into glucose, and then transports the glucose to the cells via the bloodstream.

Your endocrinologist will tell you what your target blood glucose levels are. Your levels may be different from what is usually considered as normal because of age, pregnancy, and/or other factors.

• Fasting hyperglycemia is defined as when you don’t eat for at least eight hours. Recommended range without diabetes is 70 to 130mg/dL. (The standard for measuring blood glucose is “mg/dL” which means milligrams per deciliter.) If your blood glucose level is above 130mg/dL, that’s fasting hyperglycemia. Fasting hyperglycemia is a common diabetes complication.
• Postprandial or reactive hyperglycemia occurs after eating (postprandial means “after eating”). During this type of hyperglycemia, your liver doesn’t stop sugar production, as it normally would directly after a meal, and stores glucose as glycogen (energy sugar stores). If your postprandial (1-2 hours after eating) blood glucose level is above 180mg/dL, that’s postprandial or reactive hyperglycemia.

However, it’s not just people with diabetes who can develop hyperglycemia. Certain medications and illnesses can cause it, including beta blockers, steroids, and bulimia. This article will focus on hyperglycemia caused by diabetes.

Early Hyperglycemia Symptoms

Early symptoms of hyperglycemia, or high blood glucose (sugar), may serve as a warning even before you test your glucose level. Typical symptoms may include:

• Increased thirst and/or hunger
• Frequent urination
• Sugar in your urine
• Headache
• Blurred vision
• Fatigue

Treating Hyperglycemia

Treating hyperglycemia is a matter of working on preventing it.

If your blood glucose level is consistently too high, talk with your doctor about what you can do to keep it in a more normal range. He or she may suggest:

• Medication Adjustment: Your doctor may adjust your insulin (or glucose-lowering medication) dose or when you take it to help prevent hyperglycemia.
• Meal Plan Help: A healthy diet and proper meal planning can help you avoid hyperglycemia. This includes eating often, watching intake of sugar and carbohydrates, limiting use of alcohol, and eating a diet rich in vegetables, fruit and whole grains. If you are having difficulty planning meals, talk to your doctor or dietitian.
• Exercise: Regular exercise is important (even if you don’t have diabetes). Maintaining a healthy level of activity can help you keep your blood glucose level in a normal range.

Hypoglycemia

Hypoglycemia means low (hypo) glucose (gly) in the blood (emia). Your body needs glucose to properly function. Your cells rely on glucose for energy.

Glucose comes from the foods you eat. Carbohydrates (e.g., fruit, bread, potatoes, milk, and rice) are the biggest source of glucose in a typical diet, and your body breaks down carbohydrates into glucose. The glucose is then transported in your blood to cells that need it; it gives your body energy.

However, in order to use the glucose, your body needs insulin. This is a hormone produced by the pancreas. Insulin helps transport glucose into the cells, particularly the muscle cells.

Sometimes, your blood glucose level can drop too low—that’s hypoglycemia. It usually happens quite quickly, and it can be handled quite quickly, as well.

People with type 1 diabetes do not make insulin to help their bodies use glucose, so they have to take insulin, which is injected under the skin. People with type 2 diabetes fall into two categories when it comes to insulin: either their body doesn’t make enough, or their body is unable to use it well (insulin resistance).

Normal Blood Glucose

The American Diabetes Association published the Standards of Medical Care in Diabetes that provide recommended target blood glucose ranges for people with and without diabetes.

The standard for measuring blood glucose is “mg/dL,” which means milligrams per deciliter.

Prediabetes

What Is Prediabetes?

Prediabetes is a “pre-diagnosis” of diabetes—you can think of it as a warning sign. It’s when your blood glucose level (blood sugar level) is higher than normal, but it’s not high enough to be considered diabetes. Prediabetes is an indication that you could develop type 2 diabetes if you don’t make some lifestyle changes. But here’s the good news: it is possible to prevent prediabetes from developing into type 2 diabetes. Eating healthy food, losing weight and staying at a healthy weight, and being physically active can help you bring your blood glucose level back into the normal range.

Symptoms

Diabetes develops very gradually, so when you’re in the prediabetes stage—when your blood glucose level is higher than it should be—you may not have any symptoms at all. You may, however, notice that:

• you’re hungrier than normal
• you’re losing weight, despite eating more
• you’re thirstier than normal
• you have to go to the bathroom more frequently
• you’re more tired than usual

There are several risk factors, though, that make it more likely that you’ll develop pre-diabetes. These are the same risk factors related to the development of type 2 diabetes:

• Weight: If you’re overweight (have a body mass index—a BMI—of higher than 25), you’re at a high risk for developing prediabetes. Especially if you carry a lot of extra weight in your abdomen, you may develop prediabetes. The extra fat cells can cause your body to become more insulin resistant.
• Lack of physical activity: This often goes hand-in-hand with being overweight. If you aren’t physically active, you’re more likely to develop prediabetes.
• Family history: Prediabetes has a hereditary factor. If someone in your close family has (or had) it, you are more likely to develop it.
• Race/ethnicity: Certain ethnic groups are more likely to develop prediabetes, including African-Americans, Hispanic Americans, Native Americans, and Asian Americans.
• Age: The older you are, the more at risk you are for developing prediabetes. At age 45, your risk starts to rise, and after age 65, your risk increases exponentially.
• Gestational diabetes: If you developed diabetes while you were pregnant, that increases your risk for developing prediabetes later on.
• Other health problems: High blood pressure (hypertension) and high cholesterol (the “bad” LDL cholesterol) increase your risk of getting type 2 diabetes.