Gestational Diabetes Q and A

Gestational Diabetes is a concern for many women

Gestational Diabetes is a concern for many women

Hearing the words Gestational Diabetes has an amazing way of making any pregnant woman’s skin crawl.  Often, all they think about is the dreaded Glucola drink and not being able to eat a slice of cake at their baby shower.  My colleague Rachelle Mallick rounded up some questions and misunderstandings that we have heard along the way (with the help of our friend Lauren Fox) and are happy to tackle them for yall’s reading pleasure.

 

What exactly is Gestational Diabetes? 

 

To understand how gestational diabetes comes about, you first have to have a basic understand the placenta.  Your placenta does more than support your baby; it also produces hormones to help the baby develop.  The hormones are released into your body and some hormones may cause what is called insulin resistance. 

 

Think about a time that you have eaten a carbohydrate-rich meal, like spaghetti. During digestion, the carbohydrates from the meal were broken down into a simple sugar called glucose.

 

Your body depends on the hormone insulin to help absorb and use glucose.  Insulin is released when your body senses glucose in the bloodstream after carbohydrates are eaten. 

 

The glucose needs to enter the cells of organs (like the brain) in order for it to be used as energy. The glucose depends on insulin to help it get into the cells.  Otherwise, glucose would remain in the bloodstream. 

 

 

INSULIN RESISTANCE

 

 

In insulin resistance, your cells do not respond to insulin. As a result, the glucose may not enter the cells, and may stay in the bloodstream.  This is called having a HIGH blood sugar level. The body will attempt to overcome this challenge by secreting MORE insulin.  The cells literally become resistant to insulin.

 

 

THE PROBLEM WITH INSULIN RESISTANCE WHILE PREGNANT

 

So, your body is experiencing insulin resistance.  As a result, the extra glucose that is not entering your cells like it did before pregnancy can pass the placenta and essentially go to your baby.  Your baby is therefore being exposed to way too much sugar if mom is not managing her gestational diabetes.  Baby can become very large, become at risk for developing diabetes herself, and have a higher chance of becoming obese.  Carrying a larger baby puts mom at risk for being unable to deliver vaginally and delivering via c-section is associated with its own risks.   Additionally, unmanaged gestational diabetes is a risk factor for premature birth.

 

 

If you have gestational diabetes, you want to make sure that you are eating enough carbohydrates to sustain yourself and your pregnancy, but not eat TOO many that results in a high blood sugar.  It is a balance that many women achieve successfully.

 

 

Are the gestational diabetes tests a test of how healthy I have been eating since I became pregnant?

 

In a word:  no.  Gestational diabetes is a result of those pesky hormones that naturally are secreted from your placenta.  It is not a test to determine how many milkshakes you enjoyed during your first trimester. 

 

With that being said, carrying excess weight puts you at a higher risk of having gestational diabetes, so swapping out a milkshake for a Greek Yogurt parfait once in a while is a good practice.

 

 

Are there any factors that put you at risk for developing gestational diabetes?

 

Yes, some factors put you more at risk for developing gestational diabetes. Most are unfortunately out of your control.  So, even if you have been eating a well-balanced diet and taking care of yourself, you may still be at risk. 

 

Some risk factors include:

advanced age (≥35 years old according to some experts, >25 according to others)

overweight or obesity

excessive gestational weight gain

excessive central body fat deposition

family history of diabetes

history of recurrent miscarriage

gestational diabetes during prior pregnancies

polycystic ovary syndrome

sedentary lifestyle (1)

 

In the literature, the lowest cutoff is ≥25 years old as a risk factor, as recommended by the American Diabetes Association. (2)

  

How does the gestational diabetes glucose tolerance test work?

 

Many providers will start with a glucose challenge test. This test determines how your body tolerates and utilizes a large amount of carbohydrate/sugar/glucose that is taken in at once.

 

Before the test, a woman will drink a very sweet drink called glucola (or an alternative).  One hour later, she will get her blood drawn to determine how much of the sugar from the glucola was used by her body, and how much remains in the bloodstream.  If the blood has too much sugar remaining in the blood after an hour of drinking the glucola, further testing may be recommended. 

 

The one-hour glucose challenge test is not a foolproof test and is not 100% accurate. It is used more as a screening to determine whether a woman needs to do the three-hour test.  As long as your provider approves and your insurance will cover it, you may be able to just take the three-hour test and skip the initial test. 

Glucose tolerance test

Unlike before the one-hour test, the three-hour glucose tolerance test should be taken after fasting.  You may be permitted to take some medication, but otherwise should not eat or drink anything before the test. 

The test is then performed as follows:

1.    You will first have your blood measured to get a value of fasting blood sugar.

2.    Afterward, you will drink Glucola (or equivalent).

3.    Your provider measures your glucose levels once per hour for the next three hours (bring a good book to read!).

 

From there, your provider will evaluate your blood sugar results obtained from your blood draws and determine whether you have gestational diabetes. 

 

 

What is glucola?  Can I drink something other than glucola?

 

Glucola is a a liquid that provides a specific amount of carbohydrates.  Is it the healthiest drink in the world?  No way. Does it taste great?  Not really.  Will it harm your baby if you drink one or two bottles of it?  In our opinion, no.  While the ingredients are not what we normally recommend pregnant women drink, we do not feel that one or two servings of the syrupy drink will cause any negative consequences to your baby.  Living with gestational diabetes and not being aware of it and therefore not managing it is much more risky to yourself and to your baby.

 

Some alternatives that have been suggested to be an acceptable alternative to the glucola are 28 jellybeans that provide 50 gm glucose (2) or ten strawberry-flavored Twizzlers (3). 

 

Please speak with your health care provider if you are exploring any alternatives to the glucola.  For the record, both of us drank the glucola.  We opted for the dye-free version.  It was not organic, not non-GMO, not that great for you.  But we both felt like one or two bottles of the sweet stuff won’t kill us. It’s all about balance, and we generally ate very balanced diets. 

 

Does the flavor of the glucola change the results?

 

We are not aware of one flavor having a different effect on the results vs. another.  All Glucola formulations contain 50 gm glucose. 

 

 

If I have been eating super-healthy, can I skip the glucose tolerance test?

 

We feel like knowledge is power.  Even if you are low-risk for getting the diagnosis and have been eating well, you are not risk-free (nobody is).  As we mentioned previously, gestational diabetes is often a result of the hormones secreted by your placenta on your body, not a result of you frequenting the fast-food lane and enjoying that afternoon daily Frosty.

 

With that being said, it is your right to decline these tests.  Please discuss pros and cons with your provider.  And if you do decline the test, please make sure that you are eating in a way that promotes stabilized blood sugars just in case (it is a healthy way of eating regardless of a diagnosis anyways). 

 

What should I eat before the test?

 

If you are going in for the three-hour test, you should be fasting unless your provider tells you otherwise. 

 

For the one-hour test, the goal should not be to “pass” the test. The goal is to allow your provider to get accurate results.  Failing has such a negative connotation to it.  If your results indicate that you have a diagnosis of gestational diabetes, don’t consider it a failure, consider it a blessing that you know what you have to do to keep your baby healthy while you are pregnant.

 

With that being said, it is possible for you to eat in a way that may give you a false-positive.  Some tips:

 

1.  Avoid high-sugar foods shortly before the test and cut back on simple, or refined, carbs. This includes fruit juice, candy, soda, and sweet tea for all of our Southern friends.  If you choose to eat a piece of fruit, pair it with a healthy fat and protein like a Tablespoon of nut butter or piece of string cheese. 

 

2. Focus on a balance of complex carbs (like whole grains), protein, and healthy fat.  A piece of whole grain toast topped with mashed avocado and an egg is a perfect option!

 

3. Don’t starve yourself.  Your body may over-compensate for the lack of energy that you did not take in and cause your blood sugars to go sky-high. 

 

 

If you are taking the three-hour test, you must be fasting before the test.  Some say that eating a carbohydrate-free snack may be ok, but this is something you need to confirm with your provider before you decide to nosh on a handful of walnuts or some scrambled eggs. 

 

 

Is there any risk to baby if I “cheat” and try to pass?

 

We understand why people may want to do everything they can to pass the test.  Just like when you were in school, cheating catches up with you in the long-run (do we sound like your parents right now?).  If your body is truly experiencing gestational diabetes, why wouldn’t you want to know about it and make some changes to help manage it.  If you have gestational diabetes and are not aware of it and therefore not managing it, ultimately you are putting your baby at risk. 

 

Don’t cheat the system.  Follow the guidelines your doctor provided you and learn what your true results are. 

 

We addressed the risks to baby previously if you do not manage your gestational diabetes if you truly have the condition.

 

Is it normal to feel like crap after the test?  What can I do to help me feel better?

 

Yes, you may feel terrible after you take the three-hour test.  Make sure to have a snack waiting for you so you can eat it when you are dismissed from your test.  Bring along a snack that contains some protein and healthy fat.  A trail mix made with nuts and dried fruit is a great quick snack after your test. 

 

If you get a diagnosis, now what?

 

I know that many look at pregnancy as a time for them to “eat for two”.  Honestly, the recommended dietary pattern to manage gestational diabetes is a way of eating that would likely benefit almost all pregnant women.  It is a balanced way of eating that is rich in fiber, healthy fats, and protein while being low in concentrated sweets. 

 

You should schedule a time to meet with a registered dietitian or a certified diabetes educator to help guide you with your food choices.  You will likely be checking your blood sugars to learn your body and determine which foods you should be focusing on. We are both trained in personalized gestational diabetes nutrition coaching and see clients virtually nationwide.

 

Some additional supplements to consider if you get a diagnosis of gestational diabetes: 

 

 

l-carnitine supplementation may be something to consider to help manage your gestational diabetes or reduce the risk of developing gestational diabetes (4). 

 

Some data also suggests that certain probiotic supplementation may help manage gestational diabetes as well (5).   

 

 

We hope this helps address some of your concerns and misconceptions about the gestational diabetes testing process.  Ultimately, we believe that knowledge is power and understanding how your body digests carbohydrates will help guide you when making food choices.  Please lean on licensed professionals if you receive a diagnosis and need some dietary guidance.  We are always happy to help either by nutrition coaching or by referring you to one of our fabulous colleagues in our network.

Lauren ManakerComment