What gestational diabetes is and how to manage it

Gestational diabetes is surprisingly common—and often comes with no warning signs. While counting carbs isn’t fun, the disease can be managed for a healthy pregnancy.

Photo: Tony Lanz

What is gestational diabetes?

Nycki Etherington was shocked when she was diagnosed with gestational diabetes mellitus (GDM). A slim 29-year-old, Etherington had no risk factors for the disease, which occurs when a woman’s pancreas isn’t able to produce the extra insulin needed to keep increased blood sugar in check during pregnancy. Since GDM has no real symptoms (common complaints of people with diabetes, such as tiredness and frequent urination, are often normal parts of pregnancy), she had no warning signs.

Etherington was given an oral glucose tolerance test between 24 and 28 weeks, and, like almost 10 percent of pregnant women, received a positive result.

Enduring yet another procedure during pregnancy can seem like an unnecessary inconvenience—the oral glucose tolerance test takes several hours to complete—yet it’s essential to catch and treat this condition. Left unchecked, high blood sugar levels increase the risk of developing pre-eclampsia, which is life-threatening to both mom and baby. As well, women with GDM may give birth to very large babies, which can get stuck in the birth canal and require intervention, such as a C-section. However, as Winnipeg endocrinologist Pam Katz notes, the condition is highly manageable. In fact, if women with GDM are properly monitored and work to keep their blood sugar levels in check, most go on to have healthy pregnancies. “With education and support,” Katz says, “most patients with gestational diabetes have a positive experience and a great outcome.”

This is why the Canadian Diabetes Association recommends that pregnant women get tested. “If we depended on risk factors alone, then 50 percent of women with GDM would be missed,” says Denice Feig, head of the Diabetes in Pregnancy Program at Mount Sinai Hospital in Toronto. In fact, one Ontario-based study by the Institute for Clinical Evaluative Sciences and Mount Sinai Hospital found the rate of GDM and pre-GDM (diabetes that existed prior to the pregnancy) doubled from 1996 to 2010, largely due to lifestyle changes.

How to manage gestational diabetes

When she was diagnosed, Etherington fretted about everything from what foods to eat to whether her baby would make it to term (premature birth is another concern with GDM). She knew she needed to adopt a healthy eating plan and incorporate more exercise into her routine to help manage her glucose levels. To ease the transition, she attended free diabetes courses at Women’s College Hospital in Toronto, where she learned about nutrition, obtained a glucose meter, and was taught how to prick her finger and interpret the results. “I felt like a human pincushion,” she says, recalling how squeamish she was at first about testing herself four times a day. “It hurt for the first little while, until I got used to it.”

Etherington became diligent about reading food labels, counting carbs and eschewing high-sugar foods for lower-sugar ones. Through trial and error, she found that potatoes, her favourite food, spiked her glucose levels so much that she had to cut them out completely, along with her beloved pasta and baguettes. “It was difficult and stressful,” she says. “I had to measure everything—even carrots.” Some days, no matter how hard she tried to eat a healthy diet, she’d still have a high blood sugar reading.

But despite the occasional elevated level, diet and exercise were enough to keep Etherington’s GDM under control during the pregnancy, as well as when she was pregnant with her second child.

Tara Peel, a 43-year-old mother of two from Winnipeg, had a trickier time with her recent second pregnancy. Having many risk factors for GDM (she’s over 35, had GDM in her first pregnancy and has a family history of diabetes), Peel was expecting the diagnosis, even though she had adopted a diabetes-friendly diet and boosted her exercise level early on. Because Peel’s blood sugar rose while she slept, no matter how perfect it was during the day, she had to give herself insulin injections every night before bed. “It wasn’t hard to learn,” she says of her pen-like needle. “It sometimes stung a little if I injected the insulin too fast or poked a blood vessel, but mostly I didn’t feel it.”

Having to take insulin pushed Peel into the category of a high-risk pregnancy, which meant she had to abandon her natural at-home birth plan in favour of a hospital delivery and add monthly consultations with an endocrinologist to her schedule. Overall, though, she has found her diabetes easier to manage the second time around. “I had a lot more control over this disease than I expected to,” she says. The keys were eating well, resisting temptation (parties were tough) and exercising frequently (she favoured going for brisk walks and dancing). Peel even found ways to work well-loved foods into her diet: When craving a hamburger, she ate it open-faced and opted for a salad instead of fries. “If I wanted to indulge a little, I had to be prepared to do some extra exercise,” she says.

Today Etherington, now a mom of two school-aged girls, is happily diabetes-free. The disease disappeared within weeks after the birth (as it does for almost all women with GDM), but she and her children are at an increased risk of developing type 2 diabetes later in life; one in five women who had GDM will be diagnosed with type 2 diabetes within nine years of giving birth, and their children are six times more likely to develop the disease than their peers. As a result, both Etherington and Peel are maintaining their healthy lifestyles, and they both schedule annual checkups to ensure they keep the diabetes at bay.

Etherington still counts carbs and tries to limit sugar. She’s also added running, an exercise she once despised, to her fitness program. “Being thin all my life, I never had to worry about what I ate,” she says. “Having gestational diabetes taught me that what we eat has consequences for our health.” But that doesn’t mean she shuns all of her favourite foods. “I still love nothing more than a beautiful baguette.”

Risk factors for gestational diabetes

• Being 35 years old or older

• Being of First Nations, Hispanic, Asian, South Asian or African descent

• Being overweight or obese before pregnancy

• Having a history of GDM

• Having a family history of type 2 diabetes

• Previously having a baby who weighed more than nine pounds at birth

• Having polycystic ovary syndrome or acanthosis nigricans (darkened patches of skin)

• Being pregnant with a boy (new research shows this increases your risk by seven percent over those who are pregnant with girls)

A version of this article appeared in our September 2015 issue with the headline, “No sweets for two”, p. 38.

Read more:
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Should gestational diabetes be treated?>
Exercise: Myths about working out during pregnancy>

For more tips on how to eat for for two and stay healthy check out this video:

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