Understand gestational diabetes
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|   Jul 15, 2016
Understand gestational diabetes

Gestational diabetes mellitus (GDM)
Women diagnosed with high blood sugar levels during pregnancy without previously diagnosed diabetes. This is more likely to happen during 24-28 weeks of gestational age. Women those already have diabetes before pregnancy, do not come under this category.
Subcategory
Type A1: abnormal oral glucose tolerance test (OGTT), but normal fasting and postprandial sugar.
Type A2: abnormal OGTT compounded by abnormal glucose level during fasting and/or after meal.

High risk factors
Overweight or obese
Impaired glucose tolerance.
Poly-cystic ovarian disease.
Previous history of GDM.
Strong family History of diabetes.    
Maternal age (women conceive after age of 35 years).
Previous pregnancy resulted baby more than 4 kgs.

Screening test
1.    Screening during pregnancy
A 50grms oral glucose challenge at 24-28 weeks of gestation. This test doesn’t require fasting.
A plasma glucose level of 140 mg/dl, 1 hr later indicate the need of further diagnostic test.
2.    Oral glucose tolerance test with an abnormal screen
After 100 grms oral glucose load, GDM may be diagnosed if two plasma values equal or exceed:
Fasting>= 95 mg/dl
1hr >=180 mg/dl
2hr >=155 mg/dl
3hr >=140 mg/dl

Effects on baby
Macrosomia (baby weigh more than 4kgs at the time of birth)
Baby with hypoglycemia just after birth.
Respiratory distress syndrome.
Higher chance of dying before or after birth.
Baby more likely to become diabetic overweight and develop type 2 diabetes when grow old.

Effects on Mother
Preeclampsia
Depression.
Increased chances for caesarean delivery.
Increased chances of being diabetic after delivery or later in life.

Treatments involve
Physical activity
Insulin shot
Healthy eating


Physical activity
Being physically active normalize blood pressure, improve insulin sensitivity, improve blood flow, helps you to maintain blood glucose levels, improve digestibility. One can do following activities.
General or daily activities.
Meditation on daily basis.
Yoga for 30 mins for 5days a week.
Stretching under expert guidance.
Aerobic exercise.
Try brisk walking, swimming, dancing.
•    Ask your doctor if you may continue some higher intensity sports to strengthen muscles and bone if you were already doing them before becoming pregnant, such as lifting weights or jogging.
•    Avoid activities in which you can get hit in the stomach, such as basketball or soccer.
•    Avoid activities that may cause you to fall, such as horseback riding or downhill skiing.
•    Do not exercise on your back after the first trimester. This kind of physical activity can put too much pressure on an important vein and limit blood flow to your baby.


Insulin shot
To maintain normal blood sugar level.
To avoid ketoacidosis.
To gain weight consistently.
Type A1 GDM may do not require insulin shots, only maintaining a good diet and physical activity can subside the effects.


Healthy eating.
 Small but frequent meals.
High protein diet.
Carbohydrate should be well distributed throughout the day into three small- to- moderate size meal and two to four snacks.
Diet plan must contain at least 175 grms of carbohydrate. Diet containing lesser carbohydrate is not recommended.
Evening snack is needed to prevent accelerated ketosis overnight.
Include milk and milk products.
Include low glycemic food.
Include fruits and vegetables on daily basis.
Avoid eating too much food at a time or high density food at a time.
Include fiber rich food in diet.
Fat restriction.
Salt restriction.
Avoid food those are responsible for water retention like- concentrated salt products, Preservatives, food rich in sodium.
Weight loss is not recommended during pregnancy but there should be calorie restriction for obese mother under proper supervision.

Myths and Truths
Myth-
Mother with GDM who is taking insulin shots can have everything and in any amount she wants to have.
Truth-
Mother with GDM has to follow an individualized plan with proper distribution of carbohydrate and particular time schedule.  So if they have craving for something they have to turn towards their nutrition expert because they distribute amount of carbohydrate according to insulin peak.
Myth-
Fasting can bring blood sugar levels to a normal.
Truth-
Fasting worse the condition, it can lead high blood sugar, high insulin in blood, ketosis and other relative condition.
Myth-
Women with GDM can’t eat rice, potatoes or mangoes.
Truth-
Women with GDM can have rice or other food.
These food have high Glycaemic index which causes immediate rise of blood sugar so before eating such food proper knowledge/ guidance require.


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