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Gestational diabetes

Diabetes - gestational

What is diabetes?

Diabetes is a common life-long health condition. There are 2.8 million people diagnosed with diabetes in the UK and an estimated 850,000 people who have the condition but don’t know it.

Diabetes is a condition where the amount of glucose in your blood is too high because the body cannot use it properly. This is because the pancreas does not produce any insulin, or not enough, to help glucose enter your body’s cells – or the insulin that is produced does not work properly (known as insulin resistance). Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it is used as fuel for energy so we can work, play and generally live our lives. It is vital for life.

Glucose comes from digesting carbohydrate and is also produced by the liver. Carbohydrate comes from many different kinds of foods and drink, including starchy foods such as bread, potatoes, rice, pasta and chapatis; fruit; some dairy products; sugar and other sweet foods.

If you have diabetes, your body cannot make proper use of this glucose so it builds up in the blood and isn’t able to be used as fuel.

During your Pregnancy, Darent Valley Hospital can offer and provide great care for you and your baby and depending on which type of Diabetes you have will determine the Care Pathway we choose for you and tailor it towards your individual needs.

If you have diabetes and you are considering starting a family, we offer a pre conceptual service in the Diabetes Centre and would love to see you in order to get good glycaemic control before you discover you are pregnant. All you need to do is discuss with your GP your plans for a future family and ask him/her to refer you to the pre-conceptual clinic at Darent Valley Hospital. It is important to have good glycaemic control prior to becoming pregnant to ensure a healthy baby and pregnancy.

What is Type 1 diabetes?

Type 1 diabetes develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin.

Insulin is the key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel. In Type 1 diabetes the body is unable to produce any insulin so there is no key to unlock the door and the glucose builds up in the blood.

Nobody knows for sure why these insulin-producing cells have been destroyed but the most likely cause is the body having an abnormal reaction to the cells. This may be triggered by a virus or other infection. Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially in childhood.

Type 1 diabetes accounts for between 5 and 15 per cent of all people with diabetes and is treated by daily insulin injections, a healthy diet and regular physical activity.

At Darent Valley we offer a service to our pregnant ladies where you are routinely monitored and seen by the Diabetes and Pregnancy team. Your care will be tailored to your needs and we endeavour to ensure you have a positive experience.

What is Type 2 diabetes?

Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance).

Insulin acts as a key unlocking the cells, so if there is not enough insulin, or it is not working properly, the cells are only partially unlocked (or not at all) and glucose builds up in the blood.

Type 2 diabetes usually appears in people over the age of 40, though in South Asian and black people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities.

Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin is often required.

If you are diagnosed with Type 2 Diabetes you receive the same high quality care as a Type 1 would receive. In addition to the team you may also see a diabetic Specialist Nurse, who will offer the same high quality service. 

Gestational diabetes

What is gestational diabetes?

Gestational diabetes mellitus (GDM) is a type of diabetes that arises during pregnancy (usually during the second or third trimester).

In some women, GDM occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy. In other women, GDM may be found during the first trimester of pregnancy. In these women, the condition most likely existed before the pregnancy. 

A test called an Oral Glucose Tolerance Test (OGTT) is used to diagnose GDM. An OGTT involves a blood test before breakfast, then again two hours after a glucose drink.

How will I know if I have it?

At the booking appointment you will be assessed for risk factors that can make you more likely to have gestational diabetes. These include:

  • Obesity 
  • A family history of diabetes (parent, brother or sister) 
  • An unexplained stillbirth or neonatal death in a previous pregnancy, and/or 
  • A very large infant in a previous pregnancy (4.5kg or over) 
  • You have had gestational diabetes before 
  • Your family origin is South Asian, Black Caribbean or Middle Eastern. 
  • Persistent sugar in your urine at Ante Natal visits. 
  • Excessive “water” around your baby. This is usually confirmed by a scan appointment. 
  • Diagnosed ‘large for dates’ diagnosed following USS.

If you have any of these characteristics you should be offered a test for gestational diabetes.

How will it affect my baby?

In most cases, gestational diabetes comes to light during the second trimester of pregnancy. Since the baby’s major organs are fairly well developed at this stage, the risk to the baby is lower than for women with Type 1 or Type 2 diabetes. However, babies of women who had blood glucose problems that were undiagnosed before pregnancy, have a higher risk of malformations. The degree of risk depends on how long blood glucose levels have been high and on how high the levels have been. 

What is the treatment?

Often, blood glucose levels can be controlled by diet. You will be referred to a dietitian and specialist nurse/midwife who will advise you about healthy eating. If your blood glucose cannot be controlled by diet, you may need tablets or insulin to treat your diabetes (this applies to about 10 - 20 per cent).

Blood glucose target levels are the same as for women with Type 1 or Type 2 diabetes and you will receive the same specialised care as they do. 

Will it go away after my baby is born?

Usually it does. Before you are discharged to the care of your GP you will be advised to have your bloods repeated 6 weeks following the delivery of your baby. This should be a fasting blood test six weeks after your baby is born and then it should be repeated every year by your GP. If you took medication (tablets or insulin) during your pregnancy, you will be able to stop them once your baby is born.

Women with GDM have a 30 per cent risk of developing Type 2 diabetes during their lifetime (compared to a ten per cent risk in the general population).

About five to ten per cent of women with GDM develop Type 1 diabetes sometime in their life. These women have a slowly developing form of Type 1 that is ‘unmasked’ during pregnancy. With this in mind will we advise you to continue with the “Healthy Eating Plan” that was adopted in pregnancy in order for you to have a healthy and happy future.

Will I get gestational diabetes with other pregnancies?

You are more likely to develop GDM again if you have had it in previous pregnancies; but, if you are overweight and lose weight, you may cut your risk of having GDM again. If you plan another pregnancy you should be offered the opportunity to self-monitor your glucose levels, with an OGTT at 16-18 weeks which will be repeated at 28 weeks if normal.

Harvesting of colostrum and breast feeding

At Darent Valley Hospital we offer a service for all mothers with diabetes who would like to breast feed their newborn babies, and commence from 36 weeks the expressing of colostrum and storage in order to feed baby at birth with pre expressed breast milk. The importance of harvesting colostrum in the ante natal period for high risk mothers has been highlighted in order to reduce the incidence of neonatal hypoglycaemia (Low blood sugars), avoiding the supplementation of breast fed babies with formula. This has numerous additional health benefits, inclusive of reduced risk of type 2 diabetes in mother and child. If you would like to discuss the possibility of harvesting of colostrum further please contact the infant feeding advisor or specialist diabetic midwife. 

Treating diabetes

Diabetes is serious and should be treated properly. People with diabetes should have access to good, regular healthcare. However, at the same time, the decisions that are made by those with diabetes are central to the management of their condition.

Although diabetes cannot yet be cured it can be managed very successfully. This is likely to involve lifestyle changes that will have enormous health benefits and allow a person to continue their normal day-to-day life. You may also be required to take diabetes medication or insulin, or a combination of the two.

Diabetes medication

If medication is needed to achieve good diabetes control your healthcare team will discuss the best choice of treatment. 

Diabetes medication will not cure your diabetes and most people will have to take them for the rest of their lives, but medication will help you to feel better by relieving the symptoms of diabetes and reducing your risk of complications.

If you take medication, it is important to know how it works, and to be aware of the potential problems/side effects you may have. Remember that you can always discuss any questions you may have about your treatment with your diabetes healthcare team.

It is important to remember that the medication is not instead of diet and physical activity: you will still need to continue with this. Increasing or changing diabetes medication is not a sign that your diabetes is becoming more severe, but that your healthcare team are working with you to improve your diabetes management.

Treatment with insulin

All people with Type 1 diabetes will require insulin and eventually, some people with Type 2 diabetes find that despite having their diabetes medication adjusted, their blood glucose levels remain too high and insulin treatment is recommended by their doctor.

Insulin cannot be taken in a tablet form because, being a protein, it would be digested in the stomach before it had any effect. Insulin can be given in different ways via an injection, using a syringe, pen device or via an insulin pump. The needle is small, as it only needs to be injected under the skin (subcutaneously), either in the stomach, buttocks, thighs or upper arms. The insulin is then absorbed into small blood vessels and arrives in the bloodstream.

There are six main types of insulin available in various combinations and they all work in different ways. Your diabetes healthcare team will discuss the different options available and answer any specific questions you may have.

Eating well

Being diagnosed with diabetes means that you should be able to continue enjoying a wide variety of foods as part of a healthy diet. At first it can appear a challenge but the food choices you make and your eating habits are important in helping you to manage your diabetes and long-term health.

The information in this section is a starting point to help you eat well when you have diabetes. You should also be referred to a registered dietitian for specific information tailored to your needs.

Steps to eating well

  • Eat three meals a day
  • Avoid skipping meals and space your breakfast, lunch and evening meal out over the day. This will not only help control your appetite but will also help control your blood glucose levels.
  • At each meal include starchy carbohydrate foods. Examples of these include bread, pasta, chapatis, potatoes, yam, noodles, rice and cereals. The amount of carbohydrate you eat is important to control your blood glucose levels. Especially try to include those that are more slowly absorbed (have a lower glycaemic index) as these won’t affect your blood glucose levels as much.
  • Better choices include: pasta, basmati or easy cook rice, grainy breads such as granary, pumpernickel and rye, new potatoes, sweet potato and yam, porridge oats, All-Bran and natural muesli. The high fibre varieties of starchy foods will also help to maintain the health of your digestive system and prevent problems such as constipation.
  • Cut down on the fat you eat, particularly saturated fats
  • A low fat diet benefits health. Choose unsaturated fats or oils, especially monounsaturated fat (e.g. olive oil and rapeseed oil) as these types of fats are better for your heart. As fat is the greatest source of calories, eating less will help you to lose weight if you need to. To cut down on the fat you eat here are some tips:
    • Use less saturated fat by having less butter, margarine and cheese. 
    • Choose lean meat and fish as low fat alternatives to fatty meats. 
    • Choose lower fat dairy foods such as skimmed or semi-skimmed milk, low-fat or diet yogurts, reduced fat cheese and lower fat spreads. 
    • Grill, steam or oven bake instead of frying or cooking with oil or other fats. 
    • Watch out for creamy sauces and dressings and swap for tomato-based sauces instead. 

Eat more fruit and vegetables

Aim for at least five portions a day to provide you with vitamins, minerals and fibre to help you to balance your overall diet. One portion is, for example, a banana or apple, a handful of grapes, a tablespoon of dried fruit, a small glass of fruit juice or fruit smoothie, three heaped tablespoons of vegetables or a cereal bowl of salad. Include more beans and lentils. Examples include kidney beans, butter beans, chickpeas or red and green lentils. They have less of an effect on your blood glucose levels and may help to control your blood fats. Try adding them to stews, casseroles and soups, or to a salad.

Aim for at least two portions of oily fish a week. Examples include mackerel, sardines, salmon and pilchards. Oily fish contains a type of polyunsaturated fat called omega 3, which helps protect against heart disease.

Limit sugar and sugary foods

This does not mean you need to eat a sugar-free diet. Sugar can be used in foods and in baking as part of a healthy diet. Using sugar-free, no added sugar or diet fizzy drinks/squashes, instead of sugary versions can be an easy way to reduce the sugar in your diet.

Reduce salt in your diet to 6g or less a day

More than this can raise your blood pressure, which can lead to stroke and heart disease. Limit the amount of processed foods you eat (as these are usually high in salt) and try flavouring foods with herbs and spices instead of salt.

Drink alcohol in moderation only

That’s a maximum of two units of alcohol per day for a woman and three units per day for a man. For example, a single pub measure (25ml) of spirit is about 1 unit or half pint of lager, ale, bitter or cider has 1–1 1/2 units.

Over the years the alcohol content of most drinks has gone up. A drink can now contain more units than you think – a small glass of wine (175ml) could contain as much as 2 units. Remember alcohol contains empty calories so think about cutting back further if you are trying to lose weight.

Never drink on an empty stomach, as alcohol can make hypoglycaemia (low blood glucose levels) more likely to occur when taking certain diabetes medication.

Don’t use diabetic foods or drinks

They offer no benefit to people with diabetes. They will still affect your blood glucose levels, contain just as much fat and calories as the ordinary versions, can have a laxative effect and are expensive.

Diabetes UK recommends

That everyone with diabetes should see a registered dietitian at diagnosis, and then have regular reviews. Ask your 

GP to refer you to a registered dietitian.

For more information visit www.diabetes.org.uk or speak to your GP/midwife.

For information in other languages please ask your health professional or visit the above website.