Gestational 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.

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 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. 

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.

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. 

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.