Gestational Diabetes Mellitus – Part 3

In the previous article, we talked about the importance of treating gestational diabetes mellitus. We will discuss in depth about the management of gestational diabetes in this article.

Key Components of Gestational Diabetes Management

  • Healthy eating
  • Physical activity
  • Blood glucose (sugar) monitoring
  • Medications (if needed)

1. Healthy Eating

A healthy eating plan is an integral part of gestational diabetes management.

The aims of a health eating plan are:

  • To keep your blood glucose levels within the target range (as advised by your doctor)
  • To provide adequate nutrition for you and your growing baby
  • To achieve appropriate weight changes during the remainder of your pregnancy

Women diagnosed with gestational diabetes are encouraged to eat regular meals with smaller portion sizes. A small snack can be incorporated between the main meals. Some carbohydrates need to be included in every meal and snack.

Carbohydrates in foods are broken down into glucose (sugar) and used by the body for energy. Carbohydrates are very important for the nutrition of both your baby and yourself. To help manage blood glucose levels, it is important to spread carbohydrate-containing foods over 3 small meals and 2-3 snacks each day.

Foods containing carbohydrate include:

  • Breads and breakfast cereals
  • Rice, noodles, pasta
  • Chapati, thosai, idli
  • Potatoes, sweet potatoes, corn, yam
  • Legumes such as baked beans and lentils
  • Fruits
  • Milk, yoghurt

It is important to avoid carbohydrate foods that contain little nutritional value. These include include sucrose (sugar), soft drinks, cordials, fruit juices, cakes and biscuits.

In some women, blood glucose levels continue to be high even with
healthy eating and regular activity. If this happens, it is important for the woman not to cut back on carbohydrates as the baby requires carbohydrate as its main energy source. Medications will be needed to control blood glucose levels in this case.

It may be helpful for you to see a dietitian (or nutritionist) who will advise you on getting the proper nutrients for you and your baby, while assisting you to make healthy food choices for managing your blood glucose levels.

2. Physical Activity

Any activity that gets you moving is generally good for lowering blood glucose levels in gestational diabetes.

Walking is a great way to be physically active. Incorporate walking after eating your meals will help to lower your post-meal blood glucose levels and improve overall control of gestational diabetes. Walking can also help to prevent excessive weight gain during pregnancy.

It is important to try and be physically active every day. Before starting or continuing any form of physical activity, always check with your doctor first.

3. Blood Glucose Monitoring

Testing or monitoring your blood glucose levels will enable you to:

  • Understand the effect of food and physical activity on your blood glucose levels
  • Know when to seek advice from your doctor
  • Develop confidence in managing your gestational diabetes

Target blood glucose levels for women with gestational diabetes:

  • Before meal: 4.0 to 5.5 mmol/L (70 to 100 mg/dL)
  • 1 hour after meal: 6.6 to 7.7 mmol/L (120 to 140 mg/dL)
  • 2 hours after meal: 5.5 to 6.6 mmol/L (100 to 120 mg/dL)

If your blood glucose levels consistently exceed the blood glucose targets, you should seek advice from your doctor regarding if medication is necessary for blood glucose control.

4. Medications For Blood Glucose Control

If your blood glucose levels cannot be controlled by healthy eating and physical activity, your doctor may suggest to start medication.

Insulin treatment is the safest and most utilized method for blood glucose control in women with gestational diabetes.

Insulin therapy is the safest because insulin does not cross the placenta into the baby’s body and does not affect the baby directly. Insulin controls the mother’s blood glucose levels and the baby’s blood glucose levels will also be controlled in turn.

Insulin is given via injections over the abdomen. usually using a pen device. For best blood glucose control, rapid-acting insulin has to injected before each main meal to control post-meal blood glucose level rise. Long-acting insulin may also need to be injected at bedtime to control blood glucose level during the sleeping hours and in between meals.

It is common for the insulin doses to be increased regularly as pregnancy progresses. This is due to the increase levels of placental hormones being produced and causing insulin resistance.

Insulin treatment is continued until the delivery of the baby. As gestational diabetes resolves for most women after the delivery of the baby, insulin treatment is usually stopped after the baby is delivered.

Another medication that can be used for blood glucose control in gestational diabetes is a tablet medication known as metformin. Metformin can help control blood glucose levels that are mild to moderately elevated in women with gestational diabetes.

Although metformin crosses the placenta and enters the baby’s body, studies have shown no short-term harm to the baby when metformin is used during pregnancy. Long term safety of metformin for the child remains to be determined.

Summary

Healthy eating, physical activity and regular blood glucose monitoring is essential for every woman diagnosed with gestational diabetes.

The majority of women with gestational diabetes will be able to achieve satisfactory blood glucose control and prevent complications through healthy eating and physical activity alone.

A minority of women will need medications (insulin injections or metformin) to help improve blood glucose levels.

In the final part, we will talk about the post-delivery management and future risks of gestational diabetes.