With gestational
diabetes there generally aren't any symptoms. However, there are patients who
are at greater risk. So a a woman whose parents have had type 2 diabetes, or
who is obese, or who has had a very large baby, or who is spilling sugar in her
urine, or who has polycystic ovarian syndrome or who's had gestational diabetes
before, those are all high risk conditions and those women we would test for
glucose tolerance as soon as we saw them in pregnancy.
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| GESTATIONAL DIABETES: DIAGNOSIS AND TREATMENT |
I mentioned that having
gestational diabetes greatly increases your risk of having type 2 diabetes and
sometimes women will develop that type 2 diabetes between pregnancies and we
want to know if that's happened. Now for the average patient, we'll test them
with a blood glucose testing when they get to be about twenty-four to
twenty-eight weeks pregnant. And that's because the hormonal changes of
pregnancy are exerting their effects.
1. They're increasing the
resistance to the action of insulin. And so if we're going to see glucose
intolerance or gestational diabetes, it'll be evident by twenty-four to
twenty-eight weeks. The other point is if we test the patients and we find they
have an abnormal test and we treat them, we can prevent some of the adverse
outcomes, which for gestational diabetes one of the biggest concerns is having
a baby that's over ten pounds that can be very difficult to deliver and have a
traumatic birth.
2. The other reason we
want to avoid the babies getting too big and too fat is cause if they are too
big and too fat at delivery, they're more likely to grow up to be fatter as
children and adults and they're also more likely to grow up to have diabetes
themselves. So the testing that we do includes, at about twenty-four to
twenty-eight weeks, having the mother drink a sugary liquid and then measuring
her glucose one hour later. If that's elevated, that screening test is
positive, then we go on and we do a full three-hour oral glucose tolerance
test. And if that's abnormal, then we begin treatment. And for most patients,
treatment is going to be diet, making sure that the patient has a balanced diet
and doesn't eat concentrated sweets, candies, soda pop that's sweetened with
sugar. Eats a balanced diet where most of the carbohydrates come from complex
carbohydrate sources and we also encourage the moms to exercise.
3. Brisk
walking every day will help to reduce her glucose levels and reduce the chances
that she'll need to go on to additional therapy. And some patients, and it
varies from patient to patient, but overall about twenty to thirty percent of
patients, despite following the diet, will have glucose levels that are too
high and we know that because we also have the patients monitor their glucose
levels using a glucose meter usually about four times a day - when they get up
in the morning and then after each meal. And if those levels are too high, if
the pattern of those tests demonstrates they’re too high, which could be
dangerous for the baby and lead to that baby being too big, and then we would
start additional therapy. It might be an oral hypoglycemic, a pill, or it might
be insulin.
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