Managing Gestational Diabetes

The whole purpose of managing gestational diabetes is to maintain normal blood glucose levels. So that you can have the best possible outcome for you and your baby.

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Who Makes up this Health Care Team?

A few medical professionals can make up the health care team. You might not need them all in managing gestational diabetes, your doctor will advise. These health care providers are there to assist you in having a healthier pregnancy, heed their advice.

An Obstetrician. A specialist in the care of pregnant women.

A General practitioner who has an interest or training in gestational diabetes.

A Family doctor who has an interest or training in gestational diabetes.

A Medical nurse who is trained in the care of pregnant women.

A Certified professional midwife.

A physician's assistant who has training in the care of pregnant women.

A registered dietitian.

• Every person has very different personal and nutritional needs.
• Essential for ongoing assessment and counseling.

A certified diabetes educator (CDE)

• Expand your understanding of gestational diabetes.
• Help you adjust to living with gestational diabetes.
• Assist you in managing gestational diabetes.
• Any health professional that is also trained in diabetes, like:
• Registered nurses.
• Dietitians.
• Doctors.
• Pharmacists.

Other specialists.

• Usually take only one consultation, and then you return to the care of your regular doctor.
• If you need to take insulin injections, you may need an appointment with one of these:

An Endocrinologist. A Specialist in the study of the glands and hormones of the body and their related disorders.

A perinatologist. A doctor who specializes in high-risk pregnancies.

Even though all these professionals are ready to assist you, they cannot do it for you. You are the one that must make the decision to put their advice into actions.

Managing gestational diabetes is your responsibility.

It is a decision that you, and you alone can make. Nobody else can do it for you, all they can do is to support, guide and assist you.
It really is up to you.

Your baby is depending on you!

What you must Do to be Successful at
Managing Gestational Diabetes

The goal of managing gestational diabetes is to maintain normal blood glucose levels. In order to achieve this, you need to do the following:

• Follow the instructions and advice from your health care team.
• Keep a Journal of your managing gestational diabetes journey.
• Know what your blood glucose levels are, by measuring multiple times per day.
• Have an attitude of healthy eating at all times.
• Participate in daily physical activity.
• Keep your stress levels down.

Follow the Instructions and Advice
from your Health Care Team

A rather obvious instruction, work with your care team, not against them. It is the best way to managing gestational diabetes.

When you are advised on something that disagrees with you, do not ignore it! Together with the care provider, work out a plan that does suit your personal needs.

Remember, it is your body and your baby, accept responsibility and take charge.
The health care team is there to assist you to the best of their knowledge and experience.
However, it is still up to you to carry out their instructions, suggestions and advice.
It is up to you how you are managing gestational diabetes.

If you are taking insulin, take note to do the following:

• Always have emergency details available on your person or in your purse.
• Stating that you have gestational diabetes, and that you are taking insulin.
• Emergency contact number of your doctor.
• Contact number of a family member or friend.
• Anything else that you might consider helpful to anyone assisting you.
• Ensure that those around you, at work and at home, know what to do in an emergency.
• Know how to take your blood glucose measurement.
• Know that low blood sugar is when it is less than 60 mg/dl (3.3 mmol/L)
• Know how to deal with low blood sugar.

Call 911 or other emergency services when:

• You lose consciousness or become unconscious.
• You have symptoms of low blood sugar, and it does not go away after you applied corrective measures.
• When you have low blood sugar and are unable to keep food down.
• Even after applying corrective measures for low blood sugar, you are becoming more and more sleepy.

Do not wait for your next appointment, call your doctor when:

• You notice a change in the pattern of fetal movements. (Kick counts)
• Your baby stops moving.
• Your blood sugar levels stays low after following the steps for dealing with low blood sugar.
• You are taking insulin and your blood sugar levels stays high after you applied corrective measures.
• Have diarrhea for more than six hours.
• You have been vomiting for more than six hours.
• You think that you have symptoms caused by high blood sugar,
  such as:
• Increased thirst.
• Increased hunger.
• Increased urination.
• Blurred vision.
• The home treatments for high blood sugar, suggested by your doctor, have not worked.
• Your blood sugar levels are consistently above 150 mg/dl (8.25 mmol/L)

Keeping a Journal makes
Managing Gestational Diabetes easier

A journal will help your health care team in better assisting you. The more you record, the better it will be.

However, present the journal to your health care team as summaries. The full details are only necessary when a summary highlights a potential problem.

To summarize is easy, plot your blood sugar levels, and weight on graphs. At the end of each week jot down the highlights (and low points) for the week. Repeat for a monthly summary.

Record everything that you eat and drink, as well as the time and volume. Keeping a record of your ingesting habits will keep you "honest".
It is easy to underestimate how much snacking you really do. That extra nibble, snack and second helpings really do add up.

Sometimes you know what you are doing is wrong, do not hide it, record it. All mistakes and wrong doings must be recorded.
Your health care provider can zero in on these errors and suggest suitable corrective actions. It is all about managing gestational diabetes.

Useful information to record in your journal:

• Blood glucose levels.
• Daily and/or weekly weights.
• Blood pressure.
• Waking pulse count.

Kick counts.

• Start at week 25 and continue until your baby is born.
• Length of time it takes for your baby to do ten movements.
• Schedule the kick count during your baby's most active time of the day.
• You must have time available to record the movements over a three to four hour period.
• Note the time on a chart whenever your baby moves, kicks, flutters, swishes or rolls.


• Everything that you eat and drink, including times and volumes.
• Emotional and physical states throughout the day.
• Physical activities throughout the day.
• Exercises accomplished, with a rating on the effort.
• Incidents like, high/low blood sugar, dizziness, fatigue and sleepiness.
• Questions for your next prenatal appointment, together with the eventual answers.

Keeping a journal lets you take control of your situation. You cannot manage something that you do not measure.
Managing gestational diabetes will be much easier.

The journal is a record of your measurements. It is a tool that will assist in analyzing your progress and failures. Keeping daily records helps to track how well your treatment plan is working.
It shows how well you are managing gestational diabetes and where there is room for improvement.

You might think that keeping this journal is too much work. Actually, it is easier managing gestational diabetes with a journal, than without one.

The price you pay for a healthy baby can never be too high. You decide if you want to give your baby the best start in life. It is your choice!

Know your blood glucose levels 

You cannot manage something that you do not measure. Measuring your blood sugar levels helps you to stay in control of your condition.

Keeping your blood glucose levels normal is what managing gestational diabetes is all about.

Throughout the day, your blood sugar levels change, according to what you eat and your activity level.

The foods you eat, when you eat and how much you eat, influence your blood sugar.

Your level of physical activity and when you do physical activities also affect your blood sugar.

Knowing how your body utilizes glucose during the day is necessary for any treatment adjustment. It is also very useful in helping you managing gestational diabetes.

Taking your blood glucose levels often during the day, every day, will:

• Help to pinpoint when you need to eat.
• Show you how much to eat.
• Show you what foods affect your sugar level.
• Help you come to a better understanding of what you should eat.
• Let you know when your blood sugar levels are in the safe range for exercise.
• Greatly assist your health care provider to better adjust your treatment program, should the need arise.
• Should you need insulin, pinpoint the correct amount of insulin needed during the day.
• Show you the times when your glucose levels are high or low.
• Is a big asset in managing gestational diabetes.

Enquire if your health insurance plan will cover the cost of the glucose testing supplies. Most drug stores, pharmacies or medical supply stores carry the meters, lancets and strips needed.

Your health care provider will advise you as to when to test your blood glucose.

You might need to test as much as four or five times a day.

Shortly after waking in the morning, before you eat.

• Known as the fasting glucose test.
• Most important test that must be done every day, no exception.

One or two hours after each meal.

• It is necessary, to establish how quickly your sugar levels return to normal after eating.
• To let you know when you either ate too much or the wrong food.

Just before going to bed at night.

Sometimes at two or three o'clock in the morning.

• Normally, this is when your sugar levels are at the lowest.
• Known as the nocturnal or night-time glucose level.

Measuring of blood glucose and the healthy ranges.

Ways to describe concentrations of sugar in the blood.

• By weight, milligrams per deciliter. (mg/dl)

The traditional unit for measuring blood glucose.

• With molecular count, in millimoles per liter. (mmol/L)

The number of molecules in a mole is about a six with 23 zeroes.

It is the world standard unit for measuring glucose in blood. The designated SI unit.

Desirable ranges for blood glucose levels.

• Fasting glucose level: 80-108 mg/dl (4.4 - 6 mmol/L)
• Before meals: 80-120 mg/dl (4.4 - 6.6 mmol/L)
• At bedtime: 100-140 mg/dl (5.5 - 7.7 mmol/L)
• One hour after a meal: 90-150 mg/dl (5 - 8.25 mmol/L)
• Two hours after a meal: 80 - 140 mg/dl (4.4 - 7.7 mmol/L)
• Nocturnal glucose level: 80-108 mg/dl (4.4 - 6 mmol/L)

Your treatment plan may need some adjusting, if your sugar levels are consistently outside these ranges.

Consult with your health care provider on how to get back to acceptable levels.

Have an Attitude of Healthy Eating at All Times

Healthy eating is a vital part of managing gestational diabetes.

We all know what is healthy eating (well, most of us do). So why do we not eat healthy at all times?

The answer boils down to one thing, and one thing only - attitude! The most difficult thing to overcome is to get into a healthy mindset. You are what you eat, and you eat the way you think.

Therefore, it is simple; get your thoughts on the right track! The best place to start is to educate yourself and apply your knowledge.

Applied knowledge that works, gives you confidence. Confidence boosts will improve your thinking, which will in turn adjust your attitude.

Having a positive attitude, will also reduce your stress levels.

Successfully managing gestational diabetes is depending a lot on what and how you eat.

Before understanding correct eating habits, you must first know how foods are handled in your body. Understanding how your body refines food will help you develop correct eating habits.

Food consists mainly of:

Protein.

• Protein is the building blocks of the body.
• Protein is needed for muscle tissue repair.

Fat.

• Fats slow down the digestion process so the body has more time to absorb nutrients.
• Fat-soluble vitamins (A, D, E, and K) can only be absorbed if fat is present.
• Fats help provide a constant level of energy.
• Fats keep the body satiated for longer periods.
• Caveat, your fat intake should not be too high and definitely not of the "no fat" variety.

Carbohydrates.

• Carbohydrates are often at the center of a healthy diet.
• During digestion, your body breaks down most carbohydrates into simple sugars, like glucose.
• Carbohydrates are nutrients that come from certain foods, like grain products, fruits, and vegetables.
• Eating carbohydrates affect your blood sugar level.
• Carbohydrates are a major source of glucose, which is your body's main source of energy.

Your body has to work less in breaking down refined foods, like sugar. Therefore, when you eat sugar, the body converts it to glucose quickly.

The result is that your blood glucose levels rise fast. The pancreas now has to work hard to keep up with the production of glucose.

Unrefined carbohydrates take longer to digest and break down into glucose.
Glucose enters the blood stream in smaller amounts at a time. The pancreas can easily stay ahead with the production of needed insulin.

This is known as the glycemic index (GI). GI is a measure of the effects of carbohydrates on blood sugar levels.

Carbohydrates that break down quickly during digestion have a high GI. Carbohydrates that break down more slowly have a low GI.

Foods with a low GI have significant health benefits.

Eating mostly fibrous foods like vegetables will slow down the digestive process.

Including needed protein and fats in your diet, also aids in slowing down the digestive process. Therefore, improving the control over your blood sugar levels, and improving the managing of gestational diabetes.

Now you can look at what you eat with a fresh perspective, for example.

• White bread is digested faster than brown bread.
  The reason is that brown bread has more fibers than white bread.
  The refinement of the white bread ingredients, removes fibers.
  Adding fiber to your diet will assist your body to better utilize glucose.


• To make a glass of orange juice takes about four oranges.
  That is all the nutrients and calories of four oranges, excluding the fiber.
  Firstly, would you eat four oranges in one sitting, then why drink it?
  Secondly, the calories of four oranges are too much to ingest at one time.
  If you want to have fruit juice, dilute it with water.

Eating a healthy diet is such an important part of managing gestational diabetes. It is therefore, essential that you work with a nutritionist to create a healthy diet plan.

It is even more important to follow the plan as outlined by your nutritionist. It will promote health throughout your pregnancy, for you and your baby.

For more on healthy eating, see this detailed overview on the gestational diabetic diet.

Participate in Daily Physical Activity

Physical activity is good for you, even more so when you are diabetic. Regular exercise is the other half in managing gestational diabetes.

Exercise is beneficial because it can give you a feeling of well-being. Exercise can also help improve your muscle tone, circulation and heart functions. Physical activity helps to increase fitness and prepares you for the birth of your baby.

Exercise normalizes blood glucose levels by making cells more sensitive to the action of insulin.

Scientists are not sure exactly how this happens. What they do know is that muscles use more glucose during exercise. This can be as much as seven to twenty times more than normal.

Physical activity also improves the production of insulin.

You should use this metabolic mini miracle to your advantage. Knowing that exercise use more glucose, gives you extra "bullets" to fire at your condition. Using exercise is one of the best methods in managing gestational diabetes.

Every woman is unique, that includes you. Therefore, it is important to find a level of exercise that is safe for you.

Exercise can be very beneficial, only when it is done correctly and at a safe level. It is very important to discuss an exercise program with your doctor, before you start.

Your doctor must determine if you are physically ready to exercise. Your doctor will also advise you on any changes needed as your pregnancy progresses.

In most cases, exercising lowers blood glucose. Sometimes, exercising can increase blood glucose levels.

Therefore, it is important to check your blood glucose levels before and after exercise. If your blood glucose is above 200 mg/dl (11 mmol/L) then exercising may raise it higher. This is when exercising would be a bad idea.

Furthermore, if your blood glucose reaches 240 mg/dl (13.2 mmol/L) contact your doctor immediately.

Exercise can affect your blood glucose levels up to 24 hours after you have stopped exercising. If you exercise different from planned, you may upset your blood glucose levels.

Work with your health care team to get you a personal exercise routine for managing gestational diabetes.

If you exercised regularly before, please continue, but at a more moderate rate during your pregnancy.

If you are not used to regular exercise, do not start a strenuous exercise program while pregnant.

Activities that involve twists, turns, jumping and sudden starts and stops should be avoided. These include things like racket sports, golf, volleyball and basketball.

Jogging is also out, apart from the danger of falling, the pounding can harm the baby. Abstain from anything where there is a danger of falling, like cycling or skiing.

The activity should be low intensity, as simple 20-30 minute walk a day is useful. Go at the pace that is comfortable for you. If you get tired or experience contractions, take a rest and continue later or stop.

For the exercise to be most effective at improving glucose metabolism, it must be regular. Although some days this is a pain, it beats having all the interventions for gestational diabetes.

Regular means every day, or at least every second day. Going for more than two days without exercise and it loses its benefits.

Swimming is an excellent exercise as the buoyancy of the water eases stress on your joints. In addition, it is not hard on the feet or legs, and it is not bone jarring.

If it is available in your area, join a water aerobics class.

Another great way to exercise is walking. A brisk walk after a meal could be ideal for managing gestational diabetes.

At least 30 minutes of activity that gets you slightly breathless each day is recommended for managing gestational diabetes. Although 30 minutes in one go is best, it can also be spread over the day.

There are numerous ways that you can use to make your everyday living more physically active. It is all in the mind, either you want to do it, or you do not! It really is up to you.

Here are some ideas that you can do to be more physically active.

• Park further from the entrance to the shop and walk briskly, a bit more than normal.
• Better still, walk to the local shops instead of driving.
• Carry your purchases rather than pushing it in a trolley.
• Use the stairs instead of the elevator.
• Stay standing and move around while on the phone.
• Do some extra gardening.
• Put a spring in your step and move with dancing steps throughout the house.

Turn the stereo up a bit and dance while vacuuming the carpets.

• The stereo must be loud enough to hear over the noise of the vacuum cleaner.
• This can really boost your morale and lift your spirit.
• If you are not joyful then force yourself, you will emerge happy.

How to stay motivated.

• Start a walking group with friends and family.
• Great way to be in touch daily with loved ones.
• Join an existing walking group.
• Keep a journal of the exercises completed, noting the intensity and how you feel.
• Go over the journal whenever you do feel down or need motivation.
• Join a gym.
• Measure every step during the day with a pedometer, a small device that counts your steps. Aim for a minimum of 10 000 steps per day.

Keep your Stress Levels Down

Stress, be it emotional, physical or mental, will contribute to diabetes.

An important part of managing gestational diabetes is to find ways to lower your stress levels. This can be done in a number of ways including education, breathing, prayer and meditation.

You are living with a condition that can affect your baby's health. Worrying about your baby can make it harder to take care of yourself.

Prolonged stress can even cause your blood sugar level and your blood pressure to rise.

Learn as much as you can about gestational diabetes and pregnancy in general. The more you know the more in control you will feel, and stress less about it.

Talk to your health care team, jot down questions you can ask them at your appointments. Read books and articles about gestational diabetes and proactive care for childbirth in general.

Join or start a gestational diabetes support group or even just a pregnancy support group. Pay it forward by playing a supporting role to someone else.

When helping others you help yourself even more. Assisting others is a great way to find peace within yourself.

When you are frustrated and stressed, logical thinking and reactions fly out the window. You must calm down and compose yourself; otherwise, the situation will get the better of you.

Correct breathing can slow down or halt the hormonal responses that cause the stress reaction.

Correct deep breathing will:

• Stimulate the nervous system to return your body to a resting state.
• Lower your blood pressure and heart rate.
• Increase the oxygen flow to the brain and body.
• Relax the muscles involved in shallow breathing, which causes back problems and headaches.

Steps in breathing deeply and correctly:

• With your eyes closed, stand with your feet roughly a shoulder width apart.
• To feel that you are doing it right, place one hand over your belly button.
• Take a deep breath, allowing your stomach to expand.
• When breathing out, your muscles squeeze the air out of your lungs. At the same time, your stomach must move towards your spine.
• While breathing in or out observe your shoulders and upper chest.
• They must be perfectly still.
• There must be no lifting, expanding, shrugging or rotating.
• You are still breathing shallowly if there is any movement in these areas.
• Take ten very slow breaths like this and your mood will lighten.
• Do it when you feel stressed.
• Try it, lying on your back, just before going to sleep.

Nothing like the present to start with this breathing method. Do it now! Take ten super slow, deep breaths. Do you notice that you feel different?

Parting Thoughts

Changing your diet and routine might be a bit overwhelming at first. It will get easier with practice. Take it day-by-day and soon it will be as natural as brushing teeth.

Managing gestational diabetes may seem like a lot of work. However, having a healthy, happy and beautiful baby makes it all worth it.

The first chance you get to be alone, read your journal to your baby. You will see that in comparison to your beautiful baby, all the effort, worries and struggles are nothing but trivial. Managing gestational diabetes will then be understood and appreciated.

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