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  • Writer's pictureSandhya Gokal

Gestational Diabetes

Updated: Mar 11

Before getting pregnant with my little girl, I went through a period of intense, situational depression. 

You see, this wasn't my first pregnancy. I actually had a miscarriage in August 2021. It was a harrowing experience and resulted in a lot of tears, anger and a sense of desperation. 

Dark days indeed. 

So when the line on the pregnancy test turned into a plus, I was cautiously ecstatic. 

I knew, from my experience and from talking to my colleagues and patients that nothing is guaranteed in pregnancy. Up until the day the baby is born, things can go wrong. 

It's a beautiful and stressful time. 

Still, I got to 20 weeks expecting the worst and experiencing a pretty good time. 

Then 24 weeks in, I went for my OGTT - the oral glucose tolerance test. I was pretty confident that I wouldn't have this. In fact, I was more worried about the actual test than the results, since by all accounts, the drink was disgusting. 

Imagine my dismay when I was told, yes, I did have gestational diabetes. I had to go see and endocrinologist. And to top it all off, I was now at higher risk of type 2 diabetes after pregnancy, and gestational diabetes in further pregnancies. 

Devastation reigned. 

What is gestational diabetes 

Gestational diabetes (GD) is a shift in the body’s ability to handle excess glucose because of the hormonal changes that happen during pregnancy.

This important thing to know is gestational diabetes is NOT your fault. You could have a perfect diet, and still get gestational diabetes. I know someone who lived on Saladas and coca cola during pregnancy because she had hyperemesis gravidarum and she did not get gestational diabetes. This is the most common thing I hear - “I could have prevented it by eating better”.

Family history and genetics can increase the risk of getting diagnosed with GD, but it’s not a cause.

GD is considered a complication in pregnancy because when not enough insulin is produced by your body to handle the amount of glucose coursing through your blood, the excess glucose is absorbed by your cells as energy. It also passes through the placental membrane and goes to your baby. This can cause the baby to grow larger than its gestational age. If this happens, and the baby grows too much, the body thinks that the baby is ready to be born when it might not be developmentally ready, leading to premature labour.

My Experience

As I mentioned, I was pretty devastated when I got diagnosed, as I think most women would be. I should have known better, I was a healthcare professional, I should have eaten better. 

But I have never been one to feel guilty about things I cannot control for long. So I squared my shoulders and headed to the endocrinologist and dietician. To start out with, they recommended trying diet and lifestyle changes with specific recommendations, to see if I could keep my blood sugar levels under control.

Blood sugar level parameters

In normal diabetes, the parameters for blood sugar levels are a little more flexible than in gestational diabetes. The blood sugar levels for GD are as follows

Fasting: <5.3mmol/L

1 hour After meals (post prandial):7.8mmol/L

2 hours after meals: 6.7mmol/L

To check your blood sugar levels, you need something called a blood glucose monitor. They come with test strips and a finger pricking device that uses lancets to draw blood from your fingers to apply to the test strips. The process is relatively painless - perhaps a little sting. It is important that you only prick your fingers on the outer parts of the pads, not the middle. The trick is to put your palms together. Any part of your fingertip you can see is somewhere you can prick. Otherwise, you risk a buildup of scar tissue on the pads of your fingertips, which can cause numbness. 

A common question I get asked is if you can use the same needle to prick your finger multiple times. 

Quick answer? No. 

Long answer? Everytime you use the needle, it bends microscopically. Using the needle multiple times means that each subsequent time will be more painful. It increases the risk of blood borne disease. And there is a small likelihood that the needle will break off while injecting, causing pain and infection. 

Don’t do it. 

The important thing to note is that each endocrinologist will use the baseline blood sugar levels as a guide, but they may require you to stick to different levels depending on your level of risk. This will also affect how they treat you.

Diet and lifestyle guidelines for gestational diabetes.

The first line of treatment in GD is always diet and lifestyle. The rationale behind this is during pregnancy, the less medications introduced into the body the better. This is because medication can often pass through to the placenta and affect the growing baby. 

Here’s the thing. Once diagnosed with GD, I had a few days of “Why, god WHY!” moments because I thought I'd have to be super strict with what I ate and cut out anything I liked. 

But to my relief, the dietary guidelines in GD were not actually that different to what I eat normally!

I thought I had to cut out carbs

Why carbohydrates, you might ask? Isn’t the problem that your body can’t handle carbohydrates?

Well, yes. But to retrain your body to be able to properly breakdown glucose, you need to introduce carbohydrates to give your insulin practice. 

Think about it this way. Say you pulled a muscle while exercising. Once the muscle has healed, you wouldn’t overload your muscle with heavy weights. At the same time, you wouldn’t decide that you were never going to do weights again, because you want to protect your muscle. Instead, the most likely course of action would be to start with light weights and progressively use heavier weights, to build up strength. 

In the same way, eating controlled amounts of carbohydrates allows your body to recalibrate how much insulin needs to be produced in response. 

Dietitian’s talk about something called exchanges, which are basically units of carbohydrates. 15g of carbohydrates is counted as 1 exchange. As a general rule, each meal has to have at least 2-3 exchanges of carbohydrates, while snacks should contain 1-2 exchanges. However, this is always tailored to each woman’s needs. 

I thought I’d have to be overly healthy all the time

One of the real struggles I had was that I was enjoying my remaining time being my own person with no baby attached, and I felt like GD had shackled me because I would never be able to eat any unhealthy foods, even during special occasions like Christmas.

Luckily, during GD, I quickly learnt what foods caused my BGL’s to rise, and what I could handle in small quantities.

A lot of this came down to mindset. Changing mindset around what constitutes a treat and what is unacceptable to put into your body is a game-changer when it comes to frustration around eating. 

Eating snacks throughout the day is actually quite key to keeping blood sugar levels stable. The types of snacks you eat is what counts! Some of the snacks I found most satisfying were:

  • 4 x Vita-wheat crackers with cheese and tomato

  • 1 cup yoghurt with almonds

  • Pear slices with natural peanut butter

The most important snack is actually the last snack before bed - it works to keep your sugar levels steady throughout the night. There is something called the dawn phenomenon where blood sugar levels rise with the sun. The key is to eat your snack just before you go to bed, and then as soon as you wake up. Keep in mind, this is the reading that the endocrinologist may be most interested in, as it is the one you have least control over. 

I thought I only had to change what I ate.

BEEEP. Wrong. One of the best ways to keep blood sugar levels controlled, with or without diabetes, is exercise. Every health care professional I saw throughout pregnancy stressed this repeatedly. 

In GD particularly, going for a 10 minute walk straight after a meal helps bring down BGL’s dramatically. As an added bonus, it helps stave off aches and pains that come about during pregnancy. If your pregnancy symptoms prevent you from walking, light yoga or Pilates (that is safe for pregnancy) or squats can be substituted. The main thing is moving. 

As a bonus, it is great for your relationship if your partner jumps on board with you and you have uninterrupted time together. (Also, if there are hills, it's good to have someone who can lend a helping hand on your back - that is, help push you up the hill)

Remember, during pregnancy, it is inadvisable to lay on your back due to restricting blood flow to the fetus. This is particularly important during the second and third trimesters. If you are unsure about what exercises are suitable, please consult your health care professionals. 

The other amazing way to keep blood sugar levels stable is to drink water. (I know, what cutting edge advice right?) 

My doctor has put me on Insulin, what do I do?

Sometimes, all the diet and lifestyle measures you take cannot counteract what your body does internally. If this happens and your blood sugar levels cannot stay within the accepted ranges, your doctor may put you on injectable insulin. 

First things first. Insulin injections are safe in pregnancy. They are category A which means that many pregnant women have used it with no negative effects to the fetus. 

There are 2 main types of insulin recommended in pregnancy. One is called Protaphane Innolet (isophane insulin) - an intermediate acting insulin which starts working approximately 30-90 minutes after injection, and the effect remains in play for around 24 hours. Protaphane is most commonly used at night time, if the fasting glucose levels do not remain controlled. 

The other is called NovoRapid (insulin aspart) - a short acting insulin that starts working approximately 10-20 miuntes after injection and lasts for about 3-5 hours. NovoRapid is recommended when the post-prandial glucose levels are uncontrolled. 

Insulin injections sound scary as hell, but they are actually quite simple once you get the hang of it!

How do I inject myself?

The most simple explanation is to dial up the units of insulin you’ve been prescribed, and inject it into a fatty area of the body. 

No, I’m not calling you a fatty bom bom. 

Insulin needs to be injected subcutaneously - into the fat layer that sits straight under the skin. Choosing areas that typically hold fat is a sure-fire way to ensure you are injecting correctly. These areas are most commonly the belly and the thighs. It’s definitely safe to inject your stomach during pregnancy, and this is actually the best place to do it provided it is at least 2 inches away from your belly button. The main thing to remember with insulin injections is to ROTATE THE SITE. Doing this prevents scar tissue build up.

If you can’t remember which site you injected last, here are a couple of tips

  • Have a hairtie or ribbon that you tie around your wrist to indicate which side of the belly you injected in last

  • Use the clock method and record it on your phone - imagine your belly is a clock, and inject at the next number each time. This also works with a diamond shape.

To inject insulin

There is a great video to watch how to inject insulin, you can watch it below. 

Here’s a quick summary.

  • Wash your hands

  • Remove the lid of the insulin pen and wipe with an acohol swab. Wait for 10 seconds before attaching the needle. 

  • Dial up 1 unit of insulin and eject through the needle, into the sink, or air. This primes the dose so that when you inject, you can ensure accurate dosing quantities

  • Dial up the required units of insulin

  • Choose your site, and cleanly insert the needle into the site with a stabbing motion at 90 degrees (but no need to be violent about it, a gentle stab works)

  • Push down the button to release the insulin. Hold for 10 seconds.

  • Remove the needle slowly, by coming straight out.

  • Wipe the area with an alcohol wipe

  • Wash your hands and recap the insulin.

Protaphane innolet looks different, but the steps are exactly the same. 

For ease, i am including guides on how to use both Protaphane Innolet and Novorapid Insulin

What comes next? 

After birth, GD tends to disappear completely. The baby’s out, the hormones are slowly ebbing away, and insulin levels tend to stabilise pretty quickly. 

On the day you give birth, your obstetrician may tell you to skip your insulin dose. This is because during the birthing process, you tend to get quite dehydrated, and you can’t eat much, if anything. This means your blood sugar levels will definitely not be high. In fact, the opposite can happen - you can experience LOW blood sugar levels, called hypoglycemia. Hypoglycemia is quite dangerous because it can lead to loss of consciousness. 

Once the baby has safely entered the world, your days of testing and injecting are over! 

Well, for now anyway. 

6 weeks after you give birth, while you are in the throes of newborn help-me-I-have-no-sleep-and-my-baby-is-crying-why-itis, you have a blessed 2 hour break where you have to repeat the OGTT.

This OGTT tells you whether the GD has gone away with no repercussions, or if your body has decided to rebel and stubbornly keep your sugar levels uncontrolled. 

In my case, my body just didn’t want to cooperate, and I was diagnosed with pre-diabetes. Again. Sigh. All this means is that I now have to do the OGTT every year, and maintain healthy eating habits, so that it doesn't turn into full-blown diabetes.

Once you have a baby, life changes forever. If it doesn’t hit you in the beginning newborn stages, it definitely hits you somewhere around the 9 month mark where separation anxiety hits and your baby develops koala like tendencies to dig their claws into you when you try to put them down. (In a cute, screamy kind of way)

Your well-being gets put on the back burner. 

But it shouldn’t. 

Eating healthy foods and regular meals is important, not only for your energy and blood sugar levels, but also because as a parent, everything we do is copied by our offspring. So it’s crucial to show them how to develop healthy eating habits. 

The final thing I want to share is some easy tips to maintain a healthy eating routine as a new mum.

Help, I have a baby, how do I eat healthily?!

Tip #1 - Recruit your friends and family

I found the best way to get eager friends and family to help was to ask them to bring me food. 

Choose foods that you enjoy. Make sure they are freezer-friendly. Ask for added vegetables to keep your nutrition levels up.

Tip #2 - Have easy healthy snacks on hand. 

The good thing about GD is that after you give birth, you probably have some of those snacks left over. Now is the time to munch on those! Easy to grab snacks are lifesavers as a new mum. Vita-wheats, fruits, cheese, nuts and yoghurt pouches are great options. Keep them stashed around the house in easy to reach places (no locked cupboards!) so that you can have a quick bite while on the way to pick up baby. 

Tip #3 - Keep your water bottle filled.

My baby was born in the peak of summer, and was small. Until she was 7 month old, she had 3 layers MINIMUM on her at all times. We discovered the hard way that even one layer less meant hours of tears. 

I, on the other hand, sweated out half my body weight (jokes!). Often times, I was topless, because what's the point of putting on a shirt only to sweat through it and have to take it off every 2 hours for feeding? I opted for the easy alternative. 

Cold water was ambrosia on my lips. Seriously, though, drinking water is a life-saver during the newborn phase. Even though it means a few extra trips to the bathroom, I felt much more rejuvenated when I had my water bottle next to me to sip throughout the day. If you don’t like plain water, add mint, cucumber, strawberries, or lemon. If that doesn't add enough flavour, try the water infusers that many tea companies now make!

Tip #4 - Add an extra vegetable to each meal 

I remember during the throes of new motherhood, I would pull out whatever was in the freezer and eat it without paying much attention, much more focused on the crippling exhaustion coursing through my veins like thick custard. 

The easiest way I could make sure I kept up my vegetable intake was focusing on adding one extra vegetable to any meal I ate. Lettuce, tomato, cucumber, olives, you name it. 

Choose a vegetable that needs almost no prep, and use it throughout the week to add to each meal. If you’re experiencing problems like mastitis, cabbage can be a great choice as it doubles as relief from mastitis pain. 

At the end

GD is a temporary condition, but I found it gave me great insight into what life would be like if I had type 2 diabetes. It made me so much more determined to up my healthy eating habit game so that I can stave off the lifestyle condition! The whole experience really reminded me that creating rules and guidelines that suit my lifestyle can add a sense of freedom to my life by allowing me to choose foods that benefit my body. 

Have you experienced GD? Let me know your experience in the comments! 

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