in Pregnancy
Luckily, dangerous low blood glucose episodes are relatively rare because insulin resistance is so high late in pregnancy. However, if you seem prone to low blood glucose, remember that the safest time to exercise is after meals, when you are less likely to experience lows.
Insulin
You may need insulin to help you reach your blood glucose goals during pregnancy. It’s extremely important to keep glucose levels as close to normal as possible to prevent any complications. Your health care provider will help you decide whether you need to start insulin and, if so, what kind of plan you’ll follow.
You’ll become more insulin resistant during the third trimester of pregnancy. Therefore, you may need more insulin. This might require a mixture of different types of insulin such as rapid- and intermediate-acting insulin. Look for more information on insulin and insulin plans in chapter 13.
Don’t be alarmed if your total insulin dose increases as your pregnancy continues. This does not mean that your diabetes is getting worse, only that your insulin resistance is increasing, which is to be expected. You may need to make changes in your insulin dosage every 10 days or more often.
Future Considerations
After pregnancy, gestational diabetes goes away in most women. Only 5–10% of women have diabetes after giving birth (usually type 2 diabetes). However, your overall risk for developing diabetes in your lifetime goes up dramatically after having gestational diabetes. From 35% to 60% of women with gestational diabetes eventually develop type 2 diabetes.
You should be tested for diabetes 6 weeks after your baby is born. At this visit, you and your health care provider can discuss goals for maintaining a healthy weight and preventing type 2 diabetes. You can prevent diabetes by taking active steps to get in shape and lose weight after pregnancy. You should then be tested for diabetes at least every 3 years thereafter. If you continue to have diabetes after you deliver, you will be referred to a diabetes care provider.
If you had gestational diabetes, your child is also at risk for becoming obese and developing type 2 diabetes. Breast-feeding your baby is one way to protect your child from developing diabetes. Some studies have shown that breast-feeding can reduce the risk of diabetes in children. It will also help you burn extra calories (and perhaps lose weight) and ensure that your baby is getting the proper amount of nutrition.
In the future, remind all of your providers that you had gestational diabetes. Some drugs, such as steroids, can raise your blood glucose levels, just as pregnancy did. Ask to have your glucose levels tested earlier if you become pregnant again.
The message to take home is that both you and your baby have a lifetime risk of developing diabetes. It is important for the whole family to eat well, be active, and maintain healthy weights.
Tips from the National Diabetes Education Program: “It’s Never Too Early to Prevent Diabetes”
A Lifetime of Small Steps for a Healthy Family
For You:
• Tell any future health care providers about your gestational diabetes.
• Get tested for diabetes 6–12 weeks after your baby is born, then at least every 3 years.
• Breast-feed your baby. It may lower your child’s risk for type 2 diabetes.
• Talk to your doctor if you plan to become pregnant again in the future.
• Try to reach your pre-pregnancy weight 6–12 months after your baby is born. Then, if you still weigh too much, work to lose at least 5–7% (10–14 pounds if you weigh 200 pounds) of your body weight slowly over time and keep it off.
• Choose healthy foods, such as fruits and vegetables, fish, lean meats, dry beans and peas, whole grains, and low-fat or nonfat milk and cheese. Drink water.
• Eat smaller portions of healthy foods to help you reach and stay at a healthy weight.
For the Whole Family:
• Ask your child’s doctor for an eating plan to help your child grow properly and stay at a healthy weight. Tell your child’s doctor that you had gestational diabetes. Tell your child about his or her risk for diabetes.
• Help your children make healthy food choices and help them be active at least 60 minutes a day.
• Follow a healthy lifestyle together as a family. Help family members stay at a healthy weight by making healthy food choices and moving around more.
• Limit TV, video game, and computer game time to an hour or two a day.
Part III
Monitoring Diabetes
CHAPTER 6
Basics of Blood Glucose Monitoring
• How Often You Should Monitor
Monitoring your blood glucose is an important tool for taking care of yourself and your diabetes. Your health care provider will perform tests to measure your average blood glucose level at most visits, as discussed in more detail in chapter 2. However, the blood glucose monitoring that you do every day—on your own—will form the backbone of your diabetes management plan.
Blood glucose readings help you understand how you respond to different situatixons: food, exercise, illness, and even stress. Readings also help you make informed choices for treating your blood glucose with insulin or other medications, food choices, and physical activity. Ultimately, these choices help you feel better each day and prevent complications down the road.
This chapter will explain some of the basic guidelines for monitoring blood glucose, such as who should monitor, how often you should monitor, and when to do extra checks. Keep in mind that blood glucose monitoring is up to you. You will be the person most responsible for keeping tabs on your diabetes and making adjustments to fit your lifestyle and health goals.
Who Should Monitor?
The simple answer is . . . you.
People with diabetes who take insulin should always monitor their blood glucose. People with type 2 diabetes who take diabetes pills should check with their health care providers about whether and how often to monitor. Insulin and other diabetes medications are powerful drugs that lower blood glucose. You can tell how well they are doing their job by keeping track of your blood glucose. Also, when you use these medications, you are at risk for low blood glucose (hypoglycemia). Monitoring will tell you if your blood glucose is low, so that you don’t have to guess. It can also guide you in deciding how much and which foods to eat at meals.
People with type 2 or gestational diabetes who manage their blood glucose with exercise and meal plans do not need to worry as much about low blood glucose levels. However, monitoring may
