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Tuesday, 3 January 2017


Gestational Diabetes Explored. 

Gestational Diabetes Debate. 

The medical model of care for pregnancy is often focussed on the possible 'issues' or 'complications' that may arise. The standard glucose tolerance test is evidence of this, whereby without overt symptoms a diagnosis is made from pathology findings. Whether the benefit of this testing outweighs the risk is subject to debate. 

Gestational Diabetes: when sugar is on everyones lips

World renowned Obstetrician Michel Odent, in particular notes that one role of the placenta is to change the mother's physiology to accomodate the baby. That is, a mother with high glucose may indeed be growing a large baby, however her glucose is raised to facilitate this rather than causing this

The diagnoses of Gestational Diabetes is used to identify baby's at risk of: 

1. Being large for gestational age

2. Being small for gestational age

3. Hypoglycaemia (low blood sugar in the baby after birth, due to drop in blood sugar)

Click here to find out more about what Michel Odent has to say about this. I found it particularly interesting that he notes that the medication given to women doesn't prevent hypoglycaemia. 

Diagnostic Criteria and Percentage of Woman diagnosed.

In recent years the criteria for diagnosing Gestational Diabetes Mellitus (GDM) changed. In short, you are more likely to be diagnosed with Gestational Diabetes now than ever before! (Approximately 13% of women will be diagnosed)

How Diagnosis works: 

The Oral Glucose Tolerance Test (OGTT) is routinely offered at 24 weeks to 28 weeks gestation. 

First you have to fast for 10-12 hours.

Then somehow get to the pathology place without fainting- good luck finding someone to mind your other children at 7am too. 

Then they take your blood.

By the way- keep calm because fight or flight mode increases your blood glucose levels... no pressure. Hope you don't have a fear of needles. 

Then they give you 75mL of the most sickly sweet syrup "drink" that you are required to finish within five minutes. 

Then you wait- 2 hours for another blood test without vomiting. Some places like to test at one hour as well so that's fun too. 

Then you eat the muesli bar you packed in three second flat because being a starving, sugared up, nauseous, tired pregnant woman with a bruise and a bandaid on your arm is actually horrible. 

GDM would be diagnosed if one or more of the following criteria are met:

Fasting Blood Glucose level equal to or more than 5.1 mmol/l 

One Hour Blood Glucose Level equal to or more than 10.0 mmol/l 

Two Hour Blood Glucose Level equal to or more than 8.5 mmol/l

It may be helpful to compare this with the results from your test.

What happens when you are diagnosed?

Well you are now a "Gestational Diabetes Pregnancy". Hope you like labels, because there is one for you and one for your yellow card, just so everyone knows. You walked into the appointment a healthy pregnant woman and walked out with a diagnosis. 

If you are booked into a 'low risk' model of care you are likely to be kicked out. Sorry. If you are lucky you might be allowed to stay as long as the gestational diabetes is diet controlled and you attend extra appointments. 

You will be instructed to buy a glucometer and strips and that you will need to test your blood sugars regularly and write them down. 

You will not be told how many readings above their required blood glucose levels you will be allowed before you are pushed into medication such as insulin. If you ask, it might be around the number 3. 

Your care providers might like to weigh you, or even talk about you losing weight. This might be emotionally devastating if you are one of the 15% of women who have had (or currently have) an eating disorder. You have a right to autonomy in your care (all of your care), you can say no to being weighed.  

How does this feel for the woman?


It feels shit.

If this is you right now it's ok to feel shit about it. You are probably actually in a complex grief cycle, because your perception of your capabilities and your body, as well as your expectations for your pregnancy and birth have all been rocked to the core. 






The five stages of grieving is a tool to identify what is going on, label it and feel like even though you are grieving, it is ok and there is a light at the end of the tunnel. It is likely that you will be feeling these things as you process your 'diagnoses' and may fluctuate back and forward through the stages. 

Shame. Some women are so ashamed of this. It can be difficult to tell their loved ones. Diabetes comes with a stigma and scary and hard to tell your family and friends, which you will probably need to at some point if you share meals together. It might help you to know that the physiology of gestational diabetes is more related to hormones controlled by the placenta than any lifestyle decisions. Some of the most healthy, diet aware women are diagnosed with this. 

It can feel like a lot of pressure to change your entire diet and lifestyle in a couple of days. Then as time goes by many women get frustrated about having to cook different meals for themselves, partner, toddler. 

Gestational Diabetes Education: the cherry on top

You will be expected to attend a class where they briefly overview how to count carbohydrates, how many you are expected to eat and what that looks like in terms of the food you eat. 

It sort of looks like this. 

Dairy is pushed as a source of low carbs- tough luck if you are intolerant, vegan or paleo. 

Toast and biscuits seems to be the food of choice in these classes- two bikkies with cheese for your second snack, one bit of toast at breakfast and a mountain bread wrap at lunch.

They also want you to eat very frequently, at least six times a day. 

Don't eat bananas. Don't eat potatoes. Well do... but not really. 

Actually drink lots of diet drinks. They don't have any sugar. Aspartame is fine apparently. Coca-cola's studies prove it. 

Don't drink juice. Water is fine. 

Do eat 'skinny cow' ice creams. 

Exercise is mentioned vaguely- although they aren't forthcoming with options if you have pelvic pain. Insulin seems to be the answer to that. 

You can only have small quantities of rice.

All right off you go. 

WELL SHIT. If you eat anything other than the bogan western diet you have probably been left spinning from this 'education'. 

If your main meals usually consist of rice you are pretty well stuffed. Interestingly, if you cook your rice in coconut oil, cool it down then cook it again it reduces the carbohydrates by half- see here.

Some sugar coating for you 

There can actually some really fantastic positives from having a glucometer and measuring your blood sugar levels. 

The best being that you have an opportunity to become more aware of your body and how you respond to different types of carbohydrates. You may begin to know the feeling of increased blood sugar and low blood sugar, and start to trust the signs your amazing body gives you about food. 

If you are at the in-laws for lunch and they can't cook very well- you don't have to eat it all... because diabetes. 

Over time you will feel more confident in your choices and may even learn a lot about food. 

How to avoid being diagnosed?

These ideas may/may not be suitable for your individual situation. 

If you don't take the test you won't be diagnosed. Not necessarily the easy option, as many care  providers take this test very seriously and may even change the way they provide care to you. 

Get the test in Winter. According to this study you are more likely to be diagnosed in Summer than Winter. 

You can incorporate apple cider vinegar and cinnamon into your meals in the lead up to the test or see a herbalist to prepare you a therapeutic dosage of herbs that regulate blood sugar. 

During the birth

With a GDM diagnosis your blood sugars may be tested every four hours, and care providers may change your mode of care and suggest insulin if you are out of the expected range. If you want to drink electrolyte drinks during birth it might help to either water it down or drink water in between. It may help to talk to your care provider to clarify your individual expectations.

After the birth 

Breastfeeding as soon as possible and as long as possible after birth is now your priority to increase your baby's blood sugar levels as much as you can. It is likely they will want to test blood sugars (from your baby's heel) regularly over the next 24 hours. Some women express colostrum during pregnancy and bring it to hospital with them in case the baby has difficulty latching to avoid formula being used to raise the blood glucose levels.

Updated to add: A lovely reader has brought to my attention that skin to skin contact is also a strategy for regulating your baby's blood sugar levels! Which makes sense when a baby isn't using energy to keep warm or calm down. Such amazing babies. See more here :)

Thank you for reading!!!

Please feel free to leave comments below :)


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