Gestational Diabetes: What You Need To Know

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For anyone who’s been pregnant before, or spent much time in the pregnancy forums online, we’re all pretty familiar with the glucose screen performed between 24 and 28 weeks.

For a lot of women, they have to fast for 8 to 12 hours, then drink that nasty liquid glucose, and then get their glucose checked an hour later. If they fail that, they have to go back and repeat the test but get it checked 3 hours afterwards. For other women, they get the option to eat a specific meal instead of drinking the liquid glucose. Or for others, like myself, we’re allowed to do our own at home glucose testing by checking our sugars 4 times a day for 7 days while eating and drinking like normal.

I have just finished my 7 day testing period as of 6 days ago. And I had to come to the realization that I have gestational diabetes. And that I may not be able to control it through diet the way that I did with my previous pregnancies, even though I tried. I had to surrender to the fact that my body just isn’t functioning the way that it used to when I was younger.

What Is Gestational Diabetes?

According to the World Health Organization, gestational diabetes mellitus (GDM – the medical term for gestational diabetes) is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes and only occurs during pregnancy. Medical Vs defines GDM as a carbohydrate intolerance with onset OR first recognition during the present pregnancy.

WHO states that women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. These women and possibly their children are also at increased risk of type 2 diabetes in the future. It is standard practice to screen women 6 to 12 weeks postpartum to determine if the glucose levels have returned to a normal level or if they are still elevated.

How Is GDM Diagnosed?

Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms. The oral glucose tolerance test (OGTT) has, to date, been considered the cornerstone of the diagnosis of GDM.

Many women have heard of this horrible tasting drink that you’re forced to guzzle and then wait an hour to 3 hours to have your blood drawn and tested to see how well your body tolerates a large influx of sugar. (Personally, I have only ever had the orange flavor and it tastes like flat orange soda. No particularly tasty, but tolerable.)

For eight hours before the test, you won’t be able to eat or drink anything. You might want to fast overnight and schedule the test for early the following morning. When you arrive at your doctor’s office or lab, a member of your health care team will take a sample of blood from a vein in your arm. This blood sample will be used to measure your fasting blood glucose level.

If you’re being tested for gestational diabetes:

The American College of Obstetricians and Gynecologists recommends performing a one-hour blood glucose challenge test to screen for gestational diabetes in low-risk pregnant women between 24 and 28 weeks of pregnancy.

  • You’ll drink about 8 ounces (237 milliliters) of a syrupy glucose solution containing 2.6 ounces (75 grams) of sugar
  • One hour later, your blood glucose level will be measured again

If your doctor determines you’re at risk or you have a suspicious value on the one-hour test, you may be advised to take a three-hour glucose tolerance test.

For the three-hour test:

  • You will be asked to come to the test fasting — not having had anything to eat or drink for the previous eight hours. A fasting blood sugar will be obtained.
  • You’ll drink about 8 ounces (237 milliliters) of a glucose solution containing 3.5 ounces (100 grams) of sugar.
  • Your blood glucose level will be tested again one, two and three hours after you drink the solution.

After drinking the glucose solution, you’ll likely need to remain in the doctor’s office or lab while you’re waiting for your blood glucose level to be tested.

If you’re being tested for type 2 diabetes (postpartum):

  • You’ll drink about 8 ounces (237 milliliters) of a syrupy glucose solution containing 2.6 ounces (75 grams) of sugar
  • Two hours later, your blood glucose level will be measured again

Other Testing Options:

Jelly beans: 28-jelly beans contain the equivalent amount of glucose as the glucola drink.  A study from 1999 looked at the efficacy of this as an alternative. The findings showed there were no significant differences between the two glucose sources and women reported less side effects with the jelly beans.  There are organic jelly beans and jelly beans with natural coloring that can be used as an alternative.

50g of sugar from other foods/drinks:  some care providers will let you consume a special meal that they approve as an alternative (some include juice, pancakes with maple syrup, or soda).  This varies by care provider and in some areas is becoming less popular as an alternative.

One- or Two-week food diary + blood sugar test:  this alternative is one that I see many providers and their patients leaning towards.  Patients keep a food diary for two weeks and test their blood sugar using diabetes test strips when they wake up (fasted state) and two hours after each meal.  Some women enjoy this test because they’re interested in looking at the numbers themselves and others find this type of testing a nuisance.

My midwife had me do the one week test and I had way more high readings than I did passing ones. So the next step is a two week screen.

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How Is GDM Treated?

Management of GDM is usually dietary. The goal is to stabilize blood sugar levels by eating smaller more frequent meals, substituting simple carbohydrates for complex ones, and limiting daily caloric intake. The most common approach seems to be to attempt to match the blood glucose profiles of pregnancy matched non-GDM women. Caloric restriction could be problematic if is leads to increased maternal ketone levels which could have negative impacts on baby’s IQ.

Taking your blood sugar seriously is nothing to sneeze at. When carb intolerance is at play, your body is telling you to get stricter with your intake. To follow a low-carb diet, nix all sugars and reduce complex carbs dramatically, replacing them with plenty of nonstarchy vegetables and generous amounts of fat. In addition, take sleep seriously, work on repairing the gut, and increase the amount of movement you do. The low-carb diet, along with these other fundamental improvements, can often help restore order where there was previously metabolic chaos. To catalyze real metabolic change in cases of significant weight gain or diabetes, it may be warranted to take the low-carb approach to its ultimate extreme: the ketogenic protocol.

Pharmacologic therapy usually involves insulin. Both long and short acting forms have been shown to be safe. For women who would rather not inject themselves daily, both metformin and glibenclamide (glyburide) have been used safely in pregnancy. Metformin decreases hepatic production of glucose and increases insulin sensitivity. Glibenclamide increases pancreatic insulin secretion.

“Passing” The Test

Being in a lot of birth and pregnancy groups and discussions, I frequently see a lot of women asking “how to beat the gestational diabetes (GD) test” and “how to make sure my numbers stay low enough to pass the GD test”. And honestly, my answer is not one that most women want to hear.

The GD test is there to monitor you for potential of complications. It is not something that can (or should) be manipulated. My husband frequently asked during my home screen, “what do we need to do in order to get your numbers down” and all I could tell him is that there is no magic formula. I have gestational diabetes. I was diagnosed with it in a previous pregnancy and with pre-diabetes in between that pregnancy and this one. My body does not process sugar like it’s supposed to. And that’s okay.

I can’t force it to. All I can do is monitor my sugar, pay attention to what I eat, and make sure to keep the numbers in a “safe” range. This means that I don’t sit and eat the whole 5 lb bag of sour gummy worms in one sitting anymore. I don’t go all day without eating and then binge on sugary and carby foods an hour before I go to bed. I don’t eat an entire can of cinnamon rolls in a day. I skipped out on the cake and ice cream at my bonus daughter’s birthday party. I pay attention. I put my nutrition first.

Do I still fail? Hell yes I do. I had 3 bowls of sugary cereal this morning. And then I made sure to triple my water intake, up my protein, & reduce my carb intake for the rest of the day. I still have a major sweet tooth. But I make adjustments in my diet to allow for those “cheat meals” so that I don’t overwhelm my body all day long. I make adjustments in the amount of sugar & carbs that I eat in order to satisfy the sweet tooth without overly stressing my body and ultimately my baby’s body out.

It’s super hard, but it can be done. If you’d like some more information on it, I highly recommend getting the book Real Food for Gestational Diabetes by Lily Nichols, RDN, CDE, CLT. In the book, Lily gives great guidance on how to create your own lower-carb but real food based eating plan and includes easy recipes as well!

Were you or a loved one diagnosed with GDM during a pregnancy? I’d love to hear your story! Feel free to email me at

Related Posts

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