Gestational diabetes: what the diagnosis means

Source: wdv | Jan Lauer

Getting "diabetic" during pregnancy comes as a shock to many soon-to-be moms at first. But don’t panic: Gestational diabetes can be managed well.

Suddenly diabetic

"Gestational diabetes" – what this diagnosis can trigger in a woman in what is actually joyful anticipation, Jana Langer experienced in her second pregnancy. "With my first daughter, the pregnancy went completely smoothly," says the 38-year-old mother of three girls. In her second pregnancy, too, everything was initially top-notch: no complaints, all findings completely unremarkable. "That’s why I didn’t worry about the glucose test at my gynecologist’s office."For Jana, the glucose test was just another part of her prenatal care. It was on the program, but felt more like pro forma.

When the gynecologist then told her the result of the glucose test with the words, "Your values are clearly above the threshold values," she was told that she had gestational diabetes!"When I handed over the test, it was quite a shock for the pregnant woman: "I only knew darkly that with diabetes you have to watch what you eat. But what is gestational diabetes – no idea!"

Gestational diabetes – what is it??

Gestational diabetes (GDM) is a metabolic disorder that often occurs in the second half of pregnancy. During this phase, the mother’s body releases more hormones. These stimulate the production of glucose, which the baby needs for its growth. The hormone insulin ensures that glucose is transported from the blood into the cells.

Insulin is produced in the pancreas and lowers the blood glucose level. However, in about five out of 100 pregnant women, it doesn’t work properly. Her Body produces too little insulin. This increases the sugar concentration in the mother’s blood and the unborn child is "overfed" with sugar.

In babies, it can lead to developmental problems, high weight gain and malformations. Mothers are more likely to experience sharp rises in blood pressure, water retention in the body, bladder and kidney infections or seizures.

The oral glucose tolerance test (oGTT)

Since 2012, the oral glucose tolerance test (oGTT) has been standard in prenatal care. It is found between the 24th week of pregnancy. and 28. This test is carried out at the second week of pregnancy and basically consists of two tests:

Small sugar test (50-g-oGTT): The pregnant woman is given a glass of glucose solution containing 50 grams of dextrose. One hour after drinking the solution, blood is taken from the vein in her arm and the blood glucose level is determined. If it is below 7.5 millimoles per liter (mmol/l) or less than 135 milligrams per deciliter (mg/dl), the blood glucose level is fine – i.e. no gestational diabetes!

Major Sugar Test (75-g-oGTT): If the value is above 7.5 mmol (135 mg/dl), it is tested again. The pregnant woman must be fasting, i.e. she must not have eaten or drunk anything for at least eight hours – except for still water or unsweetened tea. She first gets her blood drawn and fasting blood sugar is determined. She then drinks 300 milliliters of water with 75 grams of dissolved glucose within five minutes. After one and after two hours, she gets blood drawn again to see how the blood glucose level develops. If one of the values is above the threshold values mentioned below, the woman almost certainly has gestational diabetes.

blood glucose limits:
Fasting blood glucose: 5.1 mmol/l or 92 mg/dl
1-hour blood sugar: 10 mmol/l or 180 mg/dl
2-hour blood glucose: 8.5 mmol/l or 153 mg/dl

Special care

After the first glucose test was conspicuous, Jana Langer had the big sugar test some time later. After that, it was certain that she had gestational diabetes. "For me, it was a really stupid feeling. I didn’t know what all this meant and what to expect now. My gynecologist then put me in a special diabetology practice referred. There they explained everything. I had to keep a food diary, limit the consumption of high-sugar foods such as sweets and exercise regularly."Somehow, Jana’s elation that had carried her through the first pregnancy and, so far, through the second, was gone from then on.

A fairly common reaction, confirms Tina Gruter. As a midwife, she accompanied pregnant women for 15 years: "The biggest shock for most is suddenly being classified as a high-risk patient. The joy, the happiness, the lightness are gone for the time being."What helps is extensive education about the disease and putting one’s own habits to the test. "This usually works well, because mothers are motivated to change their own eating and exercise habits for the sake of their own and their baby’s health."

Source: wdv | Jan Lauer

Same diagnosis, different feeling. Nadine Erhardt is also a mother of three children. Even during her first pregnancy, her blood glucose levels were slightly elevated. She was then also referred to a diabetologist by her gynecologist. She was cared for there, but her values remained stable enough that no therapy had to be initiated. It was different with her second and third child.

Nadine made the experience that the blood sugar limits changed over time. Today, they are much more flexible than in the past, she says. "I found my pregnancies quite relaxed, even though I had diabetes with all three boys and suffered from violent, prolonged nausea."Giving up snacking was therefore no problem for the now 43_year-old "I’m more of a hearty person anyway," she says with a smile. "However, I couldn’t smell sausage and meat, let alone eat them."

Gestational diabetes requiring insulin

The diabetologist gave Jana and Nadine a diet plan for meals and snacks. Both women kept conscientious records of what they ate during the day. They noted the time, meals and drinks. They also learned to self-monitor their blood glucose regularly and create a daily blood glucose profile.

Source: istockphoto.com | Halfpoint

Source: istockphoto.com | didesign021

Source: istockphoto.com | Halfpoint

"The prick in the fingertip was the most annoying thing," Nadine remembers. At some point, it became clear that they would not be able to control their blood sugar without additional insulin. "In the first pregnancy, it had still worked with a change of diet. With my second son, the blood glucose levels were so high that I had to inject insulin," says Nadine, admitting that it took some effort for her to prick her belly. "But you learn to deal with it. I knew it was just a phase."She also felt well looked after by her diabetologist’s office.

Jana felt the same way. She also had to substitute insulin, as the jargon goes. Through the care of the professional staff, both women quickly found out what the right dose was. Jana remembers the checks in particular: "I initially had to measure my blood glucose seven times a day: fasting blood glucose in the morning, one hour after breakfast, before lunch and one hour afterwards, before dinner and one hour afterwards, and before going to bed."Later, four measurements were enough.

Good values

This Blood sugar values should be achieved:

In the morning and before the main meals:
65 to 90 mg/dl (3.6 to 5.3 mmol/l)

One hour after a main meal:
less than 140 mg/dl (7.8 mmol/l)

Two hours after a main meal:
less than 120 mg/dl (6.7 mmol/l)

Symptoms of gestational diabetes

Gestational diabetes is ongoing often goes unnoticed from. Sometimes, however, symptoms appear that may indicate the condition. These include, for example, severe thirst, frequent urination, increased urinary tract infections or vaginal infections. New onset hypertension can also be associated with gestational diabetes. Overall, if left untreated, the health risks of this metabolic disorder are high – for both mother and child. Miscarriages or premature births and problems during delivery can occur.

Risk factors

Source: wdv | Oana Szekely

There’s no blanket answer to why gestational diabetes affects some women and not others. However, among the main risk factors are a family history of Predisposition and severe overweight. According to the current state of science, it also plays a role if pregnant women ..

Gaining excessive weight,
have already had gestational diabetes in previous pregnancies,
are over 35 years old,
have already had miscarriages,
Taking medications that negatively affect sugar metabolism (some antihypertensives, thyroid medications, cortisone),
For previous births, children with a birth weight greater than 4.Have given birth to 500 grams,
Suffering from a pathological change in the ovaries or
Smoke.

"Gestational diabetes can usually be treated well"

Tina Gruter knows the fears of expectant mothers. As a trained midwife and certified pedagogue, she accompanied women for 15 years through the emotional time of pregnancy, during birth and also afterwards.

Is gestational diabetes dangerous?

Tina Gruter: Women diagnosed with gestational diabetes are considered at-risk pregnant women. They receive closer monitoring and additional examinations, such as Doppler ultrasound. This is because undiagnosed and untreated gestational diabetes can have several effects. On the one hand, the risk of miscarriage or premature birth increases. There may also be excessive amniotic fluid production. Other health problems can include high blood pressure or increased urinary tract infections in pregnant women. In addition, the fetal body itself produces large amounts of insulin as a result of the flood of sugar: the unborn baby grows faster and puts on significantly more weight. This can lead to complications at birth. Therefore, even if the baby’s estimated weight is over 4.500 grams first advised to have a cesarean delivery.

Are there differences in gestational diabetes?

Tina Gruter: Basically, we distinguish between "diet-adjustable" and "insulin-dependent" gestational diabetes. In both forms, a diabetology practice comes into play to care for the women on an outpatient basis. Gestational diabetes that can be controlled by diet can often be treated well with an appropriate diet and more exercise. For gestational diabetes that requires insulin, the pregnant woman is shown how to control her own blood sugar and administer insulin therapy. The practice’s diabetes team advises and supports them in this process.

What happens at birth?

Tina Gruter: First of all, the calculated date of birth is important: In the case of gestational diabetes controlled by diet, the birth is usually not induced at this time, but only after a transfer of seven days – provided, of course, that mother and child are doing well. In the case of diabetes requiring insulin, on the other hand, birth is usually induced on the day of delivery. Under the birth usually no blood sugar needs to be controlled with a dietetic Gestationsdiabetes, the pregnant woman is however observed. On the other hand, if the baby is insulin-dependent, blood glucose monitoring usually takes place every two hours.

What happens after birth?

Tina Gruter: In most cases the pregnancy diabetes is past after the birth. For mothers with gestational diabetes requiring insulin, the values are nevertheless monitored closely at first. If the blood glucose values are still conspicuous on the second postpartum day, a daily blood glucose profile continues to be drawn up. If the values are normal, a new glucose test (oGTT) takes place six to twelve weeks after birth to see if the metabolism is okay again.

And what happens to the baby after birth?

Tina Grueter: The baby is examined briefly and then placed at the mother’s breast. It should drink something after 30 minutes. After two hours, some blood is taken from his heel and the blood sugar is checked. If the value is above 30 milligrams per deciliter, the metabolism is fine. If the value is below this, the pediatrician looks after the baby. In total, blood sugar is checked two, four and six hours after birth. And the babies are not fed according to their own needs, but every two to three hours.

Do "diabetic" babies have the same symptoms as adults?

Tina Gruter: Related. You may be restless and shaky. Or have muscular hypotonia, i.e. little muscle tension. Conclusions can also be drawn on the basis of shrill cries. Unlike adults, however, babies do not get cold sweats with beads of sweat on their foreheads. But they may suffer from breathing problems. This is why it is important to have a pediatrician on site.

My Glyx: Food for gestational diabetes

Source: istockphoto.com | Foxys_forest_manufacture

For diabetics, the same dietary recommendations apply in principle as for healthy people: "Eat a healthy diet Versatile, calorie-conscious and high in fiber!"If you eat fruit and vegetables every day and make sure you eat whole grains, you’re already doing a lot right.

Carbohydrate-rich foods have a direct effect on blood glucose levels. In contrast to the fast carbohydrates from white flour or sugar, whole grain products are utilized by the body much more slowly.

"It was only through my gestational diabetes that I learned about the word ‘GLYX`," reports Jana Langer. GLYX is the abbreviation of "glycemic index. And that plays a major role in any form of diabetes: the glycemic index shows how much certain carbohydrate-containing foods raise blood sugar levels compared to glucose. Dextrose enters the blood almost immediately. With other carbohydrates, especially the high quality ones, it happens little by little. This means that the blood sugar level rises more slowly and insulin production can adjust better to it.

"In addition, my diabetology practice recommended that I eat five smaller meals Eat a lot of food during the day to keep blood sugar levels at a steady, non-critical level," says Jana. For beverages, water or unsweetened tea is the first choice. Pregnant women with gestational diabetes are better off avoiding sweetened drinks like soft drinks or juice altogether. And what about for those with a sweet tooth? "I was already paying attention when I ate – but every now and then I had a piece of dark chocolate" Jana remembers. "I didn’t have to give it up completely. For happiness!"

High-quality carbohydrates

They are found, for example, in: Legumes, wholemeal bread, oatmeal, wholemeal pasta or wholemeal rice.

Vitamins and minerals are also important for health. With a varied and balanced diet, the supply is usually guaranteed.

Delicious recipes for diabetics

1. Whole grain toast with cream cheese spread

Ingredients for 2 persons:

1 small bunch of fresh herbs (dill, parsley, chives, basil)
100 g granular cream cheese (low-fat)
100 g of low-fat curd cheese
2 tablespoons milk
1 small red onion
iodized salt
Pepper from the mill
4 slices of wholemeal toast à 30 g
4 radishes

Here’s how:

Rinse herbs under cold water, shake dry and chop finely.
Mix the cream cheese with the low-fat curd cheese and the milk until smooth.
Peel onion and cut into small cubes. Stir the herbs and diced onion into the cream cheese mixture and season with salt and pepper.
Toast the wholemeal toast and spread with the cheese spread. Clean and wash the radishes and grate over them with a coarse kitchen grater.

Preparation time: 30 minutes
Per serving: 2,28 g fat, 30,3 g Carbohydrates, 19 g protein, 223 kcal

2. Chive scrambled eggs on wholemeal bread

Source: stock.adobe.com | Eddie

Ingredients for one person

1 egg
1 tablespoon drinking water
Iodized salt
1 tsp chive rolls
1 tsp. butter (5 g)
1 slice of wholemeal bread (50 g)
4 cherry tomatoes
1 lettuce leaf

Here’s how it’s done:

Whisk the egg and the water with a fork, add salt and chives. Melt some of the butter in a pan and let the beaten egg fry in it.
Spread the wholemeal bread with the remaining butter and cover it with the washed lettuce leaf.
Wash and slice the cherry tomatoes and place them in a fan shape on the lettuce leaf.
Finally, put the scrambled eggs on the tomatoes and serve immediately.

Preparation time: 10 minutes
Per serving: 9.35 g fat, 20.9 g carbohydrates, 9.33 g protein, 206 kcal

3. Colorful corn salad

Ingredients for 4 people

400 g corn kernels (from the can)
1 apple
1 red bell pepper
1 small onion
1/4 cucumber
200 g turkey breast cold cuts
1 tbsp grated horseradish (from the jar)
2 tablespoons of natural yogurt
1 tablespoon lemon juice
2 tablespoons herb vinegar
2 tablespoons canola oil
1 tablespoon each of chopped parsley and dill
1/2 tsp. sugar
Iodized salt
Pepper

How it’s done:

Drain corn kernels.
Wash the apple, cut into quarters, remove the core and cut the flesh into small cubes. Wash and halve the bell pepper. Remove stem end, seeds and white septum and dice the flesh as well. Peel and finely chop the onion. Wash and chop the cucumber. Cut the turkey breast into strips. Mix all ingredients well.
Prepare a marinade from horseradish, yogurt, lemon juice, vinegar, oil, the herbs and spices. Mix the lettuce with it and let it soak well.

Preparation time: 20 minutes
Per serving: 7,46 g fat, 21,6 g carbohydrates, 7,74 g protein, 188 kcal

4. Pear crumble

Source: stock.adobe.com | kostrez

Ingredients for 6 people

75 g cold butter
150 g wholemeal flour
450 g pears
1 tablespoon lemon juice
1 tablespoon of cinnamon
10 g cane sugar

How to make:

Preheat oven to 200 degrees (convection oven:180 degrees), put flour in a bowl, cut butter into small pieces, add to flour and make into crumbles
and pears wash, peel, quarter, core and cut into pieces. Sprinkle with lemon juice and mix with cinnamon and 3 tablespoons of water.
Put the pears in a greased baking dish, sprinkle the crumble and sugar over them.
Bake for about 25 minutes until the crumbles are golden brown.

Preparation time: 15 minutes plus 25 minutes baking time
Per serving: 11.3 g fat, 31.8 g carbohydrates, 3.38 protein, 230.8 kcal

5. Italian fish pan

Ingredients for 4 people

4 fish fillets
4 large tomatoes or a can of peeled tomatoes
1 small zucchini
2 small onions
1 tablespoon oregano
1/2 teaspoon iodized salt
some pepper
a little olive oil

How to make it:

Put the fish fillets in a baking dish brushed with olive oil.
Peel onions, wash zucchini thoroughly. Cut the onions and zucchini into cubes and put them into the baking dish.
Finally, add the washed and sliced tomatoes or the ones from the can on top of it. Season with oregano, iodized salt and pepper. The fish pan must now go into the oven at 180 degrees for half an hour. Rice tastes best with this.

Preparation time: 50 minutes
Per serving: 8.22 g fat content, 4.23 g carbohydrates, 28.7 g protein, 208 kcal

Book tip

Bettina Snowdown, Prof. Dr. Ute Schafer-Graf: Gestational diabetes under control. Healthy eating for my baby and me. Trias-Verlag (Thieme Group), Stuttgart 2020, 17,99 Euro

Gestational diabetes: What comes next?

At the end of pregnancy, gestational diabetes is usually also over. But not always – around half of all those affected develop diabetes mellitus within ten years of pregnancy. And the children of affected women also have an increased risk of diabetes.

Therefore, not only during but also after pregnancy, a healthy diet, regular physical activity and relaxation play an important role in staying healthy and preventing diabetes.

Knowledge on the net

You can find more information about diabetes at the diabetes information portal. Initiated by the German Federal Center for Health Education (BZgA), it provides scientifically validated information on preventing the disease and living with diabetes – also in Turkish.