GESTATIONAL DIABETES

Transcription

1 Maternity Services GESTATIONAL DIABETES WHAT IS GESTATIONAL DIABETES? Gestational diabetes (GDM) is the term used to describe diabetes that is first diagnosed during pregnancy, usually through a blood test at weeks into pregnancy. Usually it will disappear after the baby is born but will usually re-occur in any later pregnancies. With good management of gestational diabetes, you can increase your chances of having a healthy pregnancy and baby. WHY DO WOMEN DEVELOP GDM The hormones produced during pregnancy can make it difficult for your body to use insulin properly, putting you at an increased risk of insulin resistance. And, because pregnancy places a heavy demand on the body, some women are less able to produce enough insulin to overcome this resistance. This makes it difficult to use glucose properly for energy, so the glucose remains in the blood and the levels rise, leading to gestational diabetes. Women most at risk of developing gestational diabetes are those who: Are overweight or obese Have a family history of diabetes Have had a previous big baby, over 4.5kg. Are from certain ethnic backgrounds HOW DOES GDM AFFECT MY BABY? If your blood sugar levels are consistently high sugar will cross over to the baby via the placenta. Baby will produce high levels of insulin which will make him or her grow rapidly. They can get very large around the middle and the top half of their body this can make delivery of the baby difficult and can mean that the shoulders get stuck during delivery. You are more likely to have an Induction of your labour or a caesarean birth. As a result of the baby producing too much insulin before he/she is born, they may have a low blood sugar until they regulate their own insulin production. This may be a reason for them to be admitted to the Neonatal unit. We advise that you and your baby stay in hospital for 24 hours after the birth in order to monitor the baby s blood sugar levels. Your baby may be more at risk of being stillborn and of developing diabetes later in their life. WHAT IS THE TREATMENT FOR GDM? You will be shown how to monitor your blood sugar levels at home. You will be advised to test 4 times a day, first thing in the morning and then 1 hour after each meal. All methods of treating gestational diabetes are aimed at keeping blood sugars levels as near to normal as possible. Normal blood sugar reduces the risks to the baby and yourself

2 Target levels for your fasting blood sugar is less than 5.3mmol/L and for 1 hour after your meals, less than 7.8mmol/L. There will be some common patterns of blood sugars. A lot of women find that they will be high in the morning and lower later on in the day. It is also normal to find that over the duration of the pregnancy there is a general rise. You will be encouraged to have weekly contact with the team in the diabetes centre to monitor your blood sugar levels. Having a healthy diet and taking exercise will help to control your blood sugar levels. Some women will require oral medication and/or insulin therapy in order to normalise their blood glucose levels as well as a healthy diet and exercise. Blood glucose monitoring WHAT TYPE OF DIET IS RECOMMENDED? You don t need to buy special diabetic food; the diet that is recommended is a sensible healthy diet that the whole family can eat. You should be eating regular meals and not skipping breakfast. Try to reduce the foods that increase your blood sugar level, these are foods containing simple sugars such as: Fizzy drinks Sweets and chocolate Fruit juices Cakes and biscuits Honey, syrup and sugar added to Some breakfast cereals drinks Deserts Foods containing carbohydrates will also increase your blood sugar level, as all carbohydrates are broken down into simple sugar by your body. Carbohydrates however are an important part of your diet as they provide you with energy. Try to have some carbohydrate with each meal but keep your portion sizes down to a small amount of around 1/4 to 1/3 of your meal as carbohydrate. Aim to have grainy bread or wholemeal and brown rice as these will break down into sugars more slowly and help you to feel fuller for longer so that you are not tempted to snack. Examples of foods containing carbohydrates are;- Potatoes Cereals Rice Pasta Protein will not make your blood sugar rise. During pregnancy make sure that meat and eggs are cooked thoroughly. Aim to eat 2 potions of protein each day, examples are;- 75g meat (2-3 oz) 3 tablespoons beans or lentils 2 eggs 100g tofu 130g cooked white fish (4-5oz) - 2 -

3 Fat is also needed in your diet but in very small quantities. Too much fat will cause you to gain weight and will make you more insulin resistant. There is a leaflet that you can get from your midwife entitled weight control in pegnancy which will explain the risks of being obese during your pregnancy. Saturated fat such as is found in fatty meat and butter is less healthy for you than the less saturated fat found in oily fish, olive oil or sunflower spread. Fruit and vegetables, the same advice applies to everyone, try to eat at least 5 portions of fruit and vegetables each day. These will provide you with essential vitamins and minerals. Examples of portion sizes are:- A small banana or a hand full of grapes or an apple or an orange or 2 One small glass of juice, try to limit this to 1 a glass a day. plums or a small bowl of 3 tablespoons of any vegetables. strawberries. Calcium is essential during pregnancy to ensure good bone growth and development in the baby. Dairy produce provides a good source of calcium and also vitamin D. Aim to have 3 portions a day g cheese (match-box sized) 1 pot low sugar yoghurt. 120g cottage cheese 200mls Milk Try to keep well hydrated, this will help prevent urine infections which are common in pregnancy and even more common if your blood sugar is high. It will also keep other systems in your body working effectively. Aim for litres throughout the day

4 The eatwell plate highlights the different types of food that make up our diet, and shows the proportions we should eat them in to have a well-balanced and healthy diet. Sometimes just making some changes to your diet will be enough to keep your blood sugar within normal limits but sometimes it may be necessary to introduce medication to help you to reduce your blood sugar level. INTRODUCING INSULIN Insulin is a very efficient way of reducing your blood glucose levels. Your diabetic specialist nurse or diabetic specialist midwife will teach you how to safely inject the insulin. Insulin is injected just under the skin by using very small needles it can be injected into the stomach, outer upper arm or thigh. The amount of insulin that you have will start off small and be increased every few days until you reach your blood glucose target levels. Injecting insulin using a pen device INSULIN AND HYPOGLYCAEMIA If you are not using insulin then it is normal for a blood sugar to be as low as 3.5mmol/L. A hypo or being hypoglycaemic, if you are taking insulin is when your blood glucose falls below 4mmol/l and may happen if you: Have taken too much insulin Have not had enough carbohydrate to eat Have your insulin without eating i.e when you miss or are late for a meal. If you have vomited. You will be given advice on how to treat a hypo when you start your insulin INSULIN AND DRIVING It is important that if you are taking insulin that you insure that your blood sugar level is over 5mmol/L before you drive. More information on driving and Insulin can be found on the DVLA website

5 AFTER THE BABY IS BORN Once your baby is born you will stop the insulin and in most cases your blood glucose levels will go back to normal within a couple of days. All women with gestational diabetes whether taking insulin or not, will be asked to continue to do finger prick tests for just 2 days after the delivery. A further oral glucose tolerance test is recommended 6 weeks after you have the baby to check that your blood glucose is back to normal. You will then be offered a fasting blood glucose test every year through your G.P as 50% of women with GDM will go on to develop type 2 diabetes within 3-5years. BREAST FEEDING Breast feeding can help protect your baby from developing diabetes later in their lives and has many other health benefits for baby and for you. You will be offered support from all of the maternity team to help with breast feeding. One way to help breastfeeding get off to the best start is for you to express some of your colostrum after 36 weeks pregnant. Information will be provided to you during your routine antenatal visits. Having some colostrum ready to give to your baby can mean that he/she can be given your milk via syringe if their blood sugar level does drop low after delivery and there were to be any difficulties with feeding. PRE-CONCEPTUAL ADVICE If you are planning a further pregnancy you should aim to be a healthy weight before you conceive. Ideally you should also be taking 5mg folic acid daily for 3 months before. You will be referred back to the diabetes team early in your next pregnancy. On behalf of all your team we very much hope you have a healthy and happy pregnancy

6 Contacts / Further Information If you would like further information, regarding the evidence printed in this leaflet please contact the Antenatal Clinic on , Diabetes centre on / diabetesnurses@meht.nhs.uk or refer to: National Institute for Care and Health Excellence Royal College of Obstetricians and Gynaecologists British Dietetics Association DVLA information The pregnancy book Please ask if you require this information in other languages, large print, easy read accessible information, audio/visual, signing, pictorial and change picture bank format via the Patient Advisory Liaison Service (PALS) on (01245) Mid Essex Hospital services NHS Trust is smoke-free. You cannot smoke on site. For advice on quitting, contact your GP or the NHS smoking helpline free, Charitable donations can make a very real difference to the level of patient care at our Trust. As well as contributing to new facilities, donations can be used to buy specialist equipment and smaller items to make patient s stay in hospital more comfortable. For information about making a donation please contact the Charities Office on or visit the website at Document History Department Published/Review: File name Version/ref no Maternity Services Dec-15 / Nov-18 Gestational Diabetes 1.0 / MEHT