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Gestational Diabetes Monitoring Levels

Gestational Diabetes

Gestational Diabetes

What Is Gestational Diabetes? Gestational diabetes sometimes develops when a woman is pregnant. It’s when the blood glucose level (blood sugar level) of the mother goes too high during pregnancy. Having an elevated blood glucose level during pregnancy can cause problems for your baby—if it’s left untreated. Fortunately, doctors are vigilant about checking for gestational diabetes so that it can be identified and effectively managed. A pro-active treatment plan helps you have a good pregnancy and protects the health of your baby. Gestational Diabetes Symptoms Gestational diabetes doesn’t often cause noticeable symptoms for the mother. Other types of diabetes (eg, type 1 diabetes or type 2 diabetes) do cause symptoms such as increased thirst, but that is hardly ever noticed in gestational diabetes. Because there aren’t often symptoms, it’s very important to be tested for a high blood glucose level when you’re pregnant. (Your doctor will most likely test you for gestational diabetes sometime between the 24th and 28th week. You can learn more about the diagnostic process here.) Then your doctor will know if you need to be treated for gestational diabetes. Gestational Diabetes Causes and Risk Factors Gestational diabetes develops when your body isn’t able to produce enough of the hormone insulin during pregnancy. Insulin is necessary to transport glucose—what your body uses for energy—into the cells. Without enough insulin, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps gestational diabetes. The elevated blood glucose level in gestational diabetes is caused by hormones released by the placenta during pregnancy. The placenta produces a hormone called the human placental lactogen (HPL), also Continue reading >>

Counterpoint: Glucose Monitoring In Gestational Diabetes

Counterpoint: Glucose Monitoring In Gestational Diabetes

Lots of heat, not much light It was once fashionable for theological scholars to debate the number of angels that could dance on the head of a pin. The debates were quite heated, narrowly focused, and unencumbered by facts. They made for great controversy but solved no real problems (lots of heat, no light). In many respects, ongoing debates about the nuances of glucose monitoring for patients with gestational diabetes mellitus (GDM) are analogous to those past debates about dancing angels. The debates are heated, they are focused on very small nuances in the management of GDM that have minor if any impact on the outcomes of pregnancies complicated by GDM, and they are generally unencumbered by hard facts. While generating considerable heat, the debates shed very little real light on optimization of perinatal outcomes in pregnancies complicated by GDM. In this counterpoint, we briefly summarize the major limitations of such a narrow focus on the nuances of glucose monitoring and control in the antepartum management of GDM. We will address the topic at two levels: 1) whether there really are optimal times to measure glucose levels in women with GDM, and 2) whether all patients really need to perform glucose self-monitoring. Among clinicians and investigators working in the field of GDM, the debate rages on whether pregnant patients should measure their glucose levels before or after meals and, if after, how long after eating. Ammunition in favor of one timing or another comes largely from analyses of correlations between maternal glucose levels and fetal outcomes, such as rates of macrosomic (>4,000 g at birth) or large-for-gestational-age (LGA) infants. The results have been quite inconsistent. Fasting glucose was most strongly correlated with outcomes in some studies a Continue reading >>

Could You Be Missing The Spike In Your Blood Sugar Levels?

Could You Be Missing The Spike In Your Blood Sugar Levels?

A spike in blood sugar levels is the highest peak your blood sugar levels reach after eating or drinking. But could you be missing the spike? Depending on your test times, then you could be missing the spike and depending on your target level it can be confusing what is deemed as a spike or high level. When excess glucose in the bloodstream passes through to the baby it causes excessive growth and other possible related complications. Targets for measuring blood glucose are given and being below that target level is deemed as being a safer level for fetal growth, minimising the risks associated with diabetes in pregnancy. There has been uncertainty if it is the overall glucose control or the spikes in blood sugar levels that influence the baby's growth but the HAPO (Hyperglycemia and Adverse Pregnancy Outcomes) 2008 study suggests that both fasting and postprandial glucose levels influence fetal growth and so this is why the majority of ladies will be testing both fasting levels and pre or post meal levels. How do you know when to test your blood sugar levels and at what time? You get diagnosed with gestational diabetes. You go to your hospital appointment, get given a blood glucose test monitor, shown how to use it and then you're given your test times and targets. But this is where it can be VERY confusing, especially when you compare your targets with mothers from other hospitals... Although there are National guideline recommendations which are backed by research as to what targets should be used for the best outcomes with gestational diabetes, hospitals and Trusts do not have to follow them. This means that ladies in the UK & ROI can be given all sorts of different blood glucose monitoring targets and test times. Some may be very strict, others can be very lenient. Continue reading >>

Glucose Monitoring During Pregnancy

Glucose Monitoring During Pregnancy

Go to: Is There Evidence That Glucose Monitoring Improves Outcomes in Women With Gestational Diabetes? With the advent of home reflectance monitors in the late 1970s and early 1980s, self-monitoring of blood glucose (SMBG) was demonstrated to be possible, and perhaps beneficial, in women with gestational diabetes [1, 2]. By 2004, SMBG was widely practiced, with more than 90% of obstetrician/gynecologists recommending that their patients with gestational diabetes check fasting blood glucose (FBG). However, only 61% of obstetrician/gynecologists were recommending 2-hour postprandial tests [3]. This lack of uniformity in the approach to glucose monitoring can be attributed to several factors. Specifically, there has been uncertainty about the frequency and utility of daily testing; the necessity of SMBG in all women with diabetes during pregnancy; the timing of self-monitoring measurements and whether preprandial or postprandial testing was superior; and the ideal thresholds for implementing changes in therapy [4]. With respect to the uncertain benefits of SMBG in women with diet-treated gestational diabetes, we recently published our findings regarding the utility of SMBG at the University of Texas Southwestern Medical Center [5]. Between January 1991 and December 1997, women with diet-treated gestational diabetes had routine glycemic monitoring at weekly prenatal visits [5]. After January 1998, the standard practice was to issue home glucose meters with instructions to check blood glucose levels four times per day. A total of 675 women who underwent weekly monitoring were compared with 315 women who performed SMBG four times per day. We found that SMBG was associated with a number of maternal and fetal benefits. In particular, there were significantly fewer overgrown inf Continue reading >>

Blood Sugar Levels For Pregnant Women With Diabetes

Blood Sugar Levels For Pregnant Women With Diabetes

Whether you had diabetes before you got pregnant or you developed diabetes during your pregnancy, you'll need to keep a close eye on your blood sugar levels. Tight control will help you avoid complications and long-term health problems for both you and your baby. You're eating differently because your body needs more energy to help your baby grow and be healthy. And your changing hormones affect how your body makes and uses insulin. In the later parts of your pregnancy, you may become more insulin resistant, so blood sugar builds up to higher levels. How often should you check your blood sugar? Pre-existing diabetes: Before and after meals and before bedtime If you are pregnant and have type 1 diabetes, your doctor might sometimes ask you to check your blood sugar in the middle of the night, around 3 a.m. You should check your fasting urine ketones every day, too. For every type of diabetes, if you're pregant you need to see your doctor at least once a month, perhaps as often as once a week. Continue reading >>

Pregnancy With Gestational Diabetes Monitoring During Pregnancy And After

Pregnancy With Gestational Diabetes Monitoring During Pregnancy And After

Pregnancy with Gestational Diabetes Monitoring During Pregnancy and After Pregnancy with gestational diabetes requires extra care. Prenatal visits may be more frequent, and close blood sugar monitoring may be necessary. Most women who develop gestational diabetes have more frequent prenatal visits (once every week or two), especially if insulin is used. The purpose of these visits is to monitor your and your babys health, discuss your diet, and adjust your dose of insulin to keep your blood sugar levels near normal. It is common to change the dose of insulin as the pregnancy progresses, as insulin requirements usually increase as the pregnancy progresses. You may need tests to monitor the health of the baby during the last trimester of pregnancy, especially if your blood sugar levels have been high, you are using insulin, or if you have any pregnancy-related complications, such as high blood pressure. The most commonly used test is the nonstress test. This is done by monitoring the babys heart rate with a small device that is placed on the mothers abdomen. The babys baseline heart rate should be between 110 and 160 beats per minute and should increase above its baseline by at least 15 beats per minute for 15 seconds when the baby moves. The test is considered reassuring (called reactive) if two or more fetal heart rate increases are seen within a 20 minute period. Further testing may be needed if these increases are not seen after monitoring for 40 minutes. If your blood sugar levels are close to normal during pregnancy and you have no other complications, the ideal time to deliver is at term or between 39 and 40 weeks of pregnancy. If you do not deliver by your due date, you may need additional testing to monitor your and your babys health. In most cases, if the baby Continue reading >>

When Does The Clock Start Ticking- Just At What Time Should I Check My Blood Sugars If I Have Gestational Diabetes?

When Does The Clock Start Ticking- Just At What Time Should I Check My Blood Sugars If I Have Gestational Diabetes?

Gestational diabetes is typically a milder diabetes so does not have much in the way of symptoms or complaints. Most of what people feel that may be symptoms of diabetes, going to the bathroom frequently, tiredness, feeling warm or hungry relate much more to the pregnancy itself and not the diabetes. Because of this we have to check the blood sugar as how one feels does not give an accurate sense of how high the blood sugar may be. Some people may feel their sugar is high or low but it does not answer how high or how low. So we need real numbers as it is on these absolute values a decision on whether more treatment needs to be started is based. However, a question we face in the clinic is to decide when should one test the blood sugar and if we do suggest one or two hours after a meal just when does the clock start ticking? Nearly always we need to know the glucose or sugar level before breakfast. It tells us are we starting the day on the right track and as explained previously (See Blog Morning Sugar Rise 8th May 2011) represents how well the pancreas is controlling the liver which is always trying to make glucose. If the fasting blood sugar is up then some treatment if often needed as it is the least responsive glucose value to diet or nutrition changes. The only exception would be if someone is taking a huge snack or meal at bedtime or consuming a snack during the night. Most times in gestational diabetes the sugar goes too high after a meal and then gradually settles. Thus pre lunch, pre supper or bedtime values are often okay but directly after a meal the numbers are high. In women who do not have diabetes the peak sugar occurs just a few minutes after an hour, a bit longer if one is over weight. We have standard targets set for one and two hours after meals so us Continue reading >>

Testing Blood Sugar Levels

Testing Blood Sugar Levels

Why are we testing and monitoring blood sugar levels? Anyone diagnosed with gestational diabetes should regularly test their blood sugar levels. Sometimes ladies that are higher risk or classed as borderline, or those that have had gestational diabetes in previous pregnancies may also be advised to test and monitor levels. This is the best way to see what is happening with your blood sugar levels and how much glucose is remaining in your blood after eating and therefore being passed on to your baby. It's just a guide These capillary tests are a 'guideline' only and not 100% accurate. The only way to get an accurate blood glucose test result is from a blood test which has been analysed in a sterile laboratory environment. Therefore if you test multiple fingers, one after another, you could get different readings each time. Many ladies get frustrated when they hear this and think what is the point if the tests are not 100%, but for a mobile device they do a pretty good job of building up a good picture as to what's happening and a guide is much better than not be aware at all. If you feel there are any inaccuracies with your test monitor then please consult your healthcare professional. Large differences in readings may mean that your machine is faulty or could need calibrating. Test times and targets Different test times and targets are used all across the UK and Ireland, even a hospital a few miles away may have different guidance to yours. Please follow the guidance YOU have been given from your diabetes team/consultant and medical professionals. You may wish to take additional tests, but it important to provide your diabetes team with the information they require. Here are some examples of test times used: one hour post meals two hours post meals pre meals pre meals a Continue reading >>

Gestational Diabetes: Checking Your Blood Sugar

Gestational Diabetes: Checking Your Blood Sugar

If you have gestational diabetes, you need to know when your blood sugar level is outside the target range. Fortunately, you can see what your blood sugar level is anywhere and anytime by using a home blood sugar meter. Knowing your blood sugar level helps you treat low or high blood sugar before it becomes an emergency. Knowing your blood sugar level also helps you know how exercise and food affect your blood sugar and how much insulin to take (if you take insulin). Checking your blood sugar helps you feel more in control of your diabetes during your pregnancy. How to test your blood sugar Here is a simple way to monitor your blood sugar at home. Get organized Before you start testing your blood sugar: Link testing your blood sugar with other daily activities, such as right after preparing breakfast or right before your afternoon walk. This will help you establish the habit of self-testing. Gather the supplies to test your blood sugar. Keep your supplies together so that you can do a test quickly if you need to. Check your equipment before doing each test. Check the expiration date on your testing strips. If you use test strips after the expiration date, you may not get accurate results. Many meters don't need a code from the test strips, but some will. If your meter does, make sure the code numbers on the testing strips bottle match the numbers on your meter. If the numbers do not match, follow the instructions that come with your meter for changing the code numbers. Most manufacturers recommend that you use your meter's sugar control solution the first time you use the meter, each time you open a new bottle of test strips, and whenever you need to check the accuracy of the meter's results. Follow the instructions that came with your meter for using the control soluti Continue reading >>

Understanding Gestational Diabetes: Glucose Monitoring

Understanding Gestational Diabetes: Glucose Monitoring

Fetal Monitoring, Gestational Diabetes, Integrative Medicine, Pregnancy and Birth, Weight Management What is self blood glucose monitoring? Once you are diagnosed as having gestational diabetes, you and your health care providers will want to know more about your day-to-day blood sugar levels. It is important to know how your exercise habits and eating patterns affect your blood sugars. Also, as your pregnancy progresses, the placenta will release more of the hormones that work against insulin. Testing your blood sugar level at important times during the day will help determine if proper diet and weight gain have kept blood sugar levels normal or if extra insulin is needed to help keep the fetus protected. Self blood glucose monitoring is done by using a special device to obtain a drop of your blood and test it for your blood sugar level. Your doctor or other health care provider will explain the procedure to you. Make sure that you are shown how to do the testing before attempting it on your own. Some items you may use to monitor your blood sugar levels are: Lancet–a disposable, sharp needle-like sticker for pricking the finger to obtain a drop of blood. Lancet device–a springloaded finger sticking device. Test strip–a chemically treated strip to which a drop of blood is applied. Color chart–a chart used to compare against the color on the test strip for blood sugar level. Glucose meter–a device which “reads” the test strip and gives you a digital number value. Your health care provider can advise you where to obtain the self-monitoring equipment in your area. You may want to inquire if any places rent or loan glucose meters, since it is likely you won't be needing it after your baby is born. How often and when should I test? You may need to test your blo Continue reading >>

Diabetes In Pregnancy

Diabetes In Pregnancy

Gestational diabetes does not increase the risk of birth defects or the risk that the baby will be diabetic at birth. Also called gestational diabetes mellitus (GDM), this type of diabetes affects between 3% and 20% of pregnant women. It presents with a rise in blood glucose (sugar) levels toward the end of the 2nd and 3rd trimester of pregnancy. In 90% if cases, it disappears after the birth, but the mother is at greater risk of developing type 2 diabetes in the future. Cause It occurs when cells become resistant to the action of insulin, which is naturally caused during pregnancy by the hormones of the placenta. In some women, the pancreas is not able to secrete enough insulin to counterbalance the effect of these hormones, causing hyperglycemia, then diabetes. Symptoms Pregnant women generally have no apparent diabetes symptoms. Sometimes, these symptoms occur: Unusual fatigue Excessive thirst Increase in the volume and frequency of urination Headaches Importance of screening These symptoms can go undetected because they are very common in pregnant women. Women at risk Several factors increase the risk of developing gestational diabetes: Being over 35 years of age Being overweight Family members with type 2 diabetes Having previously given birth to a baby weighing more than 4 kg (9 lb) Gestational diabetes in a previous pregnancy Belonging to a high-risk ethnic group (Aboriginal, Latin American, Asian or African) Having had abnormally high blood glucose (sugar) levels in the past, whether a diagnosis of glucose intolerance or prediabetes Regular use of a corticosteroid medication Suffering from ancanthosis nigricans, a discoloration of the skin, often darkened patches on the neck or under the arms Screening The Canadian Diabetes Association 2013 Clinical Practice Gui Continue reading >>

What To Expect With Gestational Diabetes

What To Expect With Gestational Diabetes

Blood glucose control is key to having a healthy baby A diagnosis of gestational diabetes can cast a shadow over the joys of pregnancy. While the vast majority of these cases end with a healthy baby and mom, gestational diabetes (high blood glucose during pregnancy in a woman who has never had type 1 or type 2 diabetes) does increase risks to the health of both baby and mother. Keeping blood glucose under control is crucial for women with gestational diabetes to help safeguard their babies and themselves. Gestational diabetes is caused by issues that arise as part of a normal pregnancy: hormonal changes and weight gain. Women whose bodies can't compensate for these changes by producing enough of the hormone insulin, which ushers glucose from the blood into cells to produce energy, develop high blood glucose and gestational diabetes. Overweight mothers are at a greater risk for the condition. In the United States, gestational diabetes is reported in somewhere between 2 and 10 percent of pregnancies, but it is now believed that the condition affects 18 percent of women in pregnancy. The larger number is the result of new criteria for diagnosis, not just skyrocketing rates. The American Diabetes Association began recommending this year that gestational diabetes be diagnosed with only one abnormal test result rather than two, the previous method, and this is causing more cases to be detected. Gestational diabetes usually appears roughly halfway through pregnancy, as the placenta puts out large amounts of "anti-insulin" hormones. Women without known diabetes should be screened for gestational diabetes 24 to 28 weeks into their pregnancies. (If high blood glucose levels are detected earlier in pregnancy, the mother-to-be may actually have type 2 diabetes, rather than gestati Continue reading >>

Self-monitoring Of Blood Glucose During Pregnancy: Indications And Limitations

Self-monitoring Of Blood Glucose During Pregnancy: Indications And Limitations

Go to: Self-monitoring of blood glucose (SMBG) is an important tool to treat diabetes during pregnancy. However, proper implementation of SMBG in pregnant women requires understanding of its applications and limitations. This article reviews issues related to the implementation, efficacy, and accuracy of SMBG and discusses factors that can confound results of SMBG during pregnancy. Keywords: Self-monitoring of blood glucose, Diabetes mellitus, Pregnancy, Review Go to: Introduction Perinatal morbidity and mortality rates, often affected by maternal diabetes, have dramatically been reduced since the discovery of insulin and its therapeutic implementation. In addition to increased availability of insulin, many important technological advances have been developed over the preceding decades. These advances culminated in a larger array of diagnostic and therapeutic capabilities that contributed to improved outcomes in high-risk pregnancies. The availability of glucose meters has represented an important positive impact in the treatment of pregnant women with any type of diabetes. Data frequently show patients who perform self-monitoring of blood glucose (SMBG) more strictly adhere to treatment programs due to increased comprehension regarding treatment and participation in the prescribed treatment regimen [1]. Indications for self-monitoring of blood glucose during pregnancy complicated by diabetes SMBG is an integral part of standard diabetes care [2]. It allows pregnant women and their healthcare providers to determine the most effective therapeutic modality (e.g. diet, physical activity, or insulin) to control glucose levels and reduce risks of diabetes-related complications. The number of daily tests required to adequately monitor blood glucose levels is specific to the p Continue reading >>

Managing Gestational Diabetes

Managing Gestational Diabetes

Gestational diabetes is diagnosed during pregnancy when your body cannot cope with the extra demand for insulin production resulting in high blood glucose levels. Gestational diabetes is managed by monitoring blood glucose levels, adopting a healthy eating plan and performing regular physical activity. Effective management of gestational diabetes will reduce the risk of complications during pregnancy and the birth of your baby. Your healthcare team including your doctor, specialist, dietician and Credential Diabetes Educator, can help you with blood glucose monitoring, healthy eating and physical activity. There are three basic components in effectively managing gestational diabetes: monitoring blood glucose levels adopting a healthy eating pattern physical activity. Gestational diabetes can often initially be managed with healthy eating and regular physical activity. However, for some women with gestational diabetes, insulin injections will be necessary for the rest of the pregnancy. Approximately 10 – 20% of women will need insulin; however, once the baby is born insulin is no longer needed. This is safe for both you and your baby. After the baby is born, gestational diabetes usually disappears. A special blood glucose test (Oral Glucose Tolerance Test) (OGTT) is performed six weeks after delivery to ensure that blood glucose levels have returned to normal. However, women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life and should be tested for diabetes at least every 2 – 3 years. If gestational diabetes is not well looked after (blood glucose levels remain high) it may result in problems such as a large baby, miscarriage and stillbirth. A large baby can create the risk of injury at delivery, caesarean delivery, Continue reading >>

Monitoring Your Own Glucose Levels

Monitoring Your Own Glucose Levels

You measure your glucose levels through a finger-prick test. You should have been shown how to do this when you were told that you had gestational diabetes. You will also have discussed the ideal blood glucose levels for you during your pregnancy. The ideal target glucose levels are below but your team may have talked to you about your individual target level: fasting: 5.3 mmol/litre 1 hour after meals: 7.8 mmol/litre 2 hours after meals: 6.4 mmol/litre. How to monitor your blood glucose levels Watch this film from Diabetes UK or read the instructions below. To monitor your glucose, you will be given a blood glucose monitor. This is designed for you to measure your own blood glucose levels at home, or wherever you happen to be, by checking a drop of your blood. You produce the blood by using a finger pricker. There is less sensation in the sides of your fingers than the tips or the underneath. Try to prick the side of your finger, near the tip. To monitor your glucose, you will be given a blood glucose monitor. This is designed for you to measure your own blood glucose levels at home, or wherever you happen to be, by checking a drop of your blood. You produce the blood by using a finger pricker. There are many different brands of meter on the market, but they all work in similar ways: Step 1 Wash your hands. Step 2 Set up a finger pricker with a clean needle. Step 3 Insert one end of a test strip (usually a long, thin paper-type strip) into the meter. Step 4 Use the finger pricker to prick the side of your finger. Step 5 When a spot of blood appears where you pricked you finger, place it onto the end of the testing strip that is sticking out of the meter to transfer the blood. Step 6 After a few seconds, the meter will display your blood glucose level. Step 7 Clean the Continue reading >>

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