Gestational Diabetes

Diabetes that is diagnosed for the first time during pregnancy is called gestational diabetes.  According to the American Pregnancy Association, between 2 and 5 percent of women develop diabetes during pregnancy.  It can cause some serious complications for both mom and baby if it is not recognized and treated.  

What causes gestational diabetes?

During pregnancy, the placenta produces hormones to sustain pregnancy.  Unfortunately, these hormones also make your cells more resistant to insulin.  Your pancreas will respond by making more insulin.  Normally, the pancreas can make enough extra insulin to overcome the resistance in the cells, but sometimes the pancreas just can't keep up with the demand.  When this happens, not enough glucose gets into the cells, and blood glucose levels get too high.  

What are the symptoms of gestational diabetes?

Most women don't notice the symptoms of gestational diabetes.  They usually blame the more frequent urination on the pregnancy itself.  It may also cause some increased thirst, but this is also usually not that noticeable.  

What are the risk factors for gestational diabetes?

• Being overweight or obese
• Having a sedentary lifestyle with low level of physical activity
• Having prediabetes, or having had gestational diabetes with a prior pregnancy
• Polycystic ovary syndrome
• Family history of diabetes in a close relative
• Women who are Black, Hispanic, American Indian, or Asian American have a higher risk 
• Previously delivering a baby that weighed more than 9 pounds

How is gestational diabetes diagnosed?

Because of the seriousness of the condition and the fact that it causes few symptoms, all pregnant women are screened for gestational diabetes as a part of routine prenatal care.

• If you are at average risk, the screening is typically done between 24-28 weeks of pregnancy.
• If you have any of the risk factors mentioned above, your doctor may want to screen for diabetes early in pregnancy, even at your first prenatal visit, and may screen you more than once during pregnancy.

Screening tests can vary slightly but in general the screening test is a glucose challenge test.  For this test, you will drink a syrupy drink that is a concentrated glucose solution.  One hour later, your blood will be drawn to test your blood sugar.  If your blood sugar result is in the normal range, that's great.

If your blood sugar falls into the high range, then you will have another test called a glucose tolerance test.  This test uses a higher concentration of glucose solution.  After drinking the solution, your blood sugar will be checked every hour for 3 hours.  If two or three of the blood sugar readings are higher than expected, you will be diagnosed with gestational diabetes.

How is gestational diabetes treated?

• Lifestyle changes - Eating a healthy diet and being more physically active.
• Monitoring your blood sugar regularly - Your doctor will tell you how often.
• Medication, if necessary - When diet and exercise do not keep your blood sugar down, medication is required.  Insulin is the usual medication used during pregnancy.
• Close monitoring of your baby - You may have additional ultrasounds to monitor the baby's growth and development.  Your doctor may also want to induce labor if you do not go into labor by your due date.
  

What are the complications that can happen if gestational diabetes is not carefully managed?

Complications that may affect the baby:

• Excessive birth weight - From high glucose levels going to the baby.  Babies weighing 9 pounds or more are more likely to get wedged in the birth canal, have birth injuries, or require a C-section birth.
• Premature birth 
• Serious breathing difficulties shortly after birth
• Low blood sugar shortly after birth - This can be serious and even cause seizures in the baby.
• Higher risk for obesity and type 2 diabetes later in life.
• Stillbirth - Untreated gestational diabetes can result in a baby's death either before birth or shortly after birth.

Complications that may affect the mother:

• High blood pressure
• Preeclampsia - A serious complication of pregnancy that causes high blood pressure and other serious symptoms including seizures, which can threaten the lives of both mother and baby.
• Having a C-section delivery is more likely.
• Future diabetes - Women who have gestational diabetes have a higher risk of gestational diabetes in future pregnancies, as well as a higher risk of developing type 2 diabetes over time.

Gestational diabetes is a serious condition.  To lower your risk, try to form healthy habits before getting pregnant and try to start pregnancy at a healthy weight.

If you have any questions about gestational diabetes, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Type 2 Diabetes - Part II

Over 30 million Americans have type 2 diabetes.  We will continue our discussion of this topic today, focusing on diagnosis and treatment.

How is type 2 diabetes diagnosed?

Unlike type 1 diabetes, the symptoms of type 2 diabetes can come on gradually and sometimes may not even be noticed.  Also, sometimes symptoms are presumed by patients to be from another cause, and they might not see their doctor about the symptoms or even mention them to their doctor.  For instance, frequent urination might be blamed on an overactive bladder, or blurry vision might be blamed on age-related far-sightedness.  For these reasons, the American Diabetes Association (ADA) and the U.S. Preventive Services Task Force have recommended screening for type 2 diabetes.  The primary purpose of any screening test is to detect early disease in large numbers of apparently healthy individuals.  Screening allows us to make a diagnosis earlier and treat earlier.  In diabetes, this can help prevent complications, which helps to prevent blindness, kidney failure, and premature death.

The ADA guidelines recommend that the following people should be screened for diabetes:

• Anyone with a body mass index (BMI) higher than 25 (23 for Asian Americans), regardless of age, who has additional risk factors, such as high blood pressure, abnormal cholesterol levels, a sedentary lifestyle, a close relative with diabetes, a history of polycystic ovary syndrome (PCOS), or a history of heart disease.
• Anyone older than age 45 should have an initial blood sugar screening test.  If the results are normal, they should be screened every 3 years after that.
• Women who have had gestational diabetes should be screened every 3 years after the pregnancy.
• Anyone who has been diagnosed with prediabetes should be tested every year.
  

The tests for diagnosing type 2 diabetes are the same as those done for type 1 diabetes, which includes:

• Blood tests - To check the blood sugar level and/or the hemoglobin A1c test.
• Urine tests - To test for glucose and/or ketones in the urine.
  

How is type 2 diabetes treated?

There is nothing that can cure type 2 diabetes.  However, it can be treated to manage blood sugar levels and decrease the risk of complications.  Some of the treatments include:

• Lifestyle changes - Including eating a healthy diet, increasing physical activity, and losing weight if you are overweight.  Sometimes these lifestyle changes alone can keep blood sugar levels managed well at normal levels.
• Medications taken by mouth - There are six types of diabetes pills.  They work in different ways.  Metformin is generally the first medication prescribed for type 2 diabetes.  It inhibits the production and release of glucose from the liver.  Other oral medications work by preventing the kidneys from reabsorbing sugar into the blood, by making your cells more sensitive to insulin, by increasing production of insulin in the pancreas, or by blocking breakdown of carbohydrates in the digestive tract.
• Insulin - Many people with type 2 diabetes are treated with insulin, usually in combination with oral medications.  Adding insulin helps to overcome insulin resistance when the pancreas can't make enough insulin to keep up with the demand.  There are many types of insulin available now.  They all need to be given by injection or by an insulin pump.  
• Other injectable medications - There are some newer medications for type 2 diabetes that are injected once a week.  They work by stimulating insulin release and lowering another hormone that is responsible for raising blood sugar.
• Blood sugar checks - Done regularly, this can help you and your doctor manage your blood sugar levels.
• Bariatric (weight loss) surgery - While this is not considered a specific treatment for type 2 diabetes, people with type 2 diabetes who have a BMI over 35 may benefit from surgery such as gastric bypass.  The weight loss associated with bariatric surgery has been shown to result in significant improvements in blood sugar levels.  The long-term risks and benefits of this procedure for diabetes are still unknown.  
  

If you have type 2 diabetes, you and your doctor will work together to find the best treatment for you.

Next week, we will continue our discussion of diabetes.

If you have any questions about diabetes, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Diabetes - Type 2

I hope you have had the chance to read the last two Health Tips on diabetes - where we first covered the basics, then did a deeper dive into type 1 diabetes.  We will continue our discussion of diabetes today, focusing on type 2 diabetes.  Over 34 million Americans have diabetes, and approximately 90-95% of them have type 2 diabetes.  Type 2 diabetes used to be called "adult-onset" diabetes, because it most often develops in adults over age 45.  However, more and more children, teenagers, and young adults are developing type 2 diabetes.

What is type 2 diabetes and what causes it?

In type 2 diabetes, the cells in your body don't respond normally to insulin, which is called insulin resistance.  This means that although your pancreas is making insulin like it should, the insulin is not effective at helping the glucose move into the cells.  Your pancreas makes more insulin to compensate for the resistance, but eventually the pancreas is not able to keep up because the resistance becomes too great.  Over time, the pancreas may sort of "burn out" because it is working so hard, which may lead to lower insulin production.

We don't know exactly why this happens.  We believe that it is due to a combination of genetic and environmental factors.  Being overweight is one environmental factor that is strongly linked to the development of type 2 diabetes, although not everyone with type 2 diabetes is overweight.

What is prediabetes?

Prediabetes is a condition where your blood sugar levels are higher than normal, but not high enough to be classified as diabetes.  It is often the precursor to diabetes unless you take action to control it.  Prediabetes is reversible if appropriate measures are taken to prevent progression to type 2 diabetes.  The causes and risk factors are the same for prediabetes as they are for type 2 diabetes.

What are the risk factors for developing type 2 diabetes?

• Being overweight or obese - The more fat your body carries, the more resistant your cells become to insulin.
• Physical inactivity - Physical activity on a regular basis uses up glucose as energy, makes your cells more sensitive to insulin, and helps keep your body weight under control.
• Family history - Having a parent or sibling with type 2 diabetes increases your risk.
• Race or ethnicity - It is not clear why, but certain groups of people are at higher risk for type 2 diabetes, including Black, Hispanic, American Indian, and Asian American people.
• Age - Your risk increases as you get older, maybe because you tend to be less active, have less muscle mass, and gain weight as you get older.  But as I mentioned earlier, we are seeing increasing numbers of cases of type 2 diabetes in children, teens, and young adults.
• Polycystic ovary syndrome (PCOS) - Women with PCOS are at higher risk of type 2 diabetes.
• High blood pressure - Blood pressure over 140/90 is linked to increased risk of type 2 diabetes.
• Abnormal cholesterol and triglyceride levels - People with high triglyceride levels and people with low levels of good cholesterol (HDL) are at higher risk for type 2 diabetes.  This is another reason to have your doctor check these levels with a lipid panel.
• Gestational diabetes - We will talk more about this type of diabetes next week.  If you have this when you are pregnant, you are at higher risk of developing type 2 diabetes later in life.
  

Can type 2 diabetes be prevented?

Yes.  Here are things you can do to help prevent type 2 diabetes:

• Eat a healthy diet with plenty of fresh fruits and vegetables and less carbohydrates and sugars.
• Be more physically active - try to get at least 150 minutes of moderate level exercise each week.
• Maintain a healthy weight - aim for a body mass index (BMI) of 25 or less.

These measures can help to prevent the development of type 2 diabetes and can also reverse prediabetes.

We will talk more about type 2 diabetes next week including diagnosis and treatment options.

If you have any questions about diabetes, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor