Timing of Delivery

Timing of Delivery

There are many points of discussion around Gestational Diabetes (GDM):- how to diagnose it, when to use insulin but a thorny issue is the timing of the delivery.  In the clinic I am sometimes asked “Do I have to be induced early?”  I feel this is more an obstetrical than diabetes related decision and I work with obstetricians I trust but that does not mean the decision should not be questioned.   Understanding the background knowledge can inform those questions.

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Exercise can be helpful in Gestational Diabetes

Exercise can be helpful in Gestational Diabetes

With the treatment of gestational diabetes we are trying to control the blood sugar levels so that they will not go into the baby. The sugars rise after a meal and peak between one and two hours and so most centers ask women to check their glucose levels at either one or two hours after  the mealtime (See Blog of 21 Feb 2013).   If the sugars are high consistently despite attention to diet, then some treatment is usually introduced, typically insulin.   But is there anything else that can be done before taking medicines for the higher sugar levels?

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Gestational Diabetes in Lean Women

Gestational Diabetes in Lean Women

Gestational diabetes in someone who is lean

Typically we think of Gestational Diabetes (GDM) as due to an imperfect pancreas that cannot cope with the extra insulin needed in pregnancy. This need is there because the hormones from the placenta cause insulin resistance so one needs extra insulin just to keep the same glucose. The insulin resistance is worse if there is obesity present or the mom gains excess weight so that even more insulin is needed.   The defect in the pancreas is poorly understood but almost certainly sets the stage for the later Type 2 diabetes that women who had gestational diabetes are more prone to develop.

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Gestational Diabetes, whose fault is it anyway?

Gestational Diabetes, whose fault is it anyway?

When the sugar test results are reported high and the pregnant woman comes to the diabetes clinic, frequently the first thing she says is “I failed the test”.  I don’t think this is fair. You did not fail the test, your pancreas did so please do not dump on yourself, if you have to pick on anyone, pick on your parents who gave you a pancreas that was not up to the stress of pregnancy.

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Just providing good information.

Just providing good information.

Just providing good information.

I specialize in diabetes and pregnancy and have been conscious of the need for solid easily accessible information about gestational diabetes, Type 1 or Type 2 diabetes and pregnancy being available to people for whom this is a concern.   This need became very apparent when I found out about a woman with Type 1 diabetes who was pregnant in a northern area of Alberta, Canada and was feeling lost. She did not know much about the changes that were happening to her diabetes, what risks her baby had and felt her local caregivers did not know enough to answer her questions.  Just providing good information to her questions was a relief.

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