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?
Exercise is beneficial for diabetes. For years we have known that women who exercise get less GDM, if they have GDM they need less insulin and generally fit people get through a pregnancy with fewer problems. Long term exercise helps keep weight down, is associated with less fat and improves insulin sensitivity. This means a given amount of insulin from the pancreas can cope with more sugar and store it away safely for future energy needs compared to a person who is insulin resistant.
But what about if one is not fit, has gestational diabetes and is pregnant, does exercise help? The long term benefits of any exercise in improving insulin sensitivity won’t kick in quickly enough to make much difference but when someone exerc ises then the sugar in the blood stream gets used up and this fact may be turned to advantage. A few years ago Dr Avery at the University of Minnesota School of Nursing studied a group of women with GDM at baseline and after a period of 30 minutes on a bicycle machine or 30 minutes of resting. Those who rested started with blood sugars of 5.4 mmol/L (97 mgs/dL) and 30 minutes later the sugar was much the same at 5.2 mmol/L (94 mgs/dL). In the women who did mild exercise for 30 minutes started out with a blood sugar of 5.6 mmol/L (101 mgs/dL) and after the 30 minutes of exercise the blood sugar had dropped to 4.3 mmol/L (77 mgs/dL). Although these drops of 1.3 mmol/dL (24 mgs/dL) are not huge for many women they may make the difference between the sugars being acceptable or not.
Thus in women with GDM, exercise is beneficial unless a person is specifically on bed rest for some reason. In our clinic we suggest that if they are going to exercise to try walking in the first instance. A reasonably brisk walk for 15-20 minutes can make a big difference to the blood sugars. The important point is that it should be between the end of the meal and the glucose testing after meals with the best timing just before the the blood sugar testing. Dropping the blood sugar by such a natural means has got to be a better first way to go than insulin. If it does not work then insulin or oral hypo glycemic treatments can be brought into play.
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