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Certain traits increase your chances of getting type 2 diabetes within five years¹² of having your baby. If you have one or more of the following, you should talk to your health care provider about type 2 diabetes:

• You developed gestational diabetes before your 24th week of pregnancy.
• Your blood sugar level during pregnancy was consistently on the high end of the healthy range.
• Your blood sugar levels after the baby was born were higher-than-average, according to your health care provider.
• You are in the impaired glucose tolerance category
• You are obese, according to your health care provider.
• You have diabetes in your family.
• You belong to a high-risk ethnic group (Hispanic, African American, Native American, South or East Asian, Pacific Islander, Indigenous Australian).
• You have had gestational diabetes with other pregnancies.

If you have any of these risk factors, it is even more important that you get tested yearly for diabetes. Remember that you can take steps to lower your risk for type 2 diabetes, such as eating a low-fat diet, losing extra weight, and getting regular, moderate physical activity.

Source: National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

Like all mothers,women with gestational diabetes should breastfeed their babies, if possible. Breastfeeding provides a number of benefits for your baby, including the right balance of nutrients and protection against certain illnesses. Breastfeeding is also beneficial for mothers. It allows your body to use up some extra calories that were stored during pregnancy. Losing weight after having the baby enhances overall health and is one way to reduce your chances of developing diabetes later in life. Many women who have gestational diabetes also find that breastfeeding improves their fasting blood sugar level and allows them to maintain a lower average blood sugar level once their babies are born.

Source: National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

Your health care provider will check your blood sugar level often, starting right after your baby is born. For most women, blood sugar levels go back to normal quickly after having their babies.

Six weeks² after your baby is born, you should have a blood test to find out whether your blood sugar level is back to normal. This test is similar to the one you took to find out whether or not you had gestational diabetes. Based on the results of the test, you will fall into one of three categories.

The test also checks your risk for getting diabetes in the future. Women who have had gestational diabetes have a 40 percent higher chance^2,3 than women who haven’t had gestational diabetes of developing type 2 diabetes later in life.

Getting checked for diabetes is important because type 2 diabetes shows few symptoms. The only way to know for sure that you have type 2 diabetes is to have a blood test that reveals a higher-than-normal blood sugar level. You should also tell your health care provider right away if you notice any of these things:

• Being very thirsty
• Urinating often
• Feeling constantly or overly tired
• Losing weight quickly and/or without reason

Having one or more of these symptoms does not necessarily mean you have diabetes, but your health care provider might want to test you to make sure. Detecting type 2 diabetes early can help you avoid problems, like early heart disease and damage to your eyes, kidneys, or nerves. If you choose to use birth control methods in the future, talk with your health care provider about a method that won’t increase your risk of developing diabetes.

Source: National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow the treatment plan that their health care providers set up for them.

This booklet gives you general guidelines for how to stay healthy with gestational diabetes. Your health care provider can build a treatment program to meet your specific needs. Remember that the most important person in the treatment plan is YOU. You are the one who will be doing the work to keep yourself healthy. Make sure you feel comfortable asking questions and talking to your health care provider about any worries that you have.

One of the most important things you can do to help ensure a healthy pregnancy is to make regular health care appointments and keep them. In this way, your health care provider can catch any problems before they become major health issues.

A general treatment plan to control gestational diabetes may include these items:

* Knowing your blood sugar (also called glucose) level and keeping it under control
* Eating a healthy diet, as outlined by your health care provider
* Getting regular, moderate physical activity
* Maintaining a healthy weight gain
* Keeping daily records of your diet, physical activity, and glucose levels
* Taking insulin and/or other medications as prescribed

Your health care provider might also tell you to:

* Test your urine for ketones, if needed
* Have your blood pressure checked as indicated

What are these things? Why are they important? How do you do them? When do you do them? How do you know if you’re doing them right? To answer these questions, let’s look at each one more closely. Select an item to learn more about it. When you have finished reviewing all the items, NEXT will take you to the next section.

Source: National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

Most women who have gestational diabetes give birth to healthy babies, especially when they keep their blood sugar under control, eat a healthy diet, get regular, moderate physical activity, and maintain a healthy weight. In some cases, though, the condition can affect the pregnancy.

Keeping glucose levels under control may prevent certain problems related to gestational diabetes.

Below are some conditions that can result from your having gestational diabetes. Keep in mind that just because you have gestational diabetes does not mean that these problems will occur.

* Macrosomia (pronounced mak-row-SOHM-ee-uh)—Baby’s body is larger than normal. Large-bodied babies sometimes get injured by natural delivery through the vagina; the baby may need to be delivered through cesarean section. The most common complication for these babies is shoulder dystocia (pronounced dis-TOE-shee-uh).

* Hypoglycemia (pronounced high-po-gl-eye-SEEM-ee-uh)—Baby’s blood sugar is too low. You may need to start breastfeeding right away to get more glucose into the baby’s system. If it’s not possible for you to start feedings, the baby may need to get glucose through a thin, plastic tube in his or her arm that puts glucose directly into the blood.

* Jaundice (pronounced JAWN-diss)—Baby’s skin turns yellowish; white parts of the eyes may also change color slightly. If treated, jaundice is not a serious problem for the baby.

* Respiratory Distress Syndrome (RDS)—Baby has trouble breathing. The baby might need oxygen or other help breathing if he or she has RDS.

* Low Calcium and Magnesium Levels in the Baby’s Blood—Baby could develop a condition that causes spasms in the hands and feet, or twitching or cramping muscles. This condition can be treated with calcium and magnesium supplements.

Could gestational diabetes hurt my baby in other ways?

mom and baby Gestational diabetes usually does not cause birth defects or deformities. Most developmental or physical defects happen during the first trimester of pregnancy, between the 1st and 8th week. Gestational diabetes typically develops around or after the 24th week of pregnancy. Women with gestational diabetes usually have normal blood sugar levels during the first trimester, which allows the body and body systems of the fetus to develop normally.

The fact that you have gestational diabetes will not cause diabetes in your baby. But, your child is at higher risk for developing type 2 diabetes later in life. As your child grows, things like eating a healthy diet, maintaining a healthy weight, and getting regular, moderate physical activity may help to reduce that risk.

If your baby was macrosomic, or large-bodied at birth, then he or she is at higher risk for childhood and adult obesity (being extremely overweight). Large-bodied babies are also at greater risk for getting type 2 diabetes and often get it at an earlier age (younger than 30).

Source: National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

mom and daughter Once you have the baby, your body should be able to use its insulin more effectively. Shortly after the baby is born, the placenta is “delivered.” (This is sometimes called the afterbirth.) Because the placenta causes insulin resistance, when it’s gone, gestational diabetes usually goes away, too.

If you have gestational diabetes, you are at higher-than-normal risk for developing type 2 diabetes later in your life. Type 2 diabetes, like gestational diabetes, occurs when the body doesn’t use its insulin properly. Keeping your weight within a healthy range and keeping up regular, moderate physical activity after your baby is born can help lower your risk for type 2 diabetes. Following a healthy diet and physical activity program, maintaining a healthy weight, or taking certain medicines can help people control type 2 diabetes.

Source: National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

Most women with gestational diabetes can make it to their due dates safely and begin labor naturally. In some cases, though, gestational diabetes could change the way you feel or how your baby is delivered. Again, keep in mind that just because you have gestational diabetes does not mean that you will have any change in delivery. Talk to your health care provider about ANY concerns you have about labor or delivery.

If you have gestational diabetes, there are some things you should keep in mind about delivery:

• Blood Sugar and Insulin Balance—Keeping your blood sugar level under control during labor and delivery is vital to your own health and to your baby’s health. If you do not take insulin during your pregnancy, you probably won’t need it during labor or delivery. If you do take insulin during your pregnancy, you may receive an insulin shot when labor begins, or you may get insulin through a thin, plastic tube in your arm that goes into your bloodstream during labor.
• Early Delivery—Gestational diabetes puts women at higher risk than women without the condition for developing preeclampsia (pronounced pree-ee-KLAMP-see-uh), late in their pregnancies. Preeclampsia is a condition related to a sudden blood pressure increase; it can be a serious. (For more information on preeclampsia, go to the Your health care provider might also tell you to: Have your blood pressure checked as indicated section of this booklet.) The only way to cure preeclampsia is to deliver the baby; but delivery may not be the best option for your health or for the health of the baby. Your health care provider will keep you under close watch, possibly at the hospital, and will run multiple tests to determine whether early delivery is safe and needed. Your health care provider will give you more information about early delivery, should it be necessary.
• Cesarean Delivery—This is a type of surgery used to deliver the baby, instead of natural delivery through the vagina. Cesarean delivery is also called a cesarean section, or “C” section. Simply having gestational diabetes is not a reason to have a C section, but your health care provider may have other reasons for choosing a cesarean delivery, such as changes in your health or your baby’s health during labor.

Source: National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

Women who have gestational diabetes benefit most from a team approach, with each member playing a specific role in the management and treatment of the condition. However, the specific members of the team will vary.

In general,women have a number of choices in how they get prenatal care. They might go to an obstetrician/gynecologist (OB/GYN), a nurse-midwife, a family physician, or another health care provider. These health care providers are usually the first line of defense against gestational diabetes because they do the initial testing for the condition.

Once you are diagnosed with gestational diabetes, these providers may decide to stay on your team, working with other providers to manage your care, or they may suggest that one of the following specialists leads your team:

• A maternal-fetal medicine specialist—a doctor who cares for a woman during pregnancy, labor, and delivery only; or
• Another doctor who specializes in treating pregnant women with high-risk conditions.

S hould you need more extensive treatment and management to keep your gestational diabetes under control, it is likely that you will have to see one of these specialists to help ensure a healthy pregnancy.

You should also have a registered dietitian, a person with a bachelor’s degree or higher in dietetics, who is registered with the American Dietetic Association (ADA), on your team. Your health care provider can recommend a dietitian, or you can call the ADA at 1-800-366-1655 to find one.

In addition, you may have one or both of the following providers on your team:

• A diabetes specialist—a diabetologist (a doctor who specializes in diabetes care), endocrinologist (a doctor who specializes in treating hormone-related conditions, like diabetes), or another medical doctor who provides health services specifically for diabetics.
• A diabetes educator—a certified diabetes educator (CDE), nurse educator, registered nurse (RN), or another health care provider who can explain gestational diabetes and help you manage your condition during your pregnancy.

K eep in mind that your treatment and management team may include other members, too. This booklet uses the term health care provider to describe your doctor and the other members of your health care team.

Source:National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

What is gestational diabetes?
Gestational diabetes, also known as gestational diabetes mellitus, GDM, or diabetes during pregnancy, is a type of diabetes that only pregnant women get. If a woman gets diabetes when she is pregnant, but never had it before, then she has gestational diabetes.

Normally, your stomach and intestines digest the carbohydrate in your food into a sugar called glucose. Glucose is your body’s main source of energy. After digestion, the glucose moves into your blood to give your body energy.

To get the glucose out of your blood and into the cells of your body, your pancreas makes a hormone called insulin.  If you have diabetes, either your body doesn’t make enough insulin, or your cells can’t use it the way they should.  Instead, the glucose builds up in your blood, causing diabetes, or high blood sugar.

Gestational diabetes happens in about 5 percent of all pregnancies, or about 200,000 cases a year in the United States.
How do I know if I have gestational diabetes?
Health care providers will test most women who have average risk for gestational diabetes when they are between 24-28 weeks pregnant.

If your risk is higher-than-average, your health care provider may test you earlier, possibly as soon as you know you are pregnant.

There are two approaches to testing for gestational diabetes:

* In the one-step approach, a woman will fast for 4 to 8 hours. Then a health care provider will measure her blood sugar and will do so again 2 hours after she drinks a sugar drink.  This type of test is called an oral glucose tolerance test.
* In the two-step approach, a health care provider measures a woman’s blood sugar 1 hour after drinking a sugar drink.  Women whose blood sugar is normal after 1 hour probably don’t have gestational diabetes.  Women whose blood sugar is high after 1 hour will then have an oral glucose tolerance test to see if they have gestational diabetes.

Will gestational diabetes affect the baby?
Most women who have gestational diabetes give birth to healthy babies, especially when they control their blood sugar, eat a healthy diet, exercise, and keep a healthy weight.

In some cases, though, gestational diabetes can affect the pregnancy and baby. Some potential risks include:

* The baby’s body is larger than normal—called macrosomia.  A large baby may need to be delivered by a surgical procedure called cesarean section, instead of naturally through the vagina.
* The baby’s blood sugar is too low—called hypoglycemia.  Starting to breastfeed right away can help get more glucose to the baby.  The baby may also need to get glucose through a tube into his or her blood.
* The baby’s skin turns yellowish and the whites of the eyes may change color—called jaundice.  This condition is easily treated and is not serious if treated.
* The baby may have trouble breathing and need oxygen or other help—called Respiratory Distress Syndrome.
* The baby may have low mineral levels in the blood.  This problem can causes muscle twitching or cramping, but can be treated by giving the baby extra minerals

How is gestational diabetes treated?
Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow a treatment plan from their health care provider.

Each woman should have a specific plan designed just for her needs, but there are some general ways to stay healthy with gestational diabetes:

* Know your blood sugar and keep it under control – By testing how much sugar is in your blood, it is easier to keep it in a healthy range.  Women usually need to test a drop of their blood several times a day to find out their blood sugar level.
* Eat a healthy diet – Your health care provider can make a plan with the best diet for you.  Usually controlling carbohydrates is an important part of a healthy diet for women with gestational diabetes because carbohydrates affect blood sugar.
* Get regular, moderate physical activity – Exercise can help control blood sugar levels.  Your health care provider can tell you the best activities and right amount for you.
* Keep a healthy weight – The amount of weight gain that is healthy for you will depend on how much you weighed before pregnancy. It is important to track your both your overall weight gain and weekly rate of gain.
* Keep daily records of your diet, physical activity, and glucose level – Women with gestational diabetes should write down their blood sugar numbers, physical activity, and everything they eat and drink in a daily record book.  This can help track how well the treatment is working and what, if anything, needs to be changed.

Some women with gestational diabetes will also need to take insulin to help manage their diabetes.  The extra insulin can help lower their blood sugar level.  Some women might also have to test their urine to see if they are getting enough glucose.
What happens after the baby is born?
For most women, blood sugar levels go back to normal quickly after the baby is born.  Six weeks after the baby is born, you should have a blood test to check your blood sugar levels.  The test also checks for your risk of getting diabetes in the future.

If you know you want to get pregnant again, have a blood sugar test up to three months before becoming pregnant to make sure your blood sugar level is normal.

Children whose mothers had gestational diabetes are at higher risk for obesity, abnormal glucose tolerance, and diabetes.

Women who have had gestational diabetes and children whose mothers had gestational diabetes are at higher lifetime risk for obesity and type 2 diabetes.  It may be possible to prevent type 2 diabetes through lifestyle changes.  Talk to your health care provider about diabetes and increased risk from gestational diabetes.

Source: National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

Blood Pressure Medicines

Scientists have made great progress in developing methods that slow the onset and progression of kidney disease in people with diabetes. Drugs used to lower blood pressure can slow the progression of kidney disease significantly. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more drugs to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretic can also be useful. Beta blockers, calcium channel blockers, and other blood pressure drugs may also be needed.

An example of an effective ACE inhibitor is lisinopril (Prinivil, Zestril), which doctors commonly prescribe for treating kidney disease of diabetes. The benefits of lisinopril extend beyond its ability to lower blood pressure: it may directly protect the kidneys’ glomeruli. ACE inhibitors have lowered proteinuria and slowed deterioration even in people with diabetes who did not have high blood pressure.

An example of an effective ARB is losartan (Cozaar), which has also been shown to protect kidney function and lower the risk of cardiovascular events.

Any medicine that helps patients achieve a blood pressure target of 130/80 or lower provides benefits. Patients with even mild hypertension or persistent microalbuminuria should consult a health care provider about the use of antihypertensive medicines.

Moderate-protein Diets

In people with diabetes, excessive consumption of protein may be harmful. Experts recommend that people with kidney disease of diabetes consume the recommended dietary allowance for protein, but avoid high-protein diets. For people with greatly reduced kidney function, a diet containing reduced amounts of protein may help delay the onset of kidney failure. Anyone following a reduced-protein diet should work with a dietitian to ensure adequate nutrition.

Intensive Management of Blood Glucose

Antihypertensive drugs and low-protein diets can slow CKD. A third treatment, known as intensive management of blood glucose or glycemic control, has shown great promise for people with diabetes, especially for those in the early stages of CKD.

The human body normally converts food to glucose, the simple sugar that is the main source of energy for the body’s cells. To enter cells, glucose needs the help of insulin, a hormone produced by the pancreas. When a person does not make enough insulin, or the body does not respond to the insulin that is present, the body cannot process glucose, and it builds up in the bloodstream. High levels of glucose in the blood lead to a diagnosis of diabetes.

Intensive management of blood glucose is a treatment regimen that aims to keep blood glucose levels close to normal. The regimen includes testing blood glucose frequently, administering insulin throughout the day on the basis of food intake and physical activity, following a diet and activity plan, and consulting a health care team regularly. Some people use an insulin pump to supply insulin throughout the day.

A number of studies have pointed to the beneficial effects of intensive management of blood glucose. In the Diabetes Control and Complications Trial supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), researchers found a 50 percent decrease in both development and progression of early diabetic kidney disease in participants who followed an intensive regimen for controlling blood glucose levels. The intensively managed patients had average blood glucose levels of 150 milligrams per deciliter—about 80 milligrams per deciliter lower than the levels observed in the conventionally managed patients. The United Kingdom Prospective Diabetes Study, conducted from 1976 to 1997, showed conclusively that, in people with improved blood glucose control, the risk of early kidney disease was reduced by a third. Additional studies conducted over the past decades have clearly established that any program resulting in sustained lowering of blood glucose levels will be beneficial to patients in the early stages of CKD

If you have any specific question, you can ask the doctors at  www.mymedexpert.com