Fasting Blood Sugar Levels For Gestational Diabetes
Fasting Blood Sugar Levels For Gestational Diabetes – In this article, I share the risk factors and the approach to the diagnosis of gestational diabetes in the UK and Ireland.
Diabetes is caused by too much glucose (sugar) in the blood. The level of glucose in the blood is controlled by a hormone called insulin.
Fasting Blood Sugar Levels For Gestational Diabetes
During pregnancy, the body produces hormones such as estrogen, progesterone and human placental lactogen (HPL). These hormones make the body resistant to insulin, which means that cells respond less well to insulin and blood glucose levels remain high.
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In response to higher blood glucose levels, the body must produce more insulin. However, some women either do not produce enough insulin to transport glucose into their cells during pregnancy, or their body cells become more resistant to insulin. When this happens, blood sugar levels remain too high. This is called “gestational diabetes.” Gestational diabetes can also be defined as carbohydrate intolerance.
Figure 1. Marcinkevage, J.A., & Narayan, K.M. (2011). Gestational diabetes: keep it in mind. Primary Care Diabetes, 5 2, 81-8
Gestational diabetes is usually diagnosed by taking an OGTT/GTT (Oral Glucose Tolerance Test) between 24 and 28 weeks, however, women who develop symptoms or who are at higher risk of developing gestational diabetes may are tested earlier.
With gestational diabetes, when too much sugar remains in the mother’s blood, it is passed (fed) to the baby. The baby then has to increase its own insulin secretion to help deal with the excess sugar. Insulin is a growth hormone and as a result the baby’s AC (abdominal circumference) increases. It is the excess production of insulin that causes your baby’s “big” fat tissue (subcutaneous fat). Controlling our blood sugar through diet, exercise, and some people need medication/insulin, this helps the baby regulate insulin production to normal levels and the growth rate of -The baby’s AC decreases while the rest of the baby catches up. This means that the baby will return to “normal” growth size.
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Are some women at higher risk for gestational diabetes than others? Your risk of developing gestational diabetes increases if:
In relation to gestational diabetes, obesity is often mentioned in the media, and there is a stigma surrounding a GD diagnosis, only
Women are diagnosed. Unfortunately, this means that many women feel that testing is unnecessary because they are not overweight, or that those who are diagnosed with this complication feel embarrassed or ashamed.
We see many women join our Facebook support group who are not overweight, so I wanted to do some research on our members about the risk factors associated with a diagnosis of gestational diabetes.
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In a Google poll posted in our Facebook group and Facebook page (March 2018), I received 1,878 responses with the following results:
Here’s what we found when we asked our women to choose which of the following risk factors:
Obesity has been found to be the biggest risk factor for gestational diabetes (48%), but this does not mean that you will necessarily develop gestational diabetes if you are obese.
Obesity was the only risk factor that could be influenced by the mother before conception. The rest of the risk factors are genetic or simply cannot be controlled, so it may be for this reason that we see so much reported risk of obesity and gestational diabetes.
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It is also worth noting that while a BMI of 30 or higher was the greatest risk factor found, more than half (52%, 977 women) of our survey of 1,878 women did not have a BMI of 30 or higher .
In this picture you can see Helen at 35 weeks pregnant, she often comments on how she has gestational diabetes, so thin, even medical people say it! One consultant said,
Unfortunately, Helen is just one of many who have experienced such comments and confusion. If we have medical professionals with such opinions and assumptions, it is no wonder that we face such challenges in the diagnosis of gestational diabetes.
If we see that almost 10% of women have no apparent risk factors, how many women may go undiagnosed and suffer the consequences of gestational diabetes? This number may actually be much higher because these women were not screened at all, as in many areas only women with the above risk factors are screened.
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Typically, we see women screened after the birth of a previous large baby or after delivery with shoulder dystocia. Looking back, I see that many of the women who came to my support group during these future pregnancies often commented that they felt they had undiagnosed GD in their previous pregnancies.
It is for this reason that I believe that screening tests for gestational diabetes should be offered to all pregnant women, not just those at high risk! It’s something being made in Cambridgeshire, and if they can pull it off, they can do it anywhere!
Please share this page to help raise awareness of gestational diabetes and encourage all pregnant women to be screened, and women at risk to be screened as early as possible.
Recent research has shown that diet and exercise in people with a higher BMI before pregnancy can reduce the risk of gestational diabetes, another article published in BJOG says:
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An analysis of 13 trials involving more than 2,800 women found that exercise reduced the risk of gestational diabetes by more than 30% – and this was even higher (36%) for women who were active during pregnancy. This effect is most evident for women who combine conditioning, strength, flexibility and cardio. Symptoms of Testicular Diabetes
It is very common to have no symptoms, which is why many women who receive a positive result think they cannot have gestational diabetes and struggle to receive a diagnosis.
You will notice that many of these symptoms are common during a normal pregnancy, so it can be difficult to determine whether they are due to gestational diabetes or just the pregnancy itself until you have a glucose tolerance test.
A 2-hour 75 g oral glucose tolerance test (OGTT or GTT) is used to diagnose gestational diabetes between 24 – 28 weeks in women with any of the risk factors below on.
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If glucosuria (sugar in the urine) is found to be 2+ or more times or 1+ or more 2 or more times by urine test during routine antenatal visits, this may ‘ indicates undiagnosed gestational diabetes, so women with the disease should be referred for an OGTT.
Those previously diagnosed with gestational diabetes are usually subsequently tested at 16 weeks of pregnancy and again at 24-28 weeks if the first test is negative. Instead of testing for gestational diabetes in subsequent pregnancies, some hospitals may offer blood glucose monitoring starting in the first trimester.
The test involves fasting (not eating or drinking) from the night before, taking a fasting blood test on arrival, drinking 75 grams of glucose (possibly in the form of a glucose syrup drink), and then take a follow-up glucose blood test. 2 hours later.
Ask your hospital when you should be fasting and if water is allowed during this time.
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All hospitals may vary the goals used for the diagnosis of OGTT. Some people will have three blood tests (fasting, one hour after glucose, and two hours), while others will have two (fasting and one hour after glucose).
In some areas, they may use a fasting blood glucose test or an HbA1c blood test alone instead of an OGTT.
Due to the Covid 19 pandemic, RCOG 2020 recommends HbA1c testing for the diagnosis of gestational diabetes. This is because the HbA1c test is a simple blood test that can be done at any time of the day, rather than keeping patients waiting in the clinic for more than two hours.
Unfortunately, since the test is an average of blood sugar over a long period of time, it will still only show the average blood sugar if the blood sugar level rises only at the end of three months, so it can lead to false negative results. In fact, the mother already has gestational diabetes.
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Adequate screening for gestational diabetes should still be provided as much as possible, following NICE guidelines and being aware that modifications to screening protocols are associated with reduced detection of diabetes cases of pregnancy.
In Cambridgeshire they screen all pregnant women for gestational diabetes and offer blood glucose testing at 8-12 weeks of pregnancy, but this is not the case in the rest of the UK and Ireland.
Some women may be referred for testing if they have symptoms of gestational diabetes, but unfortunately, this is not the case for everyone.
1.2.8 Gestational diabetes is diagnosed if a woman has either: a fasting blood glucose level of 5.6 mmol/l or more or a 2-hour plasma glucose level of 7.8 mmol/l
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