HELP ON DIABETES

Gestational Diabetes
During pregnancy, women are screened for diabetes at twenty-four to twenty-eight weeks, or at the very first visit if they are at very high risk of diabetes as indicated by the following risk factors:

• There are family members with diabetes. 
• Her ethnic background is a group that is particularly susceptible to diabetes. 
• She has polycystic ovarian syndrome. 
• She had diabetes with a previous pregnancy or delivered a baby weighing more than nine pounds.
  

There are two tests that can determine whether a woman has gestational diabetes. The first test is performed on all non-high-risk women at the twenty-four to twenty-eight week visit. If this test is normal, no further testing is necessary. If this fi rst test is positive, however, a second test is performed about a week later.

• First test: One-hour 50-gram glucose challenge screening test. In this test you take a drink that contains 50 grams of glucose (there is no need to fast beforehand). The blood glucose level is checked after one hour. If your
glucose level is greater than 130 mg/dl, the test is positive. If the glucose level is 180 mg/dl or more, there is a strong likelihood that you havediabetes and you will be asked to do a fasting glucose test. Then, if this fasting glucose test is 126 mg/dl or greater, you have gestational diabetes.

• Second test: Three-hour 100-gram glucose test. If the 50-gram glucose challenge test is positive, then within one week you will do a fasting three-hour 100-gram glucose test. You should eat your usual diet, including carbohydrates, in the days before the test—in other words, don’t change your eating habits and stop eating carbohydrates in the days between the first and second test—and fast for eight to fourteen hours before taking the test. The second test is considered positive for diabetes if two or more values are at or above the threshold levels. If only one value is abnormal, this test will be repeated in four weeks.

TREATMENT

After you are diagnosed with gestational diabetes, you will be taught how to check your blood glucose at home, especially your postprandial (after meals) glucose lev­els. You will also meet a nutritionist to work out a meal plan or diet. If your glucose levels are not normal on the diet—that is, over 90 mg/dl fasting, more than 130 mg/dl after meals—then you will start insulin therapy, although glyburide therapy can be considered.

LABOR AND DELIVERY

Women with gestational diabetes are usually allowed to go into spontaneous labor. Depending on the glucose levels, you may need insulin during the labor. Usually insulin is not required after delivery.

GESTATIONAL DIABETES AND RISK FOR TYPE 2 NONGESTATIONAL DIABETES

If you have gestational diabetes, your risk of developing type 2 diabetes in the future is 5 to 50 percent. Therefore, you should have a two-hour 75-gram oral glu­cose tolerance test (OGTT) six to ten weeks after delivery.