GESTATIONAL DIABETES

 

Dustin: I'd like you all to meet my very special friend. Her name is Baby Kaye. She'll be your host for this section of the diabetes project. Take it away BABY!

 Baby Kaye: Hi there! Welcome to my world. I'll be your host for this section of the diabetes project. I'd like to thank Dustin for his introduction. I'd like to start off by letting you know how my mother found out she had gestational diabetes.

It all started in the third trimester of pregnancy. Of course I was just a bun in the oven then. Mom went to the clinic for another prenatal appointment. The visit went something like this:

 

Dr. Sandstone's office at I.H.S.

 

Dr. Sandstone: Hi Anna! How are you feeling this week?

GLOSSARY

Gestational diabetes- A form of diabetes which begins during pregnancy and usually disappears following delivery.

Trimester- A period of three months. Pregnancy is divided into three trimesters. The first trimester is 0-13 weeks gestation. The second trimester is 14-26 weeks gestation. The third trimester is 27 weeks gestation until birth.

Placenta- A special tissue that joins the mother and fetus. It provides hormones necessary for a successful pregnancy, and supplies the fetus with water and nutrients (food) from the mother's blood.

Stillbirth- The birth of a dead fetus after 24 weeks of gestation.

Amniotic fluid- The fluid that surrounds the fetus in the amniotic sac.

Amniotic sac- membranes, which contain the fetus and the amniotic fluid. The amniotic sac and the amniotic fluid are often referred to as the "bag of waters."

Pancreas- A long gland that lies behind the stomach. The pancreas manufactures insulin and digestive enzymes.

Glucose- Glucose is the major source of energy for living cells and is carried to each cell through the bloodstream. The cells cannot use glucose without the help of insulin.

Cesarean section- Delivery of the baby through an incision in the abdomen and uterine walls (c-section).

Hypoglycemia- A condition where the blood sugar is lower than normal. This is a dangerous condition and should be avoided or treated rapidly.

Anna: I'm starting to feel a little more tired than usual.

Dr. Sandstone: Well, today we will be doing more tests to make sure everything is okay. Now that you are in the 24th week of pregnancy we will have to do some screening for gestational diabetes. The Indian Health Service automatically screens all pregnant women for gestational diabetes.

Anna: Since this is my first baby, I'm still learning new things about being pregnant. Can you tell me more about gestational diabetes?

Dr. Sandstone: Well, gestational diabetes usually develops around the last trimester of pregnancy and will usually disappear after delivery of the baby. During pregnancy, there are hormones produced in the placenta. These hormones create a resistance to insulin, which causes blood glucose levels to increase. Most pregnant women can handle the increase in blood sugar, but there is a small percentage (3 to 5%) of women who are unable to produce enough insulin. When there isn't enough insulin to allow blood glucose into the cells, then gestational diabetes will develop.

Anna: Which women are more at risk for developing gestational diabetes?

Dr. Sandstone: Some risk factors include, obesity, family history of diabetes, previous large baby, stillbirthor too much amniotic fluid. Also, women who are older than 25 are at greater risk than younger women are.

Anna: How does all of this affect my baby? Will my baby be all right?

Baby Kaye: Yeah, what's gonna happen to me?

Dr. Sandstone: Sometimes babies born to mothers who have gestational diabetes are large because of exposure to high levels of blood glucose. All the nutrients the baby receives come directly from the mother's blood. If the mother's blood has too much glucose, the pancreas of the baby will sense the high levels of glucose. The pancreas will then produce more insulin in an attempt to use the glucose. The baby will then convert the extra glucose to fat. The combination of high blood glucose levels from the mother and high insulin levels in the baby result in large deposits of fat, which causes the baby to grow considerably large.

Figure of Fetus in Utero

Baby Kaye: Hopefully Mom will lay off the Indian tacos now, or at least cut down on eating them.

Anna: Are there more serious complications that may affect my baby?

Dr. Sandstone: A large baby can cause some problems during the delivery. Vaginal delivery can result in damage to the baby's shoulder or in respiratory distress. Often babies with these problems will be delivered bycesarean section (C-section). In addition to having a large baby, gestational diabetes also increases the risk of hypoglycemia (low blood sugar) in the baby immediately after delivery. This problem occurs if the mother's blood sugar levels have been continually high. Hypoglycemia causes the baby to have a high level of insulin in its circulation. After delivery, the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother. This high insulin level results in the newborn's blood sugar level becoming very low. Sometimes babies with jaundice may result from gestational diabetes. Jaundice results from high glucose levels in the baby. These high levels of glucose affect the liver and, when the liver is not functioning, well, then jaundice may develop.

Anna: All this sounds kind of scary. Should I be worried about any of this?

Baby Kaye: Oh Mom! Such a worry-wart! Dr. Sandstone always does her best to make sure we're okay.

Dr. Sandstone: Well, I am trying to answer your questions the best that I can. I guess all we have to do is to get started with the test. Once we get the results back we'll know for sure what needs to be done next.

Anna: What does the test involve for diagnosing gestational diabetes? Do I need to make any special preparations or change my diet before taking the test? I want to make sure I do every thing accurately. When my child is involved, I want to make sure everything is perfect.

Dr. Sandstone: The most common test used for screening gestational diabetes is the 50-gram glucose-screening test. There are no special preparations needed and no need to fast before the test. The test involves giving 50 grams of a glucose drink and then measuring the blood sugar level one-hour later. A woman with a blood sugar level of less than 140 milligrams per deciliter after one hour is not considered to have gestational diabetes. If the blood sugar level is greater than 140 mg/dl the test is considered abnormal or "positive." Not all women with positive results will have gestational diabetes. A three-hour glucose test is needed to confirm the diagnosis of gestational diabetes.

 

Two days later at Dr. Sandstone's office

 

Baby Kaye: Boy, I sure am tired. Mom stayed up pretty late. She must have read everything there is to know about gestational diabetes. Hopefully, this appointment won't take very long. I just want to go home and take a nap.

Anna: I'm so nervous about the test results. So how did everything turn out?

Baby Kaye: Talk about being nervous. How do you think I feel? I need my pacifier!

Dr. Sandstone: Whatever the results are, I'm sure everything will be okay. So far, the pregnancy has been satisfactory. The results have shown that your blood glucose level is above 140 mg/dl. We will have to schedule a day this week to perform the three-hour glucose test. The receptionist at the lab will help you to schedule a suitable day and time. Do you have any more questions? I would be more than happy to answer any questions you have.

Baby Kaye: The test results for Mom's three-hour glucose test came back positive. I hope Mom isn't too worried. Mom's a pretty smart chick. I'm sure she'll find out how to take good care of herself and, of course, lil ol' me. 

Anna: Oh yes, I've been doing a lot of reading on pregnancy and a little bit on diabetes. I was wondering what kind of complications can result from gestational diabetes?

Dr. Sandstone: Pregnant women with gestational diabetes are more at risk for preeclampsia, which is a combination of high blood pressure and other problems. If preeclampsia is left untreated, more serious complications may occur, such as convulsions or coma. Sometimes a C-section may be needed if high blood pressure is developed during pregnancy.

Anna: What can I do to prevent permanent diabetes?

Dr. Sandstone:Diet is very important in the care of a woman with gestational diabetes. The diet should be specifically made to provide enough nutrition to meet the needs of the mother and the growing fetus. At the same time the diet has to be planned in a way to keep blood glucose levels in the normal range of 60 to 120 mg/dl. Exercise also plays an important role in managing blood glucose levels in women who develop gestational diabetes. When the muscles contract, they help stimulate glucose transport. The stimulation of glucose transport helps to control gestational diabetes without insulin. An exercise program can be made to fit the individual needs of patients. Any physical activity should be combined with an appropriate diet.

Anna: I want to make sure my baby is healthy now and in the future. So, what can I do to prevent diabetes in my baby?

Dr. Sandstone:Breast-feeding for at least the first three months reduces the child's risk of Type I diabetes. Teaching your children to eat right at a very young age will help to reduce the risk of diabetes.

Baby Kaye: Umm! Yummy! Breast-feeding is about the best part of being a baby.

 

Anna: I'm kind of nervous about monitoring my blood glucose levels at home. Will someone be able to show me how to monitor and keep track of my blood glucose levels at home?

Dr. Sandstone: Your diabetes coordinator, public health nurses, or I can teach you how to measure your own blood glucose levels at home. This is needed to see if your blood glucose levels remain in a satisfactory range while you are on a prescribed diet. Once you get the hang of it, it will seem a lot easier.

Anna: I have one more question before I go. I feel like I need someone to talk to. Someone who has been in the same situation and knows how I feel. Are there support groups for women who have or had gestational diabetes?

Dr. Sandstone: There are support groups who help pregnant women with gestational diabetes. These groups bring together other women with or those who had gestational diabetes and now have healthy babies. The diabetes coordinator or public health nurses will have more information on the support groups.

Anna: Thank you so much for answering all my questions. I really appreciate the time you took to help me understand gestational diabetes. The next thing I need to do is to get started on a healthy diet and do some exercise. I'll see you at the next appointment.

Dr. Sandstone: It's a pleasure for me to answer all you questions. I really feel that we need to do any thing we can to make sure future generations are healthy. It's up to mothers and all Native American women to help instill healthy attitudes in our children. You are a good role model Anna and I am certain you will take good care of yourself and your baby. I'll see you next time. Have a nice weekend.

Anna: Did you hear all that kiddo? It's up to you and me. I know we'll make it through this. How 'bout if we go home and take a nap?

Baby Kaye: I was hoping you had the same thing on your mind. Like they say, "Great minds think alike."

 

Baby Kaye: I'd to like thank you all for checkin' out this section of the diabetes project. I hope you all enjoyed the stay here. It's real important for all Native American women to teach children the importance of a healthy diet. The children are our future, and with the proper guidance, the generations to come will be our healthiest.

 

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