Gestational Diabetes

There’s a lot of misconceptions about diabetes in general, and I think there are just as many misconceptions about gestational diabetes (GDM).

My goal is to help clear out some of these misconceptions and give you the information that will help ease your fears, concerns, or feelings about being told “you have gestational diabetes”.

I have seen several articles, social media posts, etc offering ways to “pass” the gestational diabetes test . This isn’t even possible, by the way. If you have it, you won’t “pass” the test. Also, this testing should be looked at as a way to help you and your baby. If you have GDM- you want to know that so that you can put changes in place to keep you and your baby safe and healthy.

Using the pass/fail language is outdated, and it leads to moms feeling as though they have “failed” or “did something wrong” if they do develop GDM.

Let’s talk about why gestational diabetes can happen to anyone (yes, even incredibly “healthy” people with no family history!), predisposing factors to be aware of, and what you can do to support yourself and baby.

Let’s jump in!

It Can Happen To anyone

Before we really dig into all of the information about gestational diabetes, I want to clarify one big misconception about it: IT IS NOT YOUR FAULT OR SOMETHING YOU “DID/ATE”.

Developing gestational diabetes happens when your pregnancy hormones reduce insulin function, thus making insulin less effective. I’ll talk through this more in depth in the paragraph below.

There are several predisposing factors that could put us more at risk for developing GDM, but you can also have GDM without any of those predisposing factors- like I did!

You could be doing the absolute best job with your diet and exercise and still develop gestational diabetes. You could have no family history of diabetes and still develop GDM. You could be of “average” BMI, athletic, and healthy and still develop GDM. It is not your “fault”. It is not something you did or didn’t do. It’s not something that you can always have control over. I know it can bring up some feelings of shame, but this is not something you “caused”. If we got the diagnosis, okay, we got this, let’s learn and take control as best we can!

Insulin & Pregnancy Hormones

I like to describe insulin (secreted by the pancreas) as a key - it unlocks the door to let blood sugar into the cells so that we can use them for energy. When our bodies can’t use insulin properly, it can’t get that blood sugar into our cells, so it sits in the bloodstream, causing our blood sugar levels to rise. This is also known as "insulin resistance”.

Estrogen, cortisol, human placental lactogen, etc. are all hormones secreted during pregnancy that are potential insulin “blockers”. This means that these hormones have the potential to cause the insulin key to be rendered ineffective.

Normally, insulin resistance can be overcome as the pancreas secretes more insulin. However, the bigger the placenta gets, the more of these hormones are made, thus further blocking the body’s use of insulin, leading to gestational diabetes in some.

All in all: Gestational diabetes is simply your body’s response to pregnancy hormones!

ABSOLUTELY NOBODY should ever be shamed for having diabetes, whether it’s type 1, type 2, Gestational Diabetes, etc.

Predisposing Factors

Research has shown a link between these predisposing factors and the development of gestational diabetes. HOWEVER, you do not have to have any of these in order to develop it! AND having these predisposing factors does not automatically mean you will be diagnosed with GDM either.

When I had gestational diabetes with my first pregnancy, I had zero of these predisposing factors. They’re just helpful pieces of information to be aware of in your own body and helps conceptualize your potential for developing GDM.

Here are a some (but not all) of the risk factors:

➡ Gestational hypertension
➡ Excessive weight gain during pregnancy
➡ Prediabetes
➡ Overweight/high bmi
➡ Family history of diabetes mellitus
➡ Previous birth resulting in a baby >9 lbs
➡ Older than 25 yrs old
➡ Race: African American, American Indian, Asian American, Hispanic or Latino, Pacific Islander

There is no shame in developing GDM. It is outside of your control. So let’s move away from the “pass/fail” language and figure out how to support your body if you do develop it.

Testing For GDM

I want to say again that if you have gestational diabetes, you won’t be able to dupe the test! That’s just not how it works. You can’t cheat the test! Plus, this is something you WANT TO KNOW so that you can keep yourself and your baby healthy and safe!

Types of Testing

If someone has insulin resistance in pregnancy, it will begin to surge around 20-24 weeks, as this is when those hormones mentioned above really start to increase. This is why we generally test for GDM between 24-28 weeks.

There are a few tests that are the most prevalent. I do know there has been a lot of exploration with other ways to test (gummy bears, different drinks, etc), but these are the ones most providers offer. Please speak with your provider to determine your options.

Screening Test | The 1-hour oral glucose tolerance test (OGTT)

This usually comes in the form of a drink with 50g of sugar. There are typically a few flavors to choose from: fruit punch, orange, grape, lemon lime. You drink this sugary drink in a 5-minute timeframe, wait 1 hour, then get blood drawn. This test checks how your body responds to a lot of sugar in a short amount of time and gets an idea whether there is a potential insulin resistance or not. If you are told that your numbers “exceed the cutoff” for this test, you will be called back to complete the 3 hour OGTT. The 1 hour test is a screening tool that tells us if we need to move on to the diagnostic tool. If numbers are higher than the cutoff on this test, it does not automatically mean you have GDM. It means you need to complete the 3 hour OGTT.

Diagnostic Test | 3-hour OGTT

This test is used if your blood sugar levels are higher than your provider’s threshold with the 1 hour OGTT. (This number can vary depending on your provider, so talk to them if you have questions about it.) If this happens, they will then move to the 3-hr diagnostic test. Here’s what you can expect with that:

Fast the morning of
Get blood drawn before you eat or drink
Consume a glucose drink with 100g of sugar
Get blood drawn at the 1, 2, and 3 hour marks post consumption
If your numbers exceed the threshold with 2+ of these 4 blood draws, you are considered to have “gestational diabetes”.

Screening + Diagnostic Test | 2-hour OGTT

Some providers offer a test that covers both the screening and diagnostic tests. This is generally a 75g drink with blood drawn at 1 and 2 hour marks. Not every provider uses this testing (mine doesn’t)!

You can’t Dupe The Test!

One of the most common questions I get, and even see around the internet, is “How do I pass the GDM test?!” You can’t! If you have it, you aren’t “passing” the test!

These are all things I’ve seen suggested that WON’T WORK:

𝕏 Fasting longer than directed

𝕏 Cutting out sugar for a week before

𝕏 Eating only protein leading up to the test

𝕏 Anything else you’ve seen suggested to cheat the system

This test is in place to protect you and your baby. Please follow your doctor’s instructions and take the test so you can keep you and baby as healthy as possible! Try to put out of your mind the “pass/fail” mentality, because it will only lead to shame and other unnecessary feelings. I felt all of these things when I found out I had it, and working through the big feelings are really a huge part of having GDM, as it is a lifestyle change!

What Are The Treatment Options

Treatment will vary from person to person depending on how your body is adjusting to changes made in diet/exercise/medications/etc.

Helping educate how to navigate and manage GDM is MUCH MORE EFFECTIVE than shaming patients about how they should have or could have “prevented” it.

We cannot control how our body’s pregnancy hormones will function. GDM is your body’s response to increases in these pregnancy hormones.

If your provider tells you you should have lowered your risk pre-pregnancy via weight loss, lifestyle modifications, etc. just remember that even if you did those things, it doesn’t mean that you necessarily still wouldn’t have developed it. Sure, those modifications can absolutely prove helpful in some circumstances! But, now we are here, let’s make the goal be moving forward together as a unit instead of dwelling on the “woulda, coulda, shoulda”!

It’s important that you have a provider that supports and educates you, meets you where you’re at, and helps you figure out the steps that would most benefit you and baby.

Lifestyle Modifications

A great first starting point is usually managing dietary/lifestyle modifications to help sustain your blood sugar appropriately. Your provider will likely have you begin checking blood sugars throughout the day and keeping a log of the foods you are eating + blood sugar readings. Blood sugar checks, diet changes, lifestyle changes, medication are all different ways we can treat gestational diabetes. Some women only need a little bit of this, and some women need all of it. Some women need medication to manage, and some do not. Either way, you got this ladies!

When I had GDM I had to check my blood sugars 5 times per day and keep a food log as well (fasting morning blood sugar, one hour after each meal, before bed). My doctor had me go to a meeting with a hospital nutritionist and registered dietician who both specialized in diabetes. They taught me all about pairing carbs + protein, checking blood sugars, lowering glucose levels via food, etc. I learned so so much! If your hospital offers a class like this or an opportunity for learning, I would check it out! They also provided me with a list of meal options, carb counts, and good things to “pair” with your carbs (like proteins) to sustain blood sugars. I also started trying to walk once every day when I could. I do think being a floor nurse also benefitted me, as I walked a ton at work! I definitely had spikes in my numbers from time to time when I didn’t portion well, or ate something without pairing it appropriately, but overall, my numbers were good and I did not need medication. My baby was also monitored weekly after my GDM diagnosis. I would have weekly NSTs (fetal non-stress tests) and growth scans to ensure baby was doing well!

Medication

If you and your provider decide to go the medication route, please know that you are not doing anything wrong!

Sometimes people may have a lot of predisposing factors, sometimes the GDM needs support beyond just dietary changes - whatever the reasoning, the medication was designed for this and there is no shame in needing it.

AGAIN: This is not preventable. This is not your fault.

Risks

If we leave GDM unchecked or don’t make necessary changes to reduce its effects, there can be risks to ourselves + baby. If we’re not checking our blood sugars, working to lower the blood sugars, working through dietary changes, lifestyle modifications, taking medications, etc, it can lead to complications in some situations.

Implications of gestational diabetes in pregnancy

This link talks about the risks of gestational diabetes if left out of control. While there is no shame in having GDM, it is important to know the risks of having it so that you can better protect yourself and your baby.

The Feelings Can Be big

There is something about getting diagnosed with diabetes, including GDM, that can bring up a lot of feelings. There is such a lack of knowledge and misconceptions surrounding Diabetes, and I think that can lead to an easy shame-spiral in thinking we did something “wrong” or “did something to cause this”. Even though I am a mom/baby nurse and I know about these things/see them often, it was still hard for me, too!

I was diagnosed with GDM during my first pregnancy. I felt like this pregnancy was “supposed” to be bliss, easy, and fun because I already “knew everything as a mom/baby nurse” right?! WRONG. Very wrong. I felt like I kept getting hit with news/symptoms that weren’t what I was anticipating: hyperemesis + fluids in the hospital from being so sick, then “you have gestational diabetes”, then baby was breech and not flipping so I needed to have a c-section, etc. It just felt like one thing after the next, so the news really hit me hard and fast. I had cared for plenty of patients with GDM, but I didn’t ever think it would happen to me (as many of us don’t!) because I was overall “young and healthy”. Just goes to show that GDM doesn’t “pick and choose”. Regardless, it was hard to process. I felt like I had done something “wrong” and I should have “eaten better” or “cut out sugar” so that I didn’t put my baby at risk. I felt so ashamed of myself because of society’s stigma. I still remember, plain as day, when I told one of my friends I had GDM and she immediately turned to her husband and said “oh my Gosh! Karrie has diabetes, can you believe that?”. I know she didn’t necessarily mean it in a bad way at all, but it felt like immediate judgement, and man that hurt! I kept it a secret from as many people as I could after that because I was ashamed. I did finally talk to my coworkers about it because they would see me checking my blood sugars all of the time. Honestly, they were the most supportive people ever! I am so grateful for them! They all reminded my to check my sugars when I got busy at work, and some would even check to make sure I was eating healthy snacks throughout my 12 hour shift. One of the floor secretaries even gave me her cheat sheet meal ideas and info from when she had GDM with her pregnancy! THAT is the type of support we ALL need and deserve!

You are an amazing mama, no matter what risk factors you do or don’t have, if you develop it, choose medication - no matter what - you are amazing. There is no shame, and you aren’t doing anything wrong. We don’t have to let the fear and the shame take away from our pregnancy experience!

You’ve got this, Mama!

Xoxo,

Kar