Diet in gestational diabetes:

Some tips from experts regarding eating well during pregnancy with gestational diabetes.

How should I eat during my pregnancy?
As with any pregnancy, it is important to eat the proper foods to meet the nutritional needs of the mother and fetus. An additional goal for women with gestational diabetes is to maintain a proper diet to keep blood sugars as normal as possible.

Protein Equivalents

Food	Grams of Protein
1 cup milk	8
1 cup plain nonfat yogurt	8
1 ounce American processed cheese	7
1 ounce low-fat cheese	7
1 tbsp. peanut butter	7
1/4 cup cottage cheese	7
1/2 cup cooked dried beans	7
1 slice whole wheat bread	3
1/2 cup flaked cereal bran or corn	3

The daily need for calories increases by 300 calories during the second and third trimesters of pregnancy. If non­ pregnant calorie intake was 1800 calories per day and weight gain was maintained, a calorie intake of 2100 calories per day is usual from 14 weeks until delivery. This is the equivalent of an additional 8 ounce glass of 2% milk and one­half of a sandwich (1 slice of bread, approximately 1 ounce of meat, and I teaspoon of margarine, mayonnaise, etc.) per day. The need for protein also increases during pregnancy. Make sure your diet includes foods high in protein, but not high in fat . Most vitamins and minerals are also needed in larger amounts during pregnancy. This can be attained by increasing dairy products, especially those low in fat, and making sure you include whole grain cereals and breads, as well as fruits and vegetables in your diet each day. To make sure you get enough folate (a B vitamin critical during pregnancy) and iron, your obstetrician will probably recommend a prenatal vitamin. Prenatal vitamins do not replace a good diet; they merely help you to get the nutrients you need. To absorb the most iron from your prenatal vitamin, take it at night before going to bed, or in the morning on an empty stomach.
The Daily Food Guide serves as a guideline for food sources that provide important vitamins and minerals, as well as carbohydrates, protein, and fiber during pregnancy. The recommended minimal servings per day appear in parenthesis after each food group listed. This guide emphasizes foods that are low in fat and in sugar

Daily Food Guide(Each item equals one serving)

Milk and Milk Products
(4 Servings Per Day)
cup milk, skim or low-fat
(high protein calcium, Vitamin D)
1/3 cup powdered non-fat milk
1 cup reconstituted powdered non fat-milk
1-1/2 oz Low-fat cheese

Meat, Poultry, Fish, and Meat Substitutes
(5-6 Servings Per Day)
oz.Cooked poultry, fish, or lean meat (beef,lamb,pork) (high protein B, vitamins, iron)
1 tbsp.peanut butter
1 egg
1/4 cup low-fat cottage cheese
1/2 cup cooked dried beans or lentils

Breads, Cereals, and Other Starches
(5-6 Servings Per Day)
slice whole grain bread
(high complex carbohydrates)
(emphasize whole grams, or use fortified or enriched)
(a good source of protein, B-vitamins, fiber and minerals)
5 crackers
1 muffin,biscuit,pancake or waffle
3/4 cup dry cereal, unsweetened
1/2 cup pasta (macaroni, spaghetti), rice, mashed potatoes, or cooked cereal
1/3 cup sweet potatoes or yams
1/2 cup cooked dried beans or lentils
1/2 bagel, 1/2 English muffin, or 1/2 flour tortilla
1 small baked potato
2 taco shells

Fruit 1/2 cup
(2 Serving per day)
fruit
(fresh fruit provides fiber)
(include one vitamine C source daily)
1/2 banana, or 1 medium-sized fruit (apple, orange)
1/2 cup, orange, grapefruit, or other juice fortified with vitamine C
1/2 cup-sized grapefruite
1 cup strawberries
1/2 cup fresh apricots, nectarines, purple plums, cantaloupe or 4 halves dried apricots (vitamine A source)

Vegetables ***
(2 Serving per day)
/2 cup cooked or 1 cup raw: broccoli, spinach, carrots (vitamin A source) (include good vitamin A sources at least every other day)
1/3 cup mixed vegetables

Fats

1 tsp. butter or margarine
1 tsp. oil or mayonnaise
1 tbsp. regular salad drressing
2 tbsp. low-calorie salad dressing
1/4 cup nuts or seeds

*1 oz. low­fat cheese can also be used as 1 serving from the Meat, Poultry, Fish, and Meat Substitutes group if sufficient calcium is already being provided from 4 servings.

**This refers to plain yogurt. Commercially fruited yogurt contains a lot of added sugar

***Starchy vegetables such as corn, peas, and potatoes are included in Breads, Cereals, and Other Starches list.
The food guide is divided into six groups: milk and milk products; meat, poultry, fish, and meat substitutes; breads, cereals, and other starches; fruits; vegetables; and fats. Each group provides its own combination of vitamins, minerals, and other nutrients which play an important part in nutrition during pregnancy. Omitting the foods from one group will leave your diet inadequate in other nutrients. Plan your meals using a variety of foods within each food group, in the amounts recommended, and you'll be most likely to get all the vitamins, minerals, and other nutrients the fetus needs for growth and development.

Other Nutritional and Non­Nutritional Considerations:

Alcohol
There is no known safe level of alcohol to allow during pregnancy. Daily heavy alcohol intake causes severe defects in development of the body and brain of the fetus, called Fetal Alcohol Syndrome. Even moderate drinking is associated with delayed fetal growth, spontaneous abortions, and lowered birth weight in babies. The Surgeon General's office warns: “Women who are pregnant or even considering pregnancy should avoid alcohol completely and should be aware of the alcohol content of food and drugs.”

Salt
Salt restriction is no longer routinely advised during pregnancy. Recent research shows that during pregnancy the body needs salt to help provide the proper fluid balance. Your health care provider may recommend that you use salt in moderation.

Caffeine
Studies conflict on the potential danger of caffeine to the fetus. Caffeine is found primarily in coffee, tea, and some sodas (Table 6). Moderation is recommended. Talk to your doctor or other health professional about the maximum amount of caffeine recommended.

Caffeine Comparisons

Food	Serving	Amount of Caffeine
Regular coffee	8 oz	80-200ma
Instant coffee	8 oz	60-100 ma
Decaffeinated coffee	8 oz	3-5 ma
Tea	8 oz	60-65 ma
Carbonated drinks
e.g. colas	12 oz	30-65 mg
Hot chocolate	8 oz	13 ma

Megavitamins
Megavitamins are defined as 10 times the Recommended Dietary Allowance* of vitamins and minerals and are not recommended for pregnant women. Although it is possible to get all of the necessary nutrients from food alone, your doctor may prescribe some prenatal vitamins and minerals. If taken regularly, along with a balanced diet, you will be getting all the vitamins and minerals needed during your pregnancy.
Smoking
Research has shown without question that smoking during pregnancy increases the risk of fetal death and pre-term delivery, impairs fetal growth, and can lead to low birth weight. It is best to stop smoking entirely and permanently, or at the very least, to cut back drastically on the number of cigarettes you smoke.

What food patterns help keep blood sugar levels normal?
The following outlines food patterns which help to keep blood sugar levels within an acceptable range.
Avoid sugar and foods high in sugar. Most women with gestational diabetes, just like those without diabetes, have a desire for something sweet in their diet. In pregnant women, sugar is rapidly absorbed into the blood and requires a larger release of insulin to maintain normal blood sugar levels. Without the larger release of insulin, blood sugar levels will increase excessively when you eat sugar-containing foods.
There are many forms of sugar such as table sugar, honey, brown sugar, corn syrup, maple syrup, turbinado sugar, high fructose corn syrup, and molasses. Generally, food that ends in “ose” is a sugar (e.g., sucrose, dextrose, and glucose).
Foods that usually contain high amounts of sugar include pies, cakes, cookies, ice cream, candy, soft drinks, fruit drinks, fruit packed in syrup, commercially fruited yogurt, jams, jelly, doughnuts, and sweet rolls. Many of these foods are high in fat as well.
Be sure to check the list of ingredients on food products. Ingredients are listed in order of amount. If an ingredient is first on the list, it is present in the highest amount. If some type of sugar is listed first, second, or third on the list of ingredients, the product should be avoided. If sugar is further down, fourth, fifth, or sixth, it probably will not cause your blood sugar levels to go up excessively.
Fruit juices should only be taken with a meal and limited to 6 ounces. Tomato juice is a good choice because it is low in sugar. Six ounces of most other juice (apple, grapefruit, orange) with no sugar added still contain approximately 4 to 5 teaspoons of sugar. However, these do not contain much of the fiber of a piece of fruit which normally would act to slow the absorption of sugar into the blood. If you drink juice frequently to quench your thirst during the day, a high blood sugar level may result. Use only whole fruit for snacks.
To help with the occasional sweet tooth that we all have, artificial sweeteners may be used in foods. Aspartame has been extensively tested for safety. Use during pregnancy has been approved by the Food and Drug Administration and by the American Medical Association's Review Board. However, aspartame has not been tested for long­term safety and has not been on the market very long. It may be best to avoid its use until more tests have been done.
Saccharin is not advised during pregnancy. Likewise, use of mannitol, xylitol, sorbitol, or other artificial sweeteners is not recommended until further research is done.
Fructose is a special type of sugar that is slowly absorbed into the system. A small amount of fructose can be used if your blood sugar levels are within normal range. However, fructose still has 4 calories per gram, as much as table sugar. High fructose corn syrup is part fructose and part corn syrup, making it very similar to table sugar in composition. It will raise blood sugar levels and should definitely be avoided.
*Dietary allowances established by the National Academy of Sciences-National Research Council.
Emphasize the use of complex carbohydrates. These include vegetables, cereal, grains, beans, peas, and other starchy foods. A well­balanced diet with plenty of fiber provided by vegetables, dried beans, cereals, and other starchy foods decreases the amount of insulin your body needs to keep blood sugars within a normal range. Anything that decreases the need for insulin is beneficial The American Diabetes Association recommends that at least one-half of your calories come from complex carbohydrates. Starchy foods include pasta, rice, grains, cereals, crackers, bread, potatoes, dried beans, peas, and legumes. Also, contrary to popular belief, carbohydrates are not highly fattening when eaten in moderate amounts and without the rich sauces and toppings often added.
Emphasize foods high in dietary fiber. Fiber is the edible portion of foods of plant origin that is not digested (e.g., skins, membranes, seeds, bran). Foods with a high fiber content include whole grain cereals and breads, fruits, vegetables, and legumes (dried peas and beans). Fiber aids digestion and helps prevent constipation. The fiber found in fruits, vegetables, and legumes also helps keep your blood sugar level from becoming too high without requiring extra insulin.
Keep your diet low in fat. Some fat is needed to help with the absorption of certain vitamins and to provide the essential fatty acids necessary for fetal growth. A diet which is high in fat causes the insulin to react in a less efficient manner, necessitating more insulin to keep blood sugar levels within normal range. Foods high in saturated fats such as fatty meats, butter, bacon, cream (light, coffee, sour cream, etc.), and whole milk cheeses are likely to be high in total fat. Most foods with saturated fat are also high in cholesterol because they are fats from animal origin. However, foods such as crackers made with coconut, palm, or palm kernel oil can be high in saturated fats as well. Read labels carefully. Unsaturated fats are found in foods such as fish, margarine and vegetable oils. Keep your use of salad dressings to a minimum and whenever possible use those prepared with olive oil. To help keep the diet lower in fat, avoid adding extra fats such as rich sauces and creamy desserts, and bake or broil foods instead of frying them. Replacing fatty foods with those high in complex carbohydrates is also helpful.
Include a bedtime snack that is a good source of protein and complex carbohydrates.
Women with gestational diabetes have a tendency toward lower than normal blood sugar levels during the night. This causes the body to increase its utilization of fats as a fuel source. As fat is used, ketones (discussed later) are produced as a by­product of the breakdown of fats, and in large amounts, may be harmful to the fetus. This can be prevented by having a bedtime snack that provides protein and complex carbohydrates such as starchy foods. Starch will stabilize your blood sugar level in the early night, while protein acts as a long­acting stabilizer.

Examples of a bedtime snack are:
1 oz. American­processed cheese + 5 crackers
1/2 chicken sandwich on whole wheat bread
3 cups unbuttered popcorn + 1/4 cup nuts

If you need to take insulin, a bedtime snack is critical and you should not omit it. When taken by injection, insulin acts to lower blood sugar level, even during the night when meals are not eaten. A bedtime snack is protective against low blood sugars while sleeping or upon arising. If a bedtime snack causes heartburn, sleep with your head raised on pillows, and be careful that you are not eating too large a bedtime snack.

How do I plan meals?

A registered dietitian or qualified nutritionist can help you plan a meal pattern that is right for you. Most women with gestational diabetes need three meals and a bedtime snack each day. It is unwise for anyone who is pregnant to go long periods of time (greater than 5 hours) without eating, as this will produce ketones. Extra snacks are necessary if your schedule results in a long time between meals. Blood sugars will be easier to keep in the normal range if meal times and amounts (total calories) are evenly spaced. It's more likely that a higher blood sugar will result if the majority of calories are eaten at dinner than if they are distributed more evenly throughout the day. If insulin injections prove necessary, the time at which meals are eaten and the amounts eaten should be approximately the same from day to day. Do not skip meals and snacks, as this often results in hypoglycemia (low blood sugar), which may be harmful to the fetus and makes you feel irritable, shaky, or may result in a headache.
Sample Menu — 2000 Calories
This diet is planned for women whose normal non-pregnant weight should be 130­135 lbs. For women who weigh less than 130 before pregnancy, the diet should contain fewer calories. Women who are overweight are at higher risk for gestational diabetes. Your health care provider can discuss this and help you make necessary changes

What can be done to slow weight gain during pregnancy?

Gaining too much weight during pregnancy will make blood sugar levels higher than normal for women with gestational diabetes. Yet, for many pregnant women it is very difficult to gain weight slowly and still get all of the recommended nutrients. Luckily, fat, which is high in calories (9 calories per gram), is needed in only small amounts during pregnancy. Carbohydrates and protein, in contrast to fat, provide only 4 calories per gram. To cut calories without depriving the fetus of any necessary nutritional factors, it is best to avoid fats and fatty foods.
· Avoid high­fat meats. Choose lean cuts of beef, pork, and lamb. Emphasize more fish and poultry (without the skin).
· Avoid frying meat, fish, or poultry in added oil, shortening, or lard. Bake, broil, or roast instead.
· Avoid foods fried in oil such as chips, french fries, and doughnuts. Substitute pretzels, unbuttered popcorn, or breadsticks instead.
· Avoid using cream sauces and butter sauces, as well as salt pork for seasoning on vegetables. Season with herbs instead.
· Avoid using the fat drippings from meat or poultry for gravy. Use broth or bouillon instead and thicken with cornstarch.
· Avoid using mayonnaise or oil for salads. Use vinegar, lemon juice, or low-calorie salad dressings instead.
To help reduce calories choose low-fat dairy products. During pregnancy you need 1200 mg calcium daily to build the fetal skeleton without drawing from maternal calcium stores. Table 7 points out foods in which the calcium content is almost the same, yet the calories are not due to the difference in fat content.
The difference between 600 calories and 340 calories is only 260 calories and may seem insignificant. Yet, if your diet is cut by 260 calories daily for 1 week, your weight gain slows down by approximately 1/2 pound per week. In other words, instead of gaining 1-1/2 pounds per week you will only gain 1 pound per week.
If cheese is a part of your daily diet, use low­fat cheeses such as low­fat cottage cheese, Neufchatel, mozzarella, farmers, and pot cheese. Avoid using cream cheese, as it has little protein and most of its calories come from fat.
Even though pregnancy can be a very hectic time, with little time for meal preparation, eat less and less often at “fast food” restaurants. Studies have shown that some foods from fast food restaurants average 40 to 60 percent of their calories from fat, and are quite high in calories.* For example, chicken and fish that are coated with batter and deep-fried in fat may contain more fat and calories than a hamburger or roast beef sandwich.
*Fast Food Facts: Nutritive and Exchange Values for Fast Food Restaurants Marion J. Franz, International Diabetes Center. Minneapolis, Minnesota, 1987. 54 pp.


Go lightly when using butter and margarine. Adding only an extra three pats of butter or margarine (same calories) daily could add an extra pound of weight gain next month. It may be better to emphasize the use of foods rich in complex carbohydrates that don't use butter, margarine, or cream sauce to make them palatable. Many people find rice, noodles, and spaghetti tasty without a lot of butter. Use a variety of spices and herbs (such as curry, garlic, and parsley) to flavor rice and tomato sauce to flavor pasta without additional fats.
It is also a good idea to eat small amounts frequently, thereby keeping the edge off your appetite. This will assist your “self-control” in avoiding large portions of food that you should not have. Avoid skipping meals or trying to cut back drastically on breakfast or lunch. It will leave you too hungry for the next meal to exercise any control. Your doctor or dietitian can help you determine how you can cut extra calories.
You may find it helpful to keep food records of what you eat, as most of us tend to forget or not realize the extent of our snacking. Recording everything you eat or drink tends to be a sobering and instructive experience.
Be careful to maintain a weight gain of at least 1/2 pound per week, over several weeks, if you are in the second trimester (14 weeks or more of gestation). Cutting back more than this may increase the risk of having a low-birth-weight infant.

http://www.childbirthsolutions.com/articles/pregnancy/gestationaldiet/index.php

Gestational diabetes and weight gain:

Mom has become a little tensed after she found out today that there has been a decrease in weight by approx 1kg.
The main thing is she is maintaining a proper diet control and doing regular exercises due to gestational diabetes.
Is it due to this that she is gradually losing part of her weight?.. who knows!
Dr. will be able to judge this better.

Actually Dr. Vidya Desai, mom's gynecologist explained to her that she has even seen many patients gaining total of 5kgs during her pregnancy and has delivered healthy 3kg babies. Hence in gestational diabetes weight gain calculations is done little differently. No need to worry as long as my growth and weight gain is ok. But it is very difficult for mom to understand how much of weight is gained and me and how how much she is losing due to diet control . Mom give me a weighing scale ..i want to measure my weights here inside you and tell you every week :)

Lets see what experts have to say regarding weight gain for gestational diabetic moms..

How much weight should I gain?

Of all questions asked by pregnant women, this is the most common. The answer is particularly important for women with gestational diabetes. The weight that you gain is a rough indication of how much nutrition is available to the fetus for growth. An inadequate weight gain may result in a small baby who lacks protective calorie reserves at birth. This baby may have more illness during the first year of life. An excessive weight gain during pregnancy, however, has an insulin­resistant effect, just like the hormones produced by the placenta, and will make your blood sugar level higher.

The “optimal” weight to gain depends on the weight that you are before becoming pregnant. Your pre-pregnancy weight is also a rough indication of how well-nourished you are before becoming pregnant. If you are at a desirable weight for your body size before you become pregnant, a weight gain of 24 to 27 pounds is recommended. If you are approximately 20 pounds or more above your desirable weight before pregnancy, a weight gain of 24 pounds is recommended. Many overweight women, however, have healthy babies and gain only 20 pounds. If you become pregnant when you are underweight, you need to gain more weight during the pregnancy to give your baby the extra nutrition he or she needs for the first year. You should gain 28 to 36 pounds, depending on how underweight you are before becoming pregnant. Table 3 shows whether your pre-pregnancy weight is considered underweight, normal weight, or overweight. Your nutrition advisor or health care provider can recommend an appropriate weight gain. How your weight gain is distributed is illustrated here.

Pre­Pregnancy Weight

Use this chart to determine if your pre­pregnancy weight is normal, underweight, or overweight.

Heigth without shoes	Underweight if you weighed this or less	Normal weight *Range	Overweight if you weight this or more
4'10"	88	89-108	109
4'11"	91	92-112	113
5'	94	95-115	116
5'1"	99	100-121	122
5'2"	104	105-127	128
5'3"	108	109-132	133
5'4"	113	114-138	139
5'5"	118	119-144	145
5'6"	123	124-150	151
5'7"	127	128-155	156
5'8"	132	133-161	162
5'9"	137	138-167	168
5'10"	142	143-173	174
5'11"	146	147-178	179
6'	151	152-184	185

*Normal weight for “thin-boned” women will be closer to the lower end of this range. For “big-boned” women, it will be closer to the higher end.

Total recommended weight gain is often not as helpful as a weekly rate of gain. Most women gain 3 to 5 pounds during the first trimester (first 3 months) of pregnancy. During the second and third trimesters, a good rate of weight gain is about three­quarters of a pound to one pound per week. Gaining too much weight (2 or more pounds per week) results in putting on too much body fat. This extra body fat produces an insulin-resistant effect which requires the body to produce more insulin to keep blood sugar levels normal. An inability to produce more insulin, as in gestational diabetes, causes your blood sugar levels to rise above acceptable levels. If weight gain has been excessive, often limiting weight gain to approximately three-quarters of a pound per week (3 pounds per month) can return blood sugar levels to normal. Fetal growth and development depend on proper nourishment and will be placed at risk by drastically reducing calories. However, you can limit weight gain by cutting back on excessive calories and by eating a nutritionally-sound diet that meets your needs and the needs of your baby.

Remember that dieting and severely cutting back on weight gain may increase the risk of delivering prematurely. If blood sugar levels continue to go up and you are not gaining excessive weight or eating improperly, the safest therapy for the well-being of the fetus is insulin.
Occasionally, your weight may go up rapidly in the last trimester (after 28 weeks) and you may notice an increase in water retention, such as swelling in the feet, fingers, and face. If there is any question as to whether the rapid weight gain is due to eating too many calories or too much water retention, keeping records of how much food you eat and your exercise patterns at this time will be very helpful. In addition, by examining your legs and body for signs of fluid retention, your physician can help you to determine the cause of your weight gain. If your weight gain is due to water retention, cutting back drastically on calories may actually cause more fluid retention. Bed rest and resting on your side will help you to lose the build-up of fluid. Limit your intake of salt (sodium chloride) and very salty foods, as they tend to contribute to water retention.

Marked fluid retention when combined with an increase in blood pressure and possibly protein in the urine are the symptoms of pre-eclampsia. This is a disorder of pregnancy that can be harmful to both the mother and baby. Inform your obstetrician of any rapid weight gain, especially if you are eating moderately and gaining more than 2 pounds per week. Should you develop pre-eclampsia, be especially careful to eat a well-balanced diet with adequate calories.
After being diagnosed as having gestational diabetes, many women notice a slower weight gain as they start cutting the various sources of sugar out of their diet. This seems to be harmless and lasts only 1 or 2 weeks. It may be that sweets were contributing a substantial amount of calories to the diet.

http://www.childbirthsolutions.com/articles/pregnancy/gestationaldiet/index.php

Insulin in Gestational Diabetes:

Mama has started her daily dose of insulin!
She tried her best to keep the levels of glucose low for almost 2months, but now as she is getting bigger and gaining weight she is having problems in her regular exercises and walking, that in effect is increasing the blood glucose level to some extent.

Taking insulin everyday is not a matter of joke.
Doctor has prescribed insulin 3times a day, 30minutes before breakfast, lunch and dinner. I have heard that rapid action insulin can be given safely to pregnant ladies with GDM. There are somne types of insulin available like short acting, intermediate, long acting. But these are not very safe to be used in GDM.

In the initial stage mom was very nervous and also reluctant to take this injection everyday. As you already know she is taking proluton depot injection every week and that is also so much painful. Hence she had some fears that again taking 3injections everyday will make her life miserable!
But as she understood that she can safeguard her pregnancy her taking insulin injections daily, she made up her mind that whatever pain she will have she will sustain it but she cannot get me in trouble. I love you momma! You are doing so much for me. Whenever I think of your pain and anguish I am really speechless..you are a Mother-one in a million..I promise you I will repay you one day no matter what !

Now everyday she is pricking herself with diabetes pen needle.. Everyone say that they do not hurt too much and taking insulin by pen is so much simple and easy. But I will tell you the real fact. It does pain..specially if the needle becomes old or is used for 2days consecutively. You may say it does not pain in comparison to the normal syringe injections.

Mom was searching the net and has come to know a few facts and figures about taking insulin in gestational diabetes.

Take insulin and/or other medications as prescribed

What is it?

Even if you do everything your health care provider tells you to manage your gestational diabetes, you still might need to take insulin during your pregnancy to keep it under control. You already know that insulin moves glucose out of your bloodstream and into your cells to use as energy; you may need extra insulin to lower your blood glucose level. The only way to get extra insulin into your body is to inject it under your skin with a needle. Taking insulin is the same as any other part of this treatment plan. It's just another way to help you stay healthy.

Why do I have to do it?

You may have to include small amounts of insulin in your treatment plan if:

* Your blood sugar level is too high.
* Your blood sugar level is high too many times.
* Your blood sugar level remains high, but you are not gaining much weight or are not eating poorly.
* You cannot safely add physical activity to your treatment plan.

In these cases, the best action for maintaining a healthy pregnancy is to add insulin. Insulin does not hurt the fetus. The daily records that you keep help your health care provider decide when and if it's time to begin insulin. That's why it's important to keep good records.
Here are some other things you should know about insulin:

* If you need to take insulin, it does not mean that you didn't try hard enough or that you failed at taking care of yourself. It just means that your body has a high level of insulin resistance and needs some help getting glucose level back into healthy range. (Refer to the Knowing your blood sugar level and keeping it under control: How do I know I'm doing it right? section of this booklet for more details on the healthy range for glucose.)
* Taking insulin does not mean you have type 1 diabetes. People with type 1 diabetes have to take insulin shots every day of their lives because their bodies don't make enough insulin. As a woman with gestational diabetes, taking insulin does NOT mean that you now have type 1 diabetes. It only means that your body needs some extra help to balance its insulin and glucose levels. After your baby is born, your diabetes will likely go away, and with it, your need to take insulin.
* An increase in the amount or dosage of insulin you need does not mean that your pregnancy is in danger. The amount of insulin you take will probably increase as your pregnancy goes on. Because your insulin resistance increases as your pregnancy continues, your body needs more insulin to overcome this resistance. The goal is to keep your blood sugar under control, no matter how much insulin it takes. Most women take two insulin shots each day, but you may get better glucose control with three injections.
* You may need more insulin if you are under high amounts of stress or if you are sick because your blood sugar level gets higher on its own in these cases. Some medicines can also cause blood sugars to rise above the healthy range.

How do I do it?

Your health care provider will teach you how to give yourself insulin shots, if you need them. Use this answer sheet to write down what your health care provider tells you about your insulin treatment.

When do I do it?

How often you need insulin shots will depend on your body. Your health care provider will tell you how often to take the shots and at what times of day. Make sure you follow his or her advice about taking insulin to help ensure the safety of your pregnancy.

Special instructions for women taking insulin

* Follow a regular eating schedule. Your health care provider can tell you when to take the insulin and when to eat your meals so that the timing of both is correct. Do not skip or delay meals and snacks when taking insulin because this can affect your glucose-insulin balance.
* Know the symptoms of low blood sugar. If your blood sugar level drops below 60 at any time, you have hypoglycemia (hypo means low, and glycemia means sugar). Low blood sugar can be dangerous. Hypoglycemia is not common in women with gestational diabetes, but you are at greater risk for it if you take insulin. The table shown here describes some reasons that low blood sugar might occur and some of its symptoms.

KNOW THE SYMPTOMS OF LOW BLOOD SUGAR

Why does low blood sugar occur?
* Too much exercise
* Skipping meals or snacks
* Delaying meals or snacks
* Not eating often enough
* Too much insulin

How might I feel if I have low
blood sugar?
* Very hungry
* Very tired
* Shaky or trembling
* Sweating or clamminess
* Nervous
* Confused
* Like you're going to pass out or faint
* Blurred vision

Or…You might feel fine.

* Know when your insulin is working its hardest. Low blood sugar is more common at these times, depending on how your body uses insulin and glucose.
* Be careful about doing physical activity, but remain active. Because both insulin and physical activity lower your blood sugar level, when combined they can cause your blood sugar level to drop very quickly. Test your blood sugar before you do any physical activity. If your level is low, eat something and test again to make sure your level is higher before you start an activity. Be smart about how much physical activity you do, how much you eat, and how much insulin you take.
* Be prepared. Take your insulin supplies with you when you go out, especially if you are going to be gone a long time. You should also take some form of sugar with you, in your purse, in your car's glove compartment, or in your pocket, in case your blood sugar drops too low. The best form of sugar for an emergency is glucose paste or glucose tablets. You can buy these at the drug store or pharmacy. Ask your health care provider for more information.
* Test your blood sugar if you start to feel dizzy, faint, or tired.
* Report any abnormal blood sugar level to your health care provider right away, in case a change in your treatment plan is needed.

taken from:http://www.nichd.nih.gov/publications/pubs/gest_diabetes/

Gestational diabetes: Giving yourself insulin shots

If you have gestational diabetes and you have not been able to keep your blood sugar levels within a safe range by changing the way you eat and by exercising, you will need insulin shots.

Key points

* Taking insulin can help prevent high blood sugar. High blood sugar can lead to problems for you and your baby.
* Insulin is given as a shot into the fatty tissue just under the skin. In pregnant women, insulin usually is given in the upper arm or thigh.
* At first, you may feel nervous about giving yourself insulin shots. But, after a little while, it will become a routine part of your day. It is not hard to learn how to do, and any sting you might feel will not last long. More than 500,000 people in the United States do this every day. You can, too.
* It is also important to:
o Have the right dose of insulin, especially if you are giving two types of insulin in the same syringe.
o Practice how to give your shot.
o Store the insulin properly so that each dose will work well.


What does it mean to prepare and give an insulin shot?

Insulin comes in small glass bottles (vials) and cartridges. Each type of container is sealed with a rubber lid. One vial or cartridge contains many doses. To remove a dose of insulin from:

* A vial: You will use an insulin syringe to get the insulin and to give yourself a shot.
* A cartridge: You will use a pen-shaped device called an insulin pen. The cartridge fits inside the pen and the dose of insulin is set with a dial on the outside of the pen. The pen (with the cartridge inside) is used to give the medicine. There are disposable and reusable insulin pens. Each pen works slightly differently.

Note: If you are using an insulin pen, talk with your doctor or pharmacist about how to use the pen correctly. Giving insulin with these pens is not covered in this information.

To give an insulin shot, the needle (attached to the syringe) is inserted through the skin. The medicine is pushed from the syringe into fatty tissue just below the skin. In pregnant women, insulin usually is given in the upper arm or thigh.

Your doctor may have you take two types of insulin at the same time. Most types of insulin that are prescribed to be taken at the same time can be mixed together in the same syringe.

Why give insulin?

Normally, insulin is made by the pancreas. Insulin helps sugar (glucose) enter cells, where it is used for energy. It helps our bodies store extra sugar in muscles, fat, and liver cells. Later, that sugar can be released if it is needed. Without insulin, the body cannot use sugar, causing the blood sugar level to get too high.

If you have gestational diabetes during pregnancy, your pancreas cannot produce enough insulin. If regular exercise and changing the way you eat do not keep your blood sugar level within a safe range, you will need to take a man-made form of insulin. Keeping your blood sugar level within a safe range prevents complications for you, for your unborn baby (such as growing too large for normal delivery), and for your baby after birth (such as low blood sugar levels).

People who have type 1 diabetes and some people who have type 2 diabetes also need to take insulin.

How to prepare and give an insulin shot

Your doctor will help you learn to prepare and give yourself insulin shots. Here are some simple steps to help you learn how to do it.
Get ready
To get ready to give an insulin shot, follow these steps:

1. Gather your supplies. You will need an insulin syringe, your bottle of insulin, and an alcohol wipe or a cotton ball dipped in alcohol. Most people keep their supplies in a bag or kit so they can carry the supplies with them wherever they go.
2. Check the insulin bottle label, expiration date, and contents. When you use an insulin bottle for the first time, write the date on the bottle. On the 30th day after opening it, throw the bottle away. Insulin may not work as well after 30 days.
3. Wash your hands with soap and running water. Dry them thoroughly.

Prepare the shot

Your preparation will depend on whether you are giving one type of insulin or mixing two types of insulin.

* To prepare a shot with a single type of insulin, follow the instructions in the slideshow of steps for preparing a single dose of insulin.
* To prepare a shot containing two types of insulin, follow the instructions in the slideshow of steps for preparing a mixed dose of insulin.

Prepare the site

Before giving your shot, take the time you need to do the following:

* Choose the place. See a diagram of shot areas for guidance. If you give your shots in different places on your body each day, use the same site at the same time of day.
* Clean the area. If you use alcohol to clean the skin before you give the shot, let it dry.
* Relax your muscles in the area of the shot.

Give the shot

Follow these steps for giving an insulin shot:

1. Slightly pinch a fold of skin between your fingers and thumb of one hand.
2. Hold the syringe like a pencil close to the site, keeping your fingers off the plunger. Usually the syringe is at a 90-degree angle to the skin site. If you are thin, you may need to insert the needle at a 45-degree angle. This will prevent the insulin from being injected into muscle, causing it to be absorbed more quickly.
3. Quickly push the needle all the way into the pinched-up area.
4. Push the plunger of the syringe all the way in so the insulin goes into the fatty tissue.
5. Remove the needle slowly at the same angle that you inserted it. If you bleed a little, apply pressure over the area using your finger, a cotton ball, or piece of gauze. Do not rub the area. Check your blood sugar more frequently on the days when bleeding occurs.
6. Replace the cover over the needle. Although syringe manufacturers do not recommend it, some people reuse their syringes until the needle becomes dull or bent. If you plan to reuse your syringe, see precautions when reusing syringes.

Clean up and storage

After giving your shot:
* Store your insulin properly so that each dose from the bottle will work well.
* Do not throw your used syringe, needle, or lancet in a trash can. You can dispose of it in a metal container that either has a lid that screws on or a lid that you tape down tightly. You also can buy special containers for disposing of used needles and syringes. Talk with your local trash disposal agency or your doctor about how to get rid of the container.

Other suggestions for success and safety

To help you be safe and successful in giving your insulin shots:

* Teach someone else to give your insulin shots. Have that person give you a shot from time to time so they will know how to do it in case of an emergency.
* Do not mix other medicine with insulin without your doctor's instruction. If you are taking two types of insulin, ask your doctor or pharmacist whether they can be mixed in the same syringe.
* Never share syringes with another person because of the risk of getting diseases that can be transferred through blood, such as HIV or infection of the liver (hepatitis).

Insulin injection areas for gestational diabetes

These pictures show the areas of the body where insulin can be injected. You can give yourself a shot in:

* The top outer area of the thighs. Insulin usually is absorbed more slowly from this site, unless you exercise soon after injecting insulin into your legs.
* The upper outer area of the arms.
* The buttocks.

Change the spot where you give the shot slightly each time, so that you do not get bumps or pits in your skin. For example, use the right upper arm 5 times in different places, then use the left upper arm in 5 places.

Precautions when reusing insulin syringes:

Some people with diabetes use their insulin syringes more than once to save money. Talk with your doctor before reusing your syringes. Some people with diabetes should not reuse their syringes, including people who have:

* Trouble seeing clearly.
* Trouble using their hands.
* Infections or open wounds.

Some precautions to take if you reuse syringes:

* Put the cover back on the needle after use. The safest way to do this is to place the cover and syringe on a flat surface and slide the cover over the needle without letting the needle touch either the flat surface or your fingers. Only the inside of the cover should touch the needle. Do not hold the syringe straight up; you may accidentally stick yourself.
* Do not clean the needle with alcohol. Alcohol removes the silicone covering on the needle, causing it to become dull.
* Store the syringes at room temperature. It is best to store them with the covered needle pointing up to prevent insulin from blocking the needle opening.

Dispose of reused syringes in safe containers when:

* The shot hurts when you use the syringe.
* The needle becomes dull. Needles usually are dull after being used more than 5 times.
* The needle is bent or has touched something other than your skin.
* You notice redness or signs of infection at the place where you have given the shot. Let your doctor know if you have an infection.

taken from:http://health.yahoo.com/diabetes-treatment/

What to eat in gestational diabetes:

As you all know by this time that momma is having gestational diabetes..
She is also on strict diet but if there was a proper diet plan that would have helped a lot!
Doctor aunty will probably give a diet plan but that will be next week. Before that lets do some searches about diet plans and what she should have and should not have due to having diabetes.

But i would like to tell you all that how much i love to have sweets :(
..i must be a sweet tooth as you all say for those who love sweets..but first i need to have my teeth first ;)
Hence i must be missing all the ice creams and shakes and chocolates. But still it is better to have that for whole life than having it now and develop typeII diabetes in life and not able to eat at all!
I must have that control!!

If momma is strict i am strict enough too..


What type to follow for gestational diabetes:

Here are some general guidelines:

• Eat a variety of foods, distributing calories and carbohydrates evenly throughout the day. Make sure both your meals and your snacks are balanced. The American Diabetes Association recommends that you eat three small-to-moderate-sized meals and two to four snacks every day, including an after-dinner snack. Although your meal plan may contain fewer carbs than you normally eat, complex carbohydrates should continue to provide most of your calories.

• Don't skip meals. Be consistent about when you eat them and the amount of food you eat at each one. Your blood sugar will remain more stable if your food is distributed evenly throughout the day and consistently from day to day.

• Eat a good breakfast. Your blood glucose levels are most likely to be out of whack in the morning. To keep your level in a healthy range, you may have to limit carbohydrates (breads, cereal, fruit, and milk), boost your protein intake, and possibly avoid fruit and juice altogether.

• Include high-fiber foods, such as fresh fruits and vegetables, whole grain breads and cereals, and dried peas, beans, and legumes. These foods are broken down and absorbed more slowly than simple carbohydrates, which may help keep your blood sugar levels from going too high after meals.

• Limit your intake of foods and beverages that contain simple sugars such as soda, fruit juice, flavored teas, and most desserts — or avoid them altogether. These foods can quickly elevate your blood sugar. Ask your healthcare practitioner about using foods sweetened with an artificial sweetener if you need a sweet fix.

• Milk is high in lactose, a simple sugar, so if you drink more than two or three glasses a day, you may need to limit the amount you drink and find an alternative source of calcium. If you're looking for a new beverage of choice, try club soda with a squeeze of lemon or orange, or unsweetened decaffeinated iced tea.

Moderately increasing your activity level is also a good way to help keep your blood glucose levels at normal levels. Again, speak with your diabetes educator or practitioner about the right amount and intensity of exercise for you.

Breakfast should be 15 g of carbs with 1-2 proteins
Snack 15 g of carbs with 1-2 proteins
Lunch 45 g of carbs with 3-4 proteins
Snack 30 g of carbs with 1-2 proteins
Dinner 45 g of carbs with 3-4 proteins
Snack 30 g of carbs with 1-2 proteins Eat every 2-3 hours

taken from:http://www.babycenter.com

How will the diet change?

Here are some goals for healthy eating during pregnancy if you have gestational diabetes:

• Eat three small meals and two or three snacks at regular times every day. Do not skip meals or snacks.
• Eat less carbohydrate at breakfast than at other meals because this is when insulin resistance is the greatest.
• Try to eat a consistent amount of carbohydrate during each meal and snack.
• If you have morning sickness, eat 1-2 servings of crackers, cereal or pretzels before getting out of bed. Eat small, frequent meals throughout the day and avoid fatty, fried and greasy foods. If you take insulin and have morning sickness, make sure you know how to treat low blood sugar.
• Choose foods high in fiber such as whole-grain breads, cereals, pasta, rice, fruits, and vegetables.
• Eat foods with less sugar and fat.
• Drink at least 8 cups (or 64 ounces) of liquids per day.
• Make sure you are getting enough vitamins and minerals in your daily diet. Ask your doctor about taking a prenatal vitamin and mineral supplement to meet the nutritional needs of your pregnancy.

taken from:http://my.clevelandclinic.org/disorders

Carbohydrate Intake Recommendations:

You'll be eating more often when you have gestational diabetes, because you need to ensure that you never get hypoglycemia attacks. The recommendation is to eat every 2 hours, and only have the following amounts of carbs during those meals/snacks:

Breakfast: 30g carbs
Snack: 30g carbs
Lunch: 45g carbs
Snack: 30g carbs
Dinner: 45g carbs
Snack: 30g carbs

If you find that your blood sugar levels are not decreasing with the above recommendations, you may need to go LOWER on the carbs, or analyze whether you're eating the right types of foods. Consult your physician and/or nutritionist on what numbers are best for you.

Of course, with all of these meals and snacks, you'll want to include protein! This helps even out (and slow down,) the processing of the carbs, as well as providing the protein your growing baby needs for various functions.

The following recipes may help. They have been divided up into specific "times" so you can get the maximum benefit from the carb/protein combinations. All carb counts are included. Counts are per serving.

taken from:http://www.e-clipse.com/gestational-diabetes-recipes

Gestational diabetes:what to eat and what not:

1) To stay away from sugar and foods high in sugar.

2) Have complex carbohydrates such as pasta, rice, grains, cereals, crackers, bread, potatoes, dried beans and peas on regular basis.

3) Eat fiber-rich foods such as whole grain cereals and breads, fruits and vegetables.

4) Saturated fats such as fatty meats, butter, bacon, cream and whole milk cheeses should be avoided.

5) Eat a snack before bedtime that is protein and carbohydrate based.

In sync with a woman's needs, doctor or dietitian will tell you to have about 1,200 to 1,600 calories a day if you are a small woman who exercises, to have about 1,600 to 2,000 calories a day if you are a large woman who wants to lose weight.

As a pregnant woman, it's important that you eat well-balanced meals. You may need to eat less at each meal, depending on how much weight you gain during your pregnancy. Your doctor or dietitian will explain all these to you.

taken from:http://www.diabitieslife.com/diabetes

Answer by an expert mom:

You can eat meats, and things with high protien. A lot of carbs will result in high blood surgar levels, as carbs are broken down directly into sugars and then digested as such.

Things like whole grains are excellent for you.

Also, gluton free things are often quite good for the diabetic, as the whole complex whole grains provide more protien and less starch, which helps balance it out.

Splenda can be your best friend, and its fun to bake with. There are also tons of sugar free sweets out there, and a lot of them dont taste half bad.

jello makes a sugar free cheese cake mix, and its excellent. Cant tell the difference between it and a regular mix. There are also sugar free brownie mixes, and sugar free chocolates. Sugar free ice cream. When it comes to sweets you really do have a wide variety.

Meats, whole grains, low sugar fruits in moderation. avoid things like noodles and potatos, or white breads and baked goods. ESPECIALLY foods that come wrapped in plastic, or in boxes. Those things like snack crackers, or hamburger helper are loaded with starch, and right now, starch is just as bad as sugar. It'll build up in your body and make you sick.

taken from:http://answers.yahoo.com

Gestational Diabetes:

Seriously..this whole complexity of pregnancy problems my mamma is having is making me crazy!
So many tests and so many problems at each and every week!

Yesterday the blood test reports have come and it has shown positive results for GCT!
That means that mamma will again have to do GTT tests and pass to prove that she is not having gestational diabetes. Otherwise regular diet plans and exercise and even if not checked then insulin injections to be taken.

This is intolerable. The reason that everyone says that due to the fetus(and progesterone produced by them) the insulin producing capacity of a woman decreases and hence she cannot digest the necessary amount of carbohydrate at a given time. That means the onus of the situation for my mom's diabetes is coming to me..right?
This is not acceptable! I am really angry to know the reason. I am still a little bean..though i have developed my own pancreas and liver and other organs by now, but still you don't expect me to produce insulin and digest my own carbohydrate..right?

Yesterday pappa was real sweet and affectionate to mamma. He could understand the stress mamma is going through after she got the GCT reports. He tried to make mom understand that she will have to work little hard doing some exercises, taking healthy non starchy food and then do the GTT test after a week or so. This is to try for the fact that the blood glucose levels come at least to a normal range. Let's see and work hard together -mamma, pappa and ME !

For the next few days (for a week you can say) the following is in mom's agenda to work hard before the GTT test:

• Go for a regular one hour walk everyday with pappa in the evening
• have some bitter vegetable(boiled) during lunch
• have complex carbohydrate food like rice, cereals, whole grain biscuits etc
• drink lots of water to keep body hydrated
• avoid butter/ghee/cream/cheese
• have salty snacks/biscuits instead of sweet ones
• not to have any loose sugar with tea, curd etc

Sweet mom this will definitely help you bring down the blood sugar level..you will see! Fight mom fight..i love your fighting spirit :)

Mamma has still collected some information about gestational diabetes, if in case she develops that she will follow the regulations and bring down the levels. I am sharing that info with you all.

Definition of Gestational diabetes

Gestational diabetes is a type of diabetes that occurs in non-diabetic women during pregnancy. Diabetes is a disease in which the pancreas is unable to produce insulin or use the insulin it produces in the proper way. Gestational diabetes affects about 3 to 6 percent of all pregnant women. It usually begins in the fifth or sixth month of pregnancy (weeks 24 and 28) and usually disappears shortly after delivery.

Description of Gestational diabetes

After a meal, a portion of the food a person eats is broken down into sugar (glucose). The sugar then passes into the bloodstream and the cells via a hormone called insulin, produced by the pancreas.

Normally, the pancreas produces the right amount of insulin to accommodate the quantity of sugar. However, if the person has diabetes, either the pancreas produces little or no insulin, or the cells do not respond normally to the insulin.

In gestational diabetes, the woman is producing the right amount of insulin, however, the effect of insulin is partially blocked by a variety of other hormones (such as progesterone, prolactin, estrogen, cortisol and human placental lactogen) made in the placenta (the organ that provides nourishment to the baby while developing inside the mother). This process is called insulin resistance, and begins about 20 to 28 weeks into pregnancy. As the placenta grows, more of these hormones are produced and the greater the insulin resistance becomes. In most women, the pancreas is able to make additional insulin to overcome insulin resistance. When the pancreas makes all the insulin it can and there still is not enough to overcome the effect of these hormones, gestational diabetes results.

Causes and Risk Factors of Gestational diabetes

Any woman can develop gestational diabetes during pregnancy, however, there are certain factors that put a woman more "at risk" for developing gestational diabetes. These risk factors include:

• over the age of 30
• obesity
• family history of diabetes
• having previously given birth to a very large child (over 9 pounds, 14 ounces), having previously given birth to a stillborn child or a child with a birth defect
• having too much amniotic fluid
• having gestational diabetes in a previous pregnancy
• having high blood pressure

Symptoms of Gestational diabetes

Generally, gestational diabetes may not cause any symptoms, however, the woman may experience excessive weight gain, excessive hunger or thirst, excessive urination or recurrent vaginal infections.

Diagnosis of Gestational diabetes

Gestational diabetes is detected through a glucose tolerance test, taken from week 24 through week 28 of pregnancy. If the woman is considered at risk for developing gestational diabetes, the doctor may test the woman as early as 13 weeks into the pregnancy.

The glucose (blood sugar) tolerance test involves drinking a glucose (sugar) solution. After waiting one hour, blood is taken from a vein in the arm and the glucose level is checked. A woman with a glucose level of less than 140 mg/dl is presumed not to have gestational diabetes and no further testing is done.

If the glucose level is above 140 mg/dl, a three-hour glucose tolerance test will be performed. The three-hour glucose tolerance test involves eating a diet of at least 150 grams of carbohydrates each day, three (3) days prior to the test. Ten to 14 hours before the test, the woman should not eat or drink anything but water. The test is administered in the doctor's office in the morning and begins with the doctor taking a blood sample. This blood sample is used to determine the fasting glucose level. The woman will then drink a glucose solution and blood will be drawn every hour for three hours after the drink has been consumed. The results of the tests will be compared to the "normal" values. If two or more of the glucose levels are higher than the normal values, a diagnosis of gestational diabetes can be made.

Treatment of Gestational diabetes

Treatment for gestational diabetes includes eating a carefully planned diet, getting plenty of exercise, maintaining a healthy pregnancy weight, monitoring glucose levels and, if necessary, daily insulin injections.

Diet

To help the blood sugar level to stay within a normal range (60 to 120 mg/dl):

• Avoid sugar and foods high in sugar.
• Eat complex carbohydrates such as pasta, rice, grains, cereals, crackers, bread, potatoes, dried beans and peas.
• Eat fiber-rich foods such as whole grain cereals and breads, fruits and vegetables.
• Avoid saturated fats such as fatty meats, butter, bacon, cream and whole milk cheeses.
• Eat a snack before bedtime that is protein and carbohydrate based.

The doctor will help in determining a diet plan that fits the woman's needs.

Exercise

Talk with the doctor about what exercise program is right for the woman. According to the American College of Obstetricians and Gynecologists, women are encouraged to exercise at least three or four days a week, with each session lasting 15 to 30 minutes. Women should avoid very strenuous activity and should not become overheated. If the woman has not exercised prior to pregnancy, a gradual introduction to exercise is recommended. Talk with your doctor regarding individual exercise needs and limitations.

Maintain a healthy pregnancy weight

Optimal weight gain depends on the pre-pregnancy weight of the woman. If the woman is at a desirable weight for her body size and height, a weight gain of 25 to 35 pounds is recommended. If the woman is 20 pounds or more above the desired weight, a weight gain of 20 to 24 pounds is recommended. If the woman is underweight, a weight gain of 28 to 36 pounds is recommended. This is dependent on how underweight the woman is pre-pregnancy. Talk with the doctor about his or her views on how much the woman should gain during the entire pregnancy.

Monitor glucose levels

Depending on the severity of the gestational diabetes, the doctor may want a daily or weekly glucose level test performed. There are self-blood glucose monitoring tests available that can be administered at home. These tests are done by using a special device to obtain a drop of blood and test for the blood sugar level.

Daily insulin injections

Insulin injections may be necessary if the dietary changes and exercising does not bring the blood sugar level within normal range. When two abnormal values occur in one week, the doctor may recommend insulin. A typical regimen begins with a small dose of intermediate-acting and/or regular insulin, taken once or twice daily, with adjustments to be made as insulin resistance increases. The doctor will explain the different kinds of insulin, the right amount of insulin to take and when to take it, and how to change the dosage.

Additionally, although not a treatment, the doctor may suggest careful monitoring of the baby, using ultrasound, fetal movement records, fetal monitoring and non-stress and stress tests.

• Ultrasound is used to determine the position and the size of the baby.
• Fetal movement records involve the woman recording the number of times a baby kicks or moves within a two-hour period.
• Fetal monitoring involves measuring the baby's heart rate, and the strength and frequency of contractions at the same time.

During fetal monitoring, the doctor can also do a non-stress test on the baby. By rubbing the mother's stomach or introducing loud noises, the baby's movements and heart rate are measured. If the heart rate goes up, the test is normal. If the heart rate does not accelerate when the baby is externally stimulated, the doctor will do a stress test.

During the stress test, the mother is given a hormone (called oxytocin) which stimulates internal uterine contractions. During a contraction, the baby is momentarily deprived of its blood supply and oxygen, which forces the baby to respond with a higher heart rate. If the baby's heart rate slows down rather than speeds up, the baby may be in jeopardy.

Complications of Gestational Diabetes

If untreated or poorly controlled, gestational diabetes can cause the baby to:

• have macrosomia (excessive weight at birth exceeding 9 pounds, 14 ounces)
• develop hypoglycemia (low blood sugar) at birth
• develop jaundice (yellow skin)
• develop respiratory distress syndrome (breathing difficulties)
• die after week 28 of pregnancy (called a stillbirth)
• die in infancy

Prognosis

Gestational diabetes usually goes away after pregnancy, but, once a woman has had gestational diabetes, the chances are 75 percent that it will return in future pregnancies. In a few women, however, pregnancy uncovers insulin-dependent (Type I) or non-insulin dependent (Type II) diabetes. In other women, gestational diabetes increases their chances of developing Type II diabetes within eight years.

Questions To Ask Your Doctor About Gestational diabetes

• What tests are used to diagnose gestational diabetes?
• Can diet correct or prevent gestational diabetes?
  
• What kind of diet plan should be followed and how rigid is it?
  
• Will insulin injections be needed?
  
• Will diabetes harm the development of the fetus?
  
• Could the baby become a diabetic later on?
  
• What are the chances of remaining a diabetic after delivery or becoming a diabetic later?

(taken from: http://www.healthscout.com)

GCT Test and GTT Test:

Oh my God!

Doctor aunty has advised to get the GCT done now..mamma is little worried is there a cause of concern?
Why has she advised test this early? I am only 14weeks along and mamma has heard that it is generally done around 24-28 weeks timeframe.

However if she says that it is to be done then that is final.It is always better to be safe than worry-what you say?

Some information mom has collected regarding GCT test..I am providing that below-see if that helps you or not! These are some fears generally all pregnant aunts may have regarding GCT or GTT..

What is GCT test?

Most healthcare practitioners routinely recommend a glucose screening test (also called a glucose challenge test or GCT) between 24 and 28 weeks of pregnancy to check for gestational diabetes, a high blood sugar condition that some women get during pregnancy.

Like any screening test, this one won't give you a diagnosis — it's designed to identify as many women as possible who may have a problem and need more testing to find out. So a positive result doesn't mean that you have gestational diabetes. In fact, only about a third of women who test positive on the glucose screen actually have the condition. To find out if you're one of them, you'll have to undergo a longer, more definitive exam called a glucose tolerance test (GTT).

Between 2 and 5 percent of expectant mothers develop gestational diabetes, making it one of the most common health problems during pregnancy. And because the condition rarely causes any symptoms, testing is the only way to find out if you have it.

Your practitioner may want you to be screened earlier than 24 weeks if a routine urine test shows a high amount of sugar in the urine or if you're considered at high risk. If the results are normal, you'll be screened again at 24 to 28 weeks.

Of course, if were already diagnosed with diabetes before pregnancy, you won't need to be screened. Instead, you'll continue to work with your practitioner to manage your condition during your pregnancy.

How is the screening test done?

When you arrive for the test, you'll be given a sugar solution that contains 50 grams of glucose. The stuff tastes like a very sweet soda pop (it comes in cola, orange, or lime flavor), and you have to get all of it down in five minutes. Some centers keep it chilled or let you pour it over ice and drink it cold.

An hour later (bring a book or magazine!), your practitioner or a technician will take a blood sample from your arm to check your blood sugar level. The idea is to see how efficiently your body processes sugar. Results should be available in a few days.

If the reading is abnormal (too high), which happens 15 to 23 percent of the time, your practitioner will have you come back for a three-hour glucose tolerance test to see if you really do have gestational diabetes. The good news is that most women whose screening test shows elevated blood sugar don't turn out to have gestational diabetes.

Will this test make me feel sick?

Some moms-to-be feel nauseated after drinking the glucose solution, and a few even throw up. It sometimes helps to have eaten something a few hours before the screening test. If you vomit soon after you've gotten the drink down, you'll have to come back another day and repeat the test. But most women get through it just fine. It's actually more common for women to feel sick during the three-hour glucose tolerance test, because the solution for that test may be twice as sweet or twice as much liquid as the one for the screening test and you have to drink it after fasting.

What is an abnormal blood glucose level?

Different practitioners use different standards for determining whether your level is too high. Some will say that if your one-hour blood sugar level is 140 milligrams of glucose per deciliter of blood plasma (mg/dL) or more, you need to have the glucose tolerance test. Others put the cut-off at 130 mg/dL to catch more women who may have gestational diabetes, even though there are likely to be more false positives this way.

If your blood glucose level for this test is higher than 200 mg/dL, most practitioners will consider you diabetic and you won't be required to take the glucose tolerance test. But any score between 140 and 200 means that you'll have to take the three-hour glucose tolerance test for a definite diagnosis.

What is the glucose tolerance test like?

For three days before the test, you'll be told to eat at least 150 grams of carbohydrate a day. If you eat a normal diet and have an extra piece of bread at each meal, you'll likely be getting enough carbs. For eight to 14 hours before the test, you can't eat or drink anything but sips of water (and you're not supposed to smoke or exercise either), so you'll want to schedule it for first thing in the morning.

When you arrive for the test, the technician will take a blood sample to measure your "fasting blood glucose level" and then ask you to drink either a more concentrated dose or a larger volume of the glucose solution. Then brace yourself for three more arm pricks, as your blood is tested every hour for the next three hours. The technician should alternate arms each time she draws your blood.

You'll definitely need something to distract you this time, because you'll have to stay seated in the waiting room between blood drawings. And bring something to eat right after your final blood sample is drawn because you'll probably be starving.

If one of the readings is abnormal, you may have to take another test later in your pregnancy. Or your practitioner may ask you to make some changes in your diet and exercise routine. If two or more of your readings are abnormal, you'll be diagnosed with gestational diabetes and you'll need to talk to your practitioner about a treatment plan. This chart shows the levels that the American Diabetes Association considers abnormal at each interval of the test:

Interval	Abnormal reading
Fasting	95 mg/dl or higher
One hour	180 mg/dl or higher
Two hours	155 mg/dl or higher
Three hours	140 mg/dl or higher

What happens if I'm diagnosed with gestational diabetes?

You'll work with your practitioner or a diabetes specialist and possibly a nutritionist to come up with a plan to manage your condition. Your condition should only last as long as your pregnancy — but a small number of women who develop diabetes during pregnancy still have it after delivery, so you'll have to take another glucose test after six weeks postpartum.

If it turns out that someone has high blood sugar levels after that test they need to conduct a second test, called GTT (Glucose Tolerance Test), to confirm the results.