Gestational Diabetes Treatment during pregnancy, are screened for diabetes at twenty-four to twenty-eight weeks, the very first gestational diabetes treatment visit if they are at very high risk of diabetes as indicated by the following risk factors:
There are two gestational diabetes treatment tests that can determine whether a woman has gestational diabetes. The first gestational diabetes treatment test is performed on all non-high-risk women at the twenty-four to twenty eight week visit. If this test is normal, no further gestational diabetes treatment testing is necessary. If this first test is positive, however, a second test is performed about a week later.
• First test: One-hour 50-gram glucose challenge screening test. In this test you take a drink that contains 50 grams of glucose (there is no need to fast beforehand). The blood glucose level is checked after one hour. If your glucose level is greater than 130 mg/dl, the test is positive. If the glucose level is 180 mg/dl or more, there is a strong likelihood that you have diabetes and you will be asked to do a fasting glucose test. Then, if this fasting glucose test is 126 mg/dl or greater, you have gestational diabetes.
• Second test: Three-hour 100-gram glucose test. If the 50-gram glucose challenge test is positive, then within one week you will do a fasting three hour 100-gram glucose test (see Table 13-3). You should eat your usual diet, including carbohydrates, in the days before the test—in other words, don’t change your eating habits and stop eating carbohydrates in the days between the first and second test—and fast for eight to fourteen hours before taking the test. The second test is considered positive for diabetes if two or more values are at or above the threshold levels. If only one value is abnormal, this test will be repeated in four weeks.
Although gestational diabetes treatment there is evidence that oral glyburide is safe in pregnancy, the current practice is to have women control their diabetes with insulin when they are pregnant. If you have type 2 diabetes and you are using oral agents for your diabetes, you will be switched over to insulin before you start trying to get pregnant. Not all insulins, however, are approved for use during pregnancy. The fast-acting insulin analogs insulin lispro and insulin aspart are safe. Currently, the only long-acting insulin used during pregnancy is NPH. Recently, a small study of insulin glargine used in thirty-two pregnancies did not show any problems. There is no information about using insulin detemir during pregnancy. The goal of treatment is to get your HbA1c level into the normal range before you try to get pregnant. The time it takes to do this varies, so you may want to plan at least three months to achieve this. You may need to visit your diabetes team every two to three weeks during this time. Once you have stable glucose levels in the target range, with a normal HbA1c, then you can try to get pregnant. Once you are pregnant, your care will be transitioned to a specialty high-risk obstetrics practice staffed by a team that consists of an obstetrician, a nutritionist, a diabetes educator, a nurse, and an endocrinologist. Your insulin doses will vary during the pregnancy due to the hormonal changes. At about nine to twelve weeks you may need slightly less insulin, but then the insulin doses usually will go up until about thirty-six weeks. After you are diagnosed with gestational diabetes, you will be taught how to check your blood glucose at home, especially your postprandial (after meals) glucose levels. You will also meet a nutritionist to work out a meal plan or diet. If your glucose levels are not normal on the diet—that is, over 90 mg/dl fasting, more than 130 mg/dl after meals—then you will start insulin therapy, although glyburide therapy can be considered.
Nutrition In Gestational Diabetes Treatment
During pregnancy, you should have a balanced diet of 40 to 50 percent of calories as carbohydrate, 20 percent protein, and 30 to 40 percent fat. The number of calories you can take will depend on your prepregnancy weight: approximately 13.5 kcal per pound per day (30 kcal/kg/day) if you are currently at your ideal weight; 11 kcal per pound per day (24 kcal/kg/day) if you are 20 to 50 percent above your ideal weight, and 5.5 to 8 kcal per pound per day (12 to 18 kcal/kg/day) if you are more than 50 percent above your ideal body weight (1 kg equals 2.2 pounds).
Gestational Diabetes Treatment Fetal Surveillance Labor And Delivery
As with most pregnancies, ultrasound is used with diabetic women to follow the development of the fetus. It allows the obstetrician to estimate the age, growth, and health of the fetus and to look for malformations. With careful management of the diabetes in pregnancy, most women are able to go to term unless there are complications. Generally speaking, pregnancies are not allowed to proceed beyond forty weeks. If you have type 1 diabetes, you will be given an intravenous infusion of insulin and glucose to keep your glucose levels between 70 and 90 mg/dl during labor and delivery. High glucose levels can increase the risk of hypoglycemia in the fetus. During the active part of labor, the insulin may be stopped and a glucose infusion may be required to supply the mother with calories. After delivery, your doctor will change you back to your prepregnancy insulin doses. If you have type 2 diabetes, your doctor may ask you to stay on insulin while you are breast-feeding, and once you stop, he or she will switch you to your usual medicines for glucose control.
Women with gestational diabetes are usually allowed to go into spontaneous labor. Depending on the glucose levels, you may need insulin during the labor. Usually insulin is not required after delivery.
If you have gestational diabetes, your risk of developing type 2 diabetes in the future is 5 to 50 percent. Therefore, you should have a two-hour 75-gram oral glucose tolerance test (OGTT) six to ten weeks after delivery.
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