Questions and Answers
Diabetes does not run in our family, and I am not overweight. Furthermore, I did not develop gestational diabetes with my first child.
After reading several articles and visiting several diabetes web sites, I am not sure I have developed this. I took the three-hour GTT and my numbers compared to the common scales were only off by a few points, 5 at the most.
What are the normal levels for a pregnancy? I was feeling fine until my doctor suggested a diet of 1,900 calories and insulin shots three times a day. Since the diet, I am hungry and tired all the time. Since I have started the shots (five days ago) my blood sugars are reading under 100 mg/dl and I feel horrible. I have explained this to my nurse and doctor who tell me this is normal. Is it?
I need some advice or some kind of references to make me feel like I am getting the best health care. I would like to get opinion from another doctor but feel that I am too late in my pregnancy.
I am a diabetes educator and mother who, many years ago, had gestational diabetes. Diabetes does run in my family and I still tried to deny that I had gestational diabetes. However, half of the women who develop gestational diabetes have no family history of diabetes.
The normal values for the three-hour GTT are:
- Fasting should be below 95 mg/dl
- The one-hour should be below 180
- The two-hour value below 155
- The three-hour value less than 140
If you had two or more values equal to or over these values, then you have gestational diabetes.
If you are not overweight, you need to work with a dietitian who can help you decide how many calories and what kinds of foods you need to help keep your blood sugar in control, gain the right amount of weight and still not be hungry. This can be done with help. About 1,900 calories may be right for you, but you should not be hungry. It is very important for you to talk with your dietitian, diabetes educator and doctor and let them know about how you feel, your concerns and your fears. And don't be afraid to ask them "why," but also be willing to listen and learn.
Sometimes when the meal planning and exercise plan together do not work to keep the blood sugar levels in control (i.e., fasting below 95, 1 hour after a meal below 140, and 2 hours after a meal below 120), it is necessary to use insulin to control the blood-glucose levels. Keeping the blood glucose levels in control not only helps you, but they also prevent problems for your baby. If your blood glucose is high, even by small amounts all the time, the baby makes more insulin, which acts like a growth hormone and makes the baby get fatter. Then, when your baby is born, he or she is used to producing extra insulin because of the extra glucose that crosses the placenta. This can cause the baby to end up in the high-risk nursery because of hypoglycemia. The baby has extra insulin but the extra glucose source has stopped.
At 32 weeks, it would be pretty hard to change doctors unless you felt you are not getting good care. From what you write, it sounds like you have a doctor who cares and is trying to keep your blood sugar levels in the normal range. Remember that you do need to keep your fasting below 95, 1 hour after a meal below 140, and two hours after a meal below 120. If this makes your feel bad at the beginning, then usually your levels were running too high. And after a few days you should feel better than ever and have more energy. Remember that you are also helping to keep your baby healthy.
Last of all, having gestational diabetes puts you higher risk for developing type 2 diabetes later in life, but you can do a lot to prevent that. Right now, you need to learn about healthy meal-planning and exercise habits that will help you prevent type 2 diabetes.
Good luck and remember that gestational diabetes can be a blessing—it can help you understand healthy living, and that helps you have a longer, healthier life. Everyone would be better off to eat and exercise like we have diabetes. My family and I (even though they didn't really know it) have followed these simple principles for many years.
Thanks for being concerned about yours and your baby's health. You are the one in control and the one that will make these decisions, but you can have support and help if you seek it.
Joann Henry, RNC, Diabetes Educator
Sweet Success Express
Garden Grove, California
I admit it. As a type 2 using diet, exercise and Glucophage to control my BGs, I often skip over Diabetes Health's articles on type 1 diabetes, particularly your Up and Pumping column. That was until reading February's article "Pump Therapy Now Becoming a Type 2 Thing" (p. 46) by Dr. Alan B. Schorr.
I don't believe that I am ready for insulin therapy—conventional or pump—but now my curiosity is piqued. Dr. Schorr did teach me that pump insulin is quick-acting. He also recommended three to six BG tests per day.
Does that mean that the pump is not self-monitoring? Does that mean the user has to activate the pump every time a dose is needed? Where on the body (or on clothing) do most pump users wear this device? Do most pumps have insulin capacity for at least one day? Like contact lenses, must they be carefully cleaned at the end of the day?
The insulin pump is an open-loop system. This means it requires the patient to monitor his or her BGs and determine the amount of insulin needed to maintain control.
The insulin used in an insulin pump is either Regular insulin-buffered (which acts between three and six hours) or Humalog (which acts between two and four hours). The basal rates are set and can automatically change. However, the patient must do any modifications and the meal bolus must be manually given.
The pump has capacity for 200 to 310 units of insulin, generally enough to last two to three days. The entire syringe and tubing, along with catheters, are changed at that time.
Most catheters are inserted in the abdomen, though one could use the leg or buttocks. The use of pump therapy is not for everyone, type 1 or type 2. However, it is an option that should be considered if one is willing to commit to the work involved and has an experienced physician and team to implement it.
Alan B. Schorr DO, FAAIM, FACE