Gestational diabetes mellitus during pregnancy is a fairly common disease in Russia and the world in general. The frequency of occurrence varies according to different countries from 7 to 25%. The number of women with this disease is steadily growing every year, which is associated with an increase in the incidence of diabetes mellitus (mainly type 2) in the general population.

Today, in the era of high development of information technology and, thereby, active popularization of knowledge about various diseases of the population, incl. During pregnancy, improving family planning methods, it is relevant to increase the knowledge of women planning pregnancy about the risk of developing gestational diabetes mellitus in order to timely seek medical help in highly qualified medical institutions, where this problem is dealt with by doctors with extensive clinical experience in managing such patients.

basic information

Gestational diabetes mellitus developed during pregnancy is characterized by hyperglycemia (increased blood glucose levels). In some cases, this disorder of carbohydrate metabolism may precede pregnancy and be first identified (diagnosed) only during the development of this pregnancy.

During pregnancy, physiological (natural) metabolic changes occur in the mother's body, aimed at the normal development of the fetus - in particular, the constant supply of nutrients through the placenta.

The main source of energy for the development of the fetus and the functioning of the cells of its body is glucose, which freely (through facilitated diffusion) penetrates the placenta; the fetus cannot synthesize it on its own. The role of the conductor of glucose into the cell is played by the hormone “insulin”, which is produced in the β-cells of the pancreas. Insulin also promotes the “storage” of glucose in the fetal liver.

Amino acids - the main building material for protein synthesis in the fetus, necessary for cell growth and division - are supplied in an energy-dependent manner, i.e. through active transfer across the placenta.

In the mother’s body, in order to maintain energy balance, a protective mechanism is formed (“rapid starvation phenomenon”), which implies an immediate restructuring of metabolism - preferential breakdown (lipolysis) of adipose tissue, instead of the breakdown of carbohydrates with the slightest restriction in the supply of glucose to the fetus - ketone bodies (products) increase in the blood fat metabolism are toxic to the fetus), which also easily penetrate the placenta.

From the first days of physiological pregnancy, all women experience a decrease in fasting blood glucose levels due to accelerated excretion in the urine, decreased glucose synthesis in the liver, and glucose consumption by the fetoplacental complex.

Normally, during pregnancy, fasting blood glucose does not exceed 3.3-5.1 mmol/l. The blood glucose level 1 hour after eating in pregnant women is higher than in non-pregnant women, but does not exceed 6.6 mmol/l, which is associated with a decrease in motor activity of the gastrointestinal tract and an increase in the absorption time of carbohydrates supplied with food.

In general, in healthy pregnant women, fluctuations in blood glucose occur within very narrow limits: on an empty stomach on average 4.1 ± 0.6 mmol/l, after meals - 6.1 ± 0.7 mmol/l.

In the second half of pregnancy (starting from the 16-20th week), the fetal need for nutrients remains highly relevant against the backdrop of even faster growth rates. The placenta plays a leading role in changes in a woman’s metabolism during this period of pregnancy. As the placenta matures, active synthesis of hormones of the fetoplacental complex occurs, which maintain pregnancy (primarily placental lactogen, progesterone).

As the duration of pregnancy increases, for its normal development in the mother’s body, the production of hormones such as estrogens, progesterone, prolactin, cortisol- they reduce the sensitivity of cells to insulin. All these factors, combined with decreased physical activity of the pregnant woman, weight gain, decreased thermogenesis, and decreased insulin excretion by the kidneys, lead to development of physiological insulin resistance(poor tissue sensitivity to its own (endogenous) insulin) is a biological adaptive mechanism for creating energy reserves in the form of adipose tissue in the mother’s body in order to provide the fetus with nutrition in case of starvation.

In a healthy woman, a compensatory increase in insulin secretion by the pancreas occurs approximately three times (the mass of beta cells increases by 10-15%) to overcome such physiological insulin resistance and maintain blood glucose levels normal for pregnancy. Thus, there will be an increased level of insulin in the blood of any pregnant woman, which is the absolute norm during pregnancy!

However, if the pregnant woman has a hereditary predisposition to diabetes mellitus, obesity (BMI more than 30 kg/m2), etc. The existing secretion of insulin does not allow one to overcome the physiological insulin resistance that develops in the second half of pregnancy - glucose cannot penetrate the cells, which leads to an increase in blood sugar and the development of gestational diabetes mellitus. With the bloodstream, glucose is immediately and unhinderedly transferred through the placenta to the fetus, facilitating its production of its own insulin. Fetal insulin, having a “growth-like” effect, leads to stimulation of the growth of its internal organs against the background of a slowdown in their functional development, and the entire flow of glucose coming from the mother to the fetus through its insulin is deposited in the subcutaneous depot in the form of fat.

As a result, chronic maternal hyperglycemia harms the development of the fetus and leads to the formation of the so-called diabetic fetopathy- fetal diseases occurring from the 12th week of intrauterine life until the onset of labor: high fetal weight; violation of body proportions - large belly, wide shoulder girdle and small limbs; advance of intrauterine development - with ultrasound, an increase in the main dimensions of the fetus in comparison with gestational age; swelling of the tissues and subcutaneous fat of the fetus; chronic fetal hypoxia (impaired blood flow in the placenta as a result of prolonged uncompensated hyperglycemia in a pregnant woman); delayed formation of lung tissue; trauma during childbirth.

Diabetic fetopathy

Diabetic fetopathy is one of the main reasons for the high risk of losing a child during pregnancy and childbirth! After birth, diabetic fetopathy causes the development of neonatal (after birth) diseases of the child and requires staged observation and treatment by a neonatologist (a specialist in the physiological management of newborns/infants and pathological conditions).

Child health problems with gestational diabetes mellitus

Thus, at the birth of children with fetopathy, there is a violation of their adaptation to extrauterine life, which is manifested by the immaturity of the newborn even with a full-term pregnancy and its large size: macrosomia (child weight more than 4000 g), respiratory disorders up to asphyxia (suffocation), organomegaly (enlarged spleen, liver, heart, pancreas), heart pathology (primary damage to the heart muscle), obesity, jaundice, disorders in the blood coagulation system, the content of erythrocytes (red blood cells) in the blood increases, as well as metabolic disorders (low values ​​of glucose, calcium , potassium, magnesium blood).

Children born to mothers with uncompensated gestational diabetes mellitus are more likely to have neurological diseases (cerebral palsy, epilepsy), during puberty and beyond, the risk of developing obesity, metabolic disorders (in particular, carbohydrate metabolism), and cardiovascular diseases is increased.

On the part of a pregnant woman with gestational diabetes mellitus, polyhydramnios, early toxicosis, urinary tract infections, and late toxicosis are more common (a pathological condition that is manifested by the appearance of edema, high blood pressure and proteinuria (protein in the urine), develops in the second and third trimester up to preeclampsia - a disorder of cerebral circulation, which can lead to cerebral edema, increased intracranial pressure, functional disorders of the nervous system), premature birth, spontaneous termination of pregnancy, delivery by cesarean section, anomalies of labor, and trauma during childbirth are more often observed.

Disorders of carbohydrate metabolism can develop in any pregnant woman, taking into account the hormonal and metabolic changes that consistently occur at different stages of pregnancy. But the highest risk of developing gestational diabetes is in women who are overweight/obese and over 25 years of age; presence of diabetes in close relatives; with disorders of carbohydrate metabolism identified before the current pregnancy (impaired glucose tolerance, impaired fasting glucose, gestational diabetes in previous pregnancies); glucosuria during pregnancy (the appearance of glucose in the urine).

Gestational diabetes mellitus, which first developed during pregnancy, often does not have clinical manifestations associated with hyperglycemia (dry mouth, thirst, increased volume of urine excreted per day, itching, etc.) and requires active detection (screening) during pregnancy !

Necessary tests

All pregnant women must have their fasting venous blood plasma glucose tested in a laboratory (cannot be tested using portable glucose self-monitoring devices - glucometers!) - against the background of a normal diet and physical activity - at the first visit to the antenatal clinic or perinatal center (as possible earlier!), but no later than 24 weeks of pregnancy. It should be remembered that during pregnancy the blood glucose level on an empty stomach is lower, and after eating it is higher than outside pregnancy!

Pregnant women whose blood glucose levels, according to WHO recommendations, meet the diagnostic criteria for diabetes mellitus or impaired glucose tolerance are diagnosed with gestational diabetes mellitus. If the results of the study correspond to normal indicators during pregnancy, then an oral glucose tolerance test - OGTT ("stress test" with 75 g of glucose) is mandatory at 24-28 weeks of pregnancy in order to actively identify possible disorders of carbohydrate metabolism. All over the world, OGTT with 75 g of glucose is a safe and the only diagnostic test for detecting disorders of carbohydrate metabolism during pregnancy!

Research time	Venous plasma glucose
On an empty stomach	> 7.0 mmol/l (>126mg/dl)	> 5,1 < 7,0 ммоль/л (>92<126мг/дл)	< 5,1 ммоль/л (<92 мг/дл)
At any time of the day if there are symptoms of hyperglycemia (dry mouth, thirst, increased volume of urine excreted per day, itching, etc.)	> 11.1 mmol/l	-	-
Glycated hemoglobin (HbA1C)	> 6,5%	-	-
OGTT with 75 g anhydrous glucose h/w 1 hour after meals	-	> 10 mmol/l (>180mg/dl)	< 10 ммоль/л (<180мг/дл)
OGTT with 75 g anhydrous glucose h/w 2 hours after meals	-	> 8.5 mmol/l (>153mg/dl)	< 8,5 ммоль/л (<153мг/дл)
Diagnosis	diabetes mellitus type 1 or 2 during pregnancy	Gestational diabetes mellitus	Physiological blood glucose levels during pregnancy

Remember that normalizing carbohydrate metabolism in a pregnant woman allows you to avoid complications from both the course of pregnancy itself and the condition of the fetus!

After a diagnosis of gestational diabetes mellitus is made, all women require constant monitoring by an endocrinologist together with an obstetrician-gynecologist. Pregnant women should be trained in the principles of rational nutrition, self-control and behavior in conditions of a new pathological condition (i.e., timely testing and visits to specialists - at least once every 2 weeks).

A pregnant woman's diet should be sufficiently high in calories and balanced in basic food ingredients to provide the developing fetus with all the necessary nutrients. At the same time, in women with gestational diabetes mellitus, taking into account the characteristics of the pathological condition, nutrition should be adjusted. The basic principles of diet therapy include ensuring stable normoglycemia(maintaining blood glucose levels corresponding to those for physiological pregnancy), and preventing ketonemia(appearance of fat breakdown products - “hungry” ketones - in the urine), as mentioned above in the text.

Increased postprandial blood glucose levels (above 6.7 mmol/L) are associated with an increased incidence of fetal macrosomia. Therefore, a pregnant woman should exclude easily digestible carbohydrates from food (which lead to a rapid uncontrollable rise in blood glucose) and give preference in the diet to difficult-to-digest carbohydrates high in dietary fiber - carbohydrates protected by dietary fiber (for example, many vegetables, legumes) have a low glycemic index. The glycemic index (GI) is a factor in the rate of absorption of carbohydrates.

Diet for gestational diabetes mellitus

Hard-to-digest carbohydrates	Low glycemic index product
Vegetables	Any cabbage (white cabbage, broccoli, cauliflower, Brussels sprouts, collards, kohlrabi), salads, greens (onions, dill, parsley, cilantro, tarragon, sorrel, mint), eggplant, zucchini, peppers, radishes, radishes, cucumbers, tomatoes, artichoke , asparagus, green beans, leeks, garlic, onions, spinach, mushrooms
Fruits and berries	Grapefruit, lemon, lime, kiwi, orange, chokeberry, lingonberry, blueberry, blueberry, blackberry, feijoa, currant, strawberry, strawberry, raspberry, gooseberry, cranberry, cherry.
Cereals (porridge), flour and pasta products	Buckwheat, barley; coarse flour bread; Italian durum wheat pasta
Milk and dairy products	Cottage cheese, low-fat cheeses

Products containing carbohydrates with a high amount of dietary fiber should make up no more than 45% of the daily calorie intake, they should be evenly distributed throughout the day (3 main meals and 2-3 snacks) with a minimum carbohydrate content in breakfast, because. the counter-insular effect of increased levels of maternal hormones and the feto-placental complex in the morning increases tissue insulin resistance. Daily walks after meals in the second half of pregnancy help normalize blood glucose levels.

Pregnant women regularly need to monitor ketone bodies in urine (or blood) to identify insufficient carbohydrate intake from food, because. the mechanism of “rapid fasting” with a predominance of fat breakdown can immediately start (see comments above in the text). If ketone bodies appear in the urine (blood), then it is necessary to additionally eat ~ 12-15 g of carbohydrates and ~ 10 g of protein (a glass of milk/kefir or a sandwich with cheese) before going to bed or at night to reduce the long period of fasting at night.

Pregnant women with gestational diabetes mellitus should conduct regular self-monitoring - measuring glycemia using self-monitoring devices (glucometer) - on an empty stomach and 1 hour after each main meal, recording the measurements in a personal self-monitoring diary. Also, the diary should reflect in detail: dietary habits (the number of foods eaten) at each meal, the level of ketones in the urine (using test urine strips for ketones), weight and blood pressure values ​​measured once a week, the amount of fluid drunk and excreted.

Target self-control indicators for pregnant women with GDM are less than 5.0 mmol/l on an empty stomach, less than 7.0 mmol/l 1 hour after a meal, less than 5.5 mmol/l before bedtime and at night!

If, against the background of diet therapy, it is not possible to achieve target blood glucose values ​​within 1-2 weeks, then the pregnant woman is prescribed insulin therapy (tablet glucose-lowering drugs are contraindicated during pregnancy!). For therapy, insulin preparations that have passed all stages of clinical trials and are approved for use during pregnancy are used. Insulin does not penetrate the placenta and has no effect on the fetus, but excess glucose in the mother’s blood immediately goes to the fetus and contributes to the development of those pathological conditions mentioned above (perinatal losses, diabetic fetopathy, neonatal diseases of newborns).

Gestational diabetes mellitus itself during pregnancy - is not an indication for caesarean section or early delivery(until the 38th week of pregnancy). If the pregnancy proceeded against the background of compensation of carbohydrate metabolism (maintaining blood glucose levels corresponding to those for a physiological pregnancy) and complied with all the instructions of your attending physician, then the prognosis for the mother and the unborn child is favorable and does not differ from that of a physiological full-term pregnancy!

In pregnant women with gestational diabetes mellitus, after delivery and expulsion of the placenta, hormones return to normal levels, and, consequently, cell sensitivity to insulin is restored, which leads to normalization of carbohydrate metabolism. However, women with gestational diabetes remain at high risk of developing diabetes in later life.

Therefore, all women with a disorder of carbohydrate metabolism that developed during pregnancy, 6-8 weeks after birth or after the end of lactation, undergo an oral glucose tolerance test (“load test” with 75 g of glucose) in order to reclassify the condition and actively identify disorders of carbohydrate metabolism. exchange.

All women who have had gestational diabetes mellitus are recommended to change their lifestyle (diet and physical activity) in order to maintain normal body weight, and undergo mandatory regular (once every 3 years) blood glucose testing.

Children born to mothers with gestational diabetes mellitus during pregnancy should be observed by appropriate specialists (endocrinologist, therapist, nutritionist, if necessary) to prevent the development of obesity and/or carbohydrate metabolism disorders (impaired glucose tolerance).

Timely seeking qualified medical help, possibly even at the stage of pregnancy planning, will allow timely identification of carbohydrate metabolism disorders or a high risk of their development during the upcoming pregnancy, receive recommendations for prevention or begin treatment as early as possible in order to preserve the health of the woman and her future offspring!

Author of the article Tatyana Yurievna Golitsyna, endocrinologist at the REMEDI Institute of Reproductive Medicine

Good day. Today we will talk about gestational diabetes during pregnancy. What are the signs and symptoms of diabetes during pregnancy? About its influence on the fetus of the child. What to eat during pregnancy with diabetes. And you will also find out how it is in the blood.

Most often, the pathological condition begins to develop starting from 15-16 weeks. It is observed in 4-6% of women bearing a child. Symptoms of gestational diabetes usually go away after giving birth, but the risk of developing regular diabetes in the future increases. How dangerous is this disease, why does it develop, and are there measures to prevent it?

Diabetes mellitus during pregnancy

The main trigger factor for gestational diabetes mellitus is pathological glucose tolerance. The cause of such disorders is overload of the pancreas. If in people outside of pregnancy such disruptions are caused by obesity and a sedentary lifestyle, then in pregnant women the nature of insulin resistance is completely different. The placenta actively secretes hormones with the opposite effect of insulin, thereby increasing the amount of glucose in the body. When certain factors are present in a woman, such as low physical activity or excessive weight gain, temporary diabetes appears. This occurs between 28 and 36 weeks of gestation.
Uncontrolled diabetes mellitus during pregnancy can affect the overall course of pregnancy and even affect the poor development of embryonic organs. If the increase in sugar began in the first trimester, then the pregnancy will end in miscarriage or numerous congenital anomalies. The brain and cardiovascular system may be primarily affected.

Source beremennuyu.ru

Signs of diabetes during pregnancy

Gestational diabetes is characterized by slow development, without pronounced symptoms.

There may be a slight thirst, severe fatigue, increased appetite, but at the same time weight loss, frequent urge to go to the toilet. Often women do not pay attention to this, attributing everything to pregnancy.

But any discomfort should be reported to the doctor, who will prescribe an examination. During pregnancy, a woman must donate blood and urine for sugar more than once. If the results are elevated, a load test may be prescribed - that is, sugar is taken on an empty stomach, and then an hour after taking 50 g of glucose. This test gives a broader picture.

Based on the results of one fasting test, a diagnosis cannot be made, but when a test is performed (more often than two, the second 10-14 days after the first), we can already talk about the presence or absence of diabetes.

The diagnosis is made if fasting sugar values ​​are above 5.8, one hour after glucose - above 10.0 mmol/l, two hours later - above 8.0.

Source diabetes-life.ru

Gestational diabetes in pregnant women: symptoms

How does a woman who is diagnosed with diabetes during pregnancy feel? Usually, expectant mothers do not notice significant changes or simply attribute them to pregnancy. Even if the diagnosis has not yet been announced, you can think about diabetes if you have the following symptoms:

Our readers write

Subject: Conquered diabetes

From: Galina S. ( [email protected])

To: Site Administration

At the age of 47, I was diagnosed with type 2 diabetes. In a few weeks I gained almost 15 kg. Constant fatigue, drowsiness, feeling of weakness, vision began to fade.

And here is my story

When I turned 55, I was already steadily injecting myself with insulin, everything was very bad... The disease continued to develop, periodic attacks began, the ambulance literally brought me back from the other world. I always thought that this time would be the last...

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Who wants to live a long, energetic life and forget about this terrible disease forever, take 5 minutes and read.

• unusually strong craving for water;
• as a consequence of the previous symptom, frequent trips to the toilet;
• inflammatory processes in the genitourinary system;
• nausea or even vomiting;
• increased appetite with existing weight loss;
• thrush, that is, vaginal candidiasis;
• fatigue on a constant basis;
• deterioration of visual abilities.

The symptoms from the list should alert the doctor, but it is important for a woman to notice them and be sure to inform her specialist.

Source mama.neolove.ru

Test for diabetes mellitus during pregnancy

Even if, from the first weeks of pregnancy, no factors indicating the possibility of developing diabetes mellitus were identified in the condition of the expectant mother, she will have to be tested for diabetes mellitus during pregnancy. A blood glucose test is prescribed in each trimester of pregnancy. If your blood sugar level exceeds 5.1 mmol/L, your doctor will order an additional glucose tolerance test.

What is this research about? On the appointed day, the pregnant woman goes to a medical facility on an empty stomach, where blood is taken from a vein. Immediately after this, she will need to drink a highly sweetened liquid, which contains approximately 50 grams of sugar.

An hour later, the doctor will again take venous blood for analysis. Then, after another 60 minutes, the analysis will be repeated, that is, a total of blood will be taken three times. A laboratory study of the taken material will show how successfully the body is able to metabolize the sugar solution and absorb glucose.

The diagnosis of gestational diabetes is confirmed if the analysis indicators look like this:

1. Fasting sugar level - more than 5.1 mmol/l;
2. After 1 hour – over 10 mmol/l;
3. Another hour later – more than 8.5 mmol/l.

To confirm the result obtained, the test is repeated after 2 weeks.

Source glavvrach.com

How to lower blood sugar during pregnancy

A healthy and balanced diet is the first point of treatment. It is better to completely exclude simple carbohydrates from the menu, and this, in turn, includes confectionery, sweets, condensed and whole milk, potatoes (especially mashed potatoes), fatty and fried ones, yoghurts, sour cream, cream, cheeses, duck and goose meat, sausages , sausages, lard, chocolate, ice cream, fatty meats.

Increased sugar requires exclusion from the menu of sweet drinks and the same fruits, as well as juices. However, the ban does not apply to complex carbohydrates - baked potatoes, buckwheat porridge, rice, durum wheat noodles. Preference should be given to bread with bran or coarsely ground black bread.

It is worth introducing more vegetables and legumes into your diet - soybeans, beans, lentils, peas. For meat, it is better to opt for veal, rabbit and chicken.

You can reduce glucose levels with foods that have a so-called antidiabetic effect - parsley, garlic, radishes, carrots, cabbage, tomatoes, spinach, rhubarb, oats, barley, barley, soy milk.

If you have high sugar levels, it is useful to eat quinces, lemons, gooseberries, lingonberries, currants and grapefruits, as well as low-fat cottage cheese and yogurt

Source mjusli.ru

Gestational diabetes during pregnancy: impact on the fetus

For the safety of the fetus in the placenta, hormones such as cortisol, estrogen and lactogen are necessary. However, these hormones are forced to resist insulin, which disrupts the normal functioning of the pancreas, and because of this, not only the mother suffers, but also her baby.

The formation of the fetus occurs in the first trimester of pregnancy, and therefore GDM that appears after 16-20 weeks cannot lead to any abnormalities in organ development. Moreover, timely diagnosis is quite capable of helping to avoid complications, but there remains the danger of diabetic fetopathy (DF) - “feeding” the fetus, the symptoms of which are associated with impaired development.

The most common symptom of DF deviation in GDM is macrosomia - an increase in fetal size in weight and height. This happens due to the large amount of glucose supplied for fetal development. The child’s pancreas, which is not yet fully developed at this moment, produces its own insulin in excess, which converts excess sugar into fat. As a consequence of this, with normal sizes of the head and limbs, an increase in the shoulder girdle, heart, liver, and abdomen occurs, and the fat layer is expressed. And what are the consequences of this:

due to obstructed passage of the child's shoulder girdle through the birth canal - a difficult birth;

for the same reason - damage to the mother’s internal organs and possible injuries to the child;

due to the enlargement of the fetus (which may not yet fully develop) causing premature birth.

Another symptom of DF is difficulty breathing in the newborn after birth. This happens due to a decrease in surfactant, a substance in the lungs (this is due to GDM in a pregnant woman), and therefore, after the birth of the child, they can be placed in a special incubator (incubator) under constant monitoring, and if necessary, they can even perform artificial respiration using a ventilator.

Source beremennost.net

Gestational diabetes mellitus during pregnancy: diet

If you are diagnosed with gestational diabetes, you will have to reconsider your diet - this is one of the conditions for successful treatment of this disease. It is usually recommended to reduce body weight in diabetes (this contributes to increased insulin resistance), but pregnancy is not the time to lose weight, because the fetus must receive all the nutrients it needs. This means that you should reduce the calorie content of food without reducing its nutritional value.

1. Eat small meals 3 times a day and another 2-3 snacks at the same time. Don't skip meals! Breakfast should consist of 40-45% carbohydrates, the last evening snack should also contain carbohydrates, approximately 15-30 grams.
2. Avoid fried and fatty foods, as well as foods rich in easily digestible carbohydrates. These include, for example, confectionery, as well as baked goods and some fruits (banana, persimmon, grapes, cherries, figs). All these products are quickly absorbed and cause a rise in blood sugar levels; they contain few nutrients, but are high in calories. In addition, to neutralize their high glycemic effect, too much insulin is required, which is an unaffordable luxury for diabetes.
3. If you feel sick in the morning, keep a cracker or dry salty cookie on your bedside table and eat a few before getting out of bed. If you are treated with insulin and feel sick in the morning, make sure you know how to deal with low blood sugar.
4. Don't eat fast foods. They undergo industrial pre-processing to reduce their preparation time, but their effect on increasing the glycemic index is greater than that of their natural counterparts. Therefore, exclude from your diet freeze-dried noodles, “5-minute” soup from a bag, instant porridge, and freeze-dried mashed potatoes.
5. Pay attention to fiber-rich foods: cereals, rice, pasta, vegetables, fruits, whole grain bread. This is true not only for women with gestational diabetes - every pregnant woman should eat 20-35 grams of fiber per day. Why is fiber so good for diabetics? It stimulates the intestines and slows down the absorption of excess fat and sugar into the blood. Fiber-rich foods also contain many essential vitamins and minerals.
6. Saturated fat in the daily diet should not be more than 10%. And in general, eat less foods containing “hidden” and “visible” fats. Eliminate sausages, sausages, sausages, bacon, smoked meats, pork, and lamb. Lean meats are much preferable: turkey, beef, chicken, and fish. Remove all visible fat from meat: lard from meat, and skin from poultry. Prepare everything in a gentle way: boil, bake, steam.
7. Cook food without fat, but with vegetable oil, but there should not be too much of it.
8. Drink at least 1.5 liters of fluid per day(8 glasses).
9. Your body does not need such fats, like margarine, butter, mayonnaise, sour cream, nuts, seeds, cream cheese, sauces.
10. Tired of restrictions? There are also products that you can there is no limit– they are low in calories and carbohydrates. These are cucumbers, tomatoes, zucchini, mushrooms, radishes, zucchini, celery, lettuce, green beans, cabbage. Eat them in main meals or as snacks, preferably in the form of salads or boiled (boiled in the usual way or steamed).
11. Make sure your body is provided with the full range of vitamins and minerals Supplements Needed During Pregnancy: Ask your doctor if you need extra vitamins and minerals.

If diet therapy does not help, and blood sugar remains at a high level, or if ketone bodies are constantly detected in the urine with normal sugar levels, you will be prescribed insulin therapy.

Insulin is only injected because it is a protein, and if you try to put it into tablets, it will be completely destroyed by our digestive enzymes.

Disinfectants are added to insulin preparations, so do not wipe the skin with alcohol before injection - alcohol destroys insulin. Naturally, you need to use disposable syringes and observe personal hygiene rules. Your doctor will tell you all the other details of insulin therapy.

Source baby.ru

Gestational diabetes mellitus during pregnancy: childbirth

The good news: after giving birth, gestational diabetes usually goes away - it develops into diabetes in only 20-25% of cases. True, the birth itself may be complicated due to this diagnosis. For example, due to the already mentioned overfeeding of the fetus, the child may be born very large.

Many might want a “hero,” but the large size of the child can be a problem during labor and childbirth: in most such cases, a cesarean section is performed, and in the case of natural delivery there is a risk of injury to the child’s shoulders.

With gestational diabetes, babies are born with low blood sugar, but this can be corrected simply by feeding. If there is no milk yet, and the child does not have enough colostrum, the child is fed with special formulas to raise the sugar level to normal. Moreover, the medical staff constantly monitors this indicator, measuring glucose levels quite often, before feeding and 2 hours after.

Analyzes Analysis for hidden diabetes mellitus during pregnancy

Gestational diabetes: find out everything you need to know. The signs and diagnosis of this disease are described below. Treatment with diet and insulin injections is described in detail. Read the blood glucose standards for pregnant women, how to reduce morning sugar, what you can eat, in what cases you need to inject insulin, what doses are prescribed. Using the treatments described in this article, you will most likely be able to do without insulin.

Gestational diabetes is high blood sugar that is first detected in a woman during pregnancy. As a rule, this problem occurs in the second half of pregnancy. Sugar increases due to natural physiological reasons against the background of a woman’s predisposition and the presence of risk factors. The diagnosis of gestational diabetes assumes that the patient's glucose levels were normal before conception. Planning and management of pregnancy in women who already have type 1 or type 2 diabetes is discussed in the article “”.

Gestational diabetes: detailed article

Below you will learn how to normalize sugar during pregnancy, carry and give birth to a healthy baby, and protect yourself from type 2 diabetes in subsequent years.

Gestational diabetes is a complication of pregnancy that occurs with an incidence of 2.0-3.5%. Its risk factors:

• overweight, obesity;
• the pregnant woman is over 30 years old;
• diabetes mellitus in one of your relatives;
• polycystic ovary syndrome;
• pregnancy with twins or triplets;
• During a previous pregnancy, a large baby was born.

This page describes in detail the diagnosis of high blood sugar in pregnant women, as well as treatment with diet and insulin injections. Answers are given to questions that women often have about this disease.

What are the signs of gestational diabetes in pregnant women?

This metabolic disorder has no external signs until an ultrasound shows that the fetus is too large. At this point, you can still start treatment, but it’s too late. It is better to start treatment in advance. Therefore, all women are routinely required to take a glucose tolerance test between 24 and 28 weeks of pregnancy. High blood sugar in a pregnant woman can be suspected if the woman gains excessive weight. Sometimes patients note increased thirst and frequent urge to urinate. But that rarely happens. You cannot rely on these symptoms. A glucose tolerance test must be taken in any case.

Diagnostics

The above are risk factors for gestational diabetes. Women who have them need to undergo a glucose tolerance test at the stage of pregnancy planning. During this examination, a blood test is taken on an empty stomach, then the patient is given a glucose solution to drink, and the blood is taken again after 1 and 2 hours. In people with impaired carbohydrate metabolism, sugar levels increase after consuming glucose. The test may detect previously undiagnosed type 1 or type 2 diabetes. In the absence of risk factors, a glucose tolerance test is taken not at the planning stage, but already during pregnancy, at the beginning of its third trimester.

What is the test for diabetes mellitus in pregnant women?

You need to take a laboratory test for glucose tolerance. It takes 2 or 3 hours and requires several blood draws. Different doctors conduct this test using a solution of 50, 75 or 100 grams of glucose. Analysis for glycated hemoglobin is more convenient, but in this case it is not suitable because it gives too late results.

Acceptable blood sugar levels during pregnancy

After taking a glucose tolerance test, a diagnosis of gestational diabetes mellitus is made if at least one of the values ​​exceeds the specified threshold. In the future, insulin dosages are selected in such a way as to reduce fasting glucose levels to normal, 1 and 2 hours after meals. Let us repeat that impaired glucose metabolism is hidden. It can only be detected in time with blood sugar tests. If the disease is confirmed, you also need to monitor your blood pressure and kidney function. To do this, the doctor will prescribe additional blood and urine tests and advise you to buy a tonometer for home.

Normal blood sugar levels in pregnant women

When is insulin prescribed for gestational diabetes?

If a pregnant woman is diagnosed with high blood sugar, the doctor can immediately prescribe insulin injections. Sometimes doctors say that you can’t get by with just one drug, and you need to inject two at once. This can be long-acting insulin in the morning or evening, as well as a quick-acting drug before meals.

Instead of starting insulin injections right away, switch to. Completely give up everything, including fruits. Over the course of 2-3 days, evaluate the effect it has on your blood glucose readings. It may turn out that insulin injections are not necessary. Or you can limit yourself to minimal doses, many times lower than those to which doctors are accustomed.

What insulin is used for GDM?

First of all, they start injecting extended-release insulin. The drug most often prescribed. Because this type of insulin has received convincing evidence of its safety for pregnant women. You can also use one of the competing drugs or. It is not advisable to inject medium insulin Protafan or any of its analogues - Humulin NPH, Insuman Basal, Biosulin N, Rinsulin NPH.

In severe cases, you may need additional injections of short or ultra-short insulin before meals. They may prescribe the drug Humalog, Apidra, Novorapid, Actrapid or some other drug.

Read about short-acting and ultra-short-acting insulin preparations:

Pregnant women on a low-carb diet generally do not need to inject rapid insulin before meals. Except in rare cases, type 1 diabetes is mistaken for gestational diabetes.

At the moment, it is better to avoid domestically produced types of insulin. Use a high-quality imported drug, even if you have to buy it with your own money. Let us repeat that compliance reduces the required doses of insulin by 2-7 times compared to those to which doctors are accustomed.

How is insulin discontinued after childbirth for gestational diabetes?

Immediately after childbirth, the need for insulin in diabetic women drops significantly. Because the placenta stops secreting substances that reduce the body’s sensitivity to this hormone. Most likely, it will be possible to completely cancel insulin injections. And blood sugar will not rise despite this cancellation.

If after childbirth you continue to inject insulin in the same doses as during pregnancy, your glucose level may decrease significantly. Most likely it will happen. However, doctors are usually aware of this danger. They reduce their patients' insulin doses in time to prevent it.

Women who have had gestational diabetes are advised to remain on a low-carbohydrate diet after giving birth. You are at significant risk of developing type 2 diabetes after age 35 to 40. Eliminate unhealthy carbohydrates from your diet to avoid this disaster.

Gestational diabetes mellitus is not considered a common disease and occurs in 5% of pregnant women. Typically, pathology occurs in the second trimester, at which point a noticeable disturbance in carbohydrate metabolism begins due to hormonal changes.

When an elevated glucose level is detected in a timely manner and treated, it does not pose a serious danger to the woman and fetus.

However, if left untreated, diabetes can provoke developmental defects in the unborn child and aggravate the course of pregnancy.

Diabetes– a chronic pathology of the endocrine system, which occurs due to a lack of the hormone insulin. A significant increase in glucose levels is associated with changes in carbohydrate, protein, water-salt balance. The disease affects almost all organs and systems.

There are 2 types of diabetes:

1. The first type is when the body produces an incomplete amount of insulin or is unable to produce it completely.
2. The second type - the pancreas preserves its activity, produces insulin, but due to a violation of the insulin endings, the cells cannot perceive it. This type is typical for people who are overweight, have insufficient physical activity, and are elderly.

Gestational diabetes occurs in pregnant women, since it is detected at the time of pregnancy and is directly related to the position of the expectant mother.

Causes and risk factors

The main factor leading to gestational diabetes is a change in carbohydrate metabolism. There are also other reasons:

• growing fetus– pregnancy lasts 40 weeks, the baby needs energy throughout the entire period, representatives – carbohydrates; glucose is the necessary nutrition for the fetus, the mother’s body spends a lot of energy on its productivity;
• progesterone– a steroid hormone, which is responsible for the successful course of pregnancy, affects the amount of insulin, partly complicating its production; The pancreas secretes insulin with greater force to maintain the required level of glucose in the blood.

During pregnancy, the placenta produces special hormones necessary for the development of the fetus. They interfere with the production of insulin, insulin resistance appears - cells become resistant to insulin, sugar levels increase.

During childbirth, glucose surges are possible due to emotional and physical overload aimed at the birth of the baby. 7-14 days after the birth of the child blood sugar levels are restored.

Risk factors for women include:

• with excess body weight, obesity;
• having a hereditary predisposition;
• with the birth of a baby over 4 kg;
• with pregnancy after 30 years of age;
• with a history of stillbirth;
• who have ovarian pathology;
• with the presence of ordinary diabetes mellitus;
• with pregnancy accompanied by polyhydramnios;
• with endocrine pathologies.

If a woman has any factor, she will need to perform a special test to determine the level of insulin performance and the degree of increase in glucose. This will help detect pathology at an early stage and provide timely treatment.

Symptoms

Gestational diabetes during pregnancy can be asymptomatic, but some still experience certain symptoms. Their severity is determined by the concentration of sugar in the blood.

Common diabetes symptoms:

• dry mouth, feeling thirsty;
• increased urge to empty the bladder;
• dyspeptic manifestations;
• increased appetite;
• insomnia caused by emotional instability;
• itching of the skin in the perineal area;
• malaise, lethargy.

Determining the disease based on the patient’s complaints is difficult, since the presence of such symptoms is inherent in pregnancy itself. And the expectant mother needs to be tested once every 3 months. to determine blood sugar.

Diagnostics

A pregnant woman should constantly monitor her health and, at the first suspicion, immediately contact her doctor.

Diagnostic measures include:

• blood chemistry;
• general blood and urine analysis.

A highly specialized blood sugar tolerance test is quite effective. A pregnant woman should take a glass of water with 50 g glucose.

Through 15-20 min. Blood is taken from a vein to determine sugar levels. Using the identified indicators, doctors find out how the body metabolizes sweetened liquid and absorbs glucose.

During the tests, the expectant mother should remain in the normal rhythm of life, her diet remains the same.

Treatment of gestational diabetes mellitus

All therapeutic actions are aimed at eliminating symptoms and preventing complications. Symptomatic therapy includes nutritional adjustments, special physical exercises, and glucose level monitoring.

Diet

The mainstay of treatment for gestational diabetes is diet. It consists of reducing the number of carbohydrates and increasing the percentage of protein and fiber.

Allowed and contraindicated products for gestational diabetes:

A day you can eat a few sour berries, half a grapefruit, no more than 1 apple, orange. Dairy products (butter, sour cream) should be consumed in small quantities.

It is good to take food boiled, baked, stewed or steamed. You need to eat often ( every 3 hours.), but in small portions. Try to drink more water - The recommended daily dose is 2 liters.

Physical exercise

Physical exercises for diabetes in pregnant women reduce excess weight and strengthen muscle structure. Physical stress activates the proper functioning of insulin, helps reduce its excessive levels, which leads to normalization of the symptoms of gestational disease.

• Loads should be measured according to health status
• Abdominal exercises should not be performed during pregnancy.

What exercises can pregnant women do with gestational diabetes?

Consequences

The danger is a change in metabolism, this adversely affects the functioning of a woman’s body and creates a lack of nutritional components for the fetus.

Diabetes leads to the following complications:

• disturbances in the functioning of the reproductive system;
• death of a woman or newborn;
• gestosis;
• the formation of jaundice in a baby;
• polyhydramnios.

If you have diabetes, you can give birth, you just need to plan your pregnancy in advance. At the preparatory stage, you should conduct an examination, subsequently monitor your well-being, and adhere to the doctor’s instructions.

Childbirth with diabetes

Once the diagnosis is established, some complications may arise during childbirth. The baby is usually large, and doctors have to perform a caesarean section.

When a woman in labor has gestational diabetes, the baby's glucose levels are reduced. This manifestation does not require drug therapy. During breastfeeding, sugar levels are restored.

After childbirth, the mother needs a low-calorie diet to eliminate hyperglycemia and prevent the onset of diabetes mellitus in the future.

Video - caesarean section for diabetes

This is an increase in blood sugar above normal for the first time during pregnancy.

Normal blood sugar level pregnant women in the morning on an empty stomach (before meals) no more 5.0 mmol/l, 1 hour after eating no more than 7.0 mmol/l.

And after a glucose load when conducting a glucose tolerance test at 24-28 weeks of pregnancy: after 1 hour< 10,0 ммоль/л, через 2 часа < 8,5 ммоль/л.

Glucose loading cannot be performed if the morning fasting blood sugar level was already ≥ 5.1 mmol/l.

What you need to know about gestational diabetes.

Gestational diabetes mellitus (GDM) is a disease first identified during pregnancy and, as a rule, resolving after childbirth, characterized by an increase in blood sugar levels (hyperglycemia).

Due to physiological changes in a woman’s metabolism during this period, any pregnancy itself is a risk factor for the development of gestational diabetes mellitus. Especially if the pregnancy is multiple or after IVF, and excess weight before pregnancy and a large increase during it increase the risk of developing GDM. In the second half of pregnancy, the body's need for insulin increases due to the fact that some pregnancy hormones block its action. Sometimes it happens that the pancreas cannot produce enough insulin. Then the excess sugar is not removed from the blood, but remains in it in large quantities. From the mother's blood, glucose enters the fetal blood through the placenta, therefore, maternal hyperglycemia will lead to the development of fetal hyperglycemia. The fetal pancreas is stimulated, producing an increased amount of insulin, with the subsequent formation of insulin resistance (decreased sensitivity to insulin), which affects the development of diabetic changes in the child. It can also lead to complications during childbirth, respiratory disorders, hypoglycemia (low glucose levels) after birth, and neonatal jaundice. If GDM is not detected in a timely manner or the expectant mother does not take any action to treat it, then the risk of early aging of the placenta and, as a consequence, delayed fetal development, premature birth, as well as polyhydramnios, increased blood pressure, preeclampsia, the formation of a large fetus and the need to in caesarean section, traumatization of the woman and child during childbirth, hypoglycemia and respiratory failure in the newborn. The most serious complication of untreated GDM is perinatal fetal death.. Therefore, a modern health organization around the world recommends mandatory screening of ALL pregnant women for the earliest possible detection of GDM and its timely treatment.

If you have been diagnosed with GDM, then then there is no reason to despair. Without delay, you must take all measures to ensure that your blood sugar is within normal limits throughout the remaining period of pregnancy. Since the increase in blood sugar during GDM is very slight and is not subjectively felt, it is necessary to begin regular self-monitoring of blood sugar using a portable device - glucometer(during pregnancy, only glucometers calibrated by blood plasma are used - see the instructions for the device).

Blood sugar norms for pregnant: in the morning before meals 3.3-5.0 mmol/l, 1 hour after meals - less than 7.0 mmol/l.

Each sugar value must be recorded in self-control diary indicating the date, time and a detailed description of the contents of the meal after which you measured your sugar.

You should take this diary with you every time to an appointment with an obstetrician-gynecologist and endocrinologist.

Treatment of GDM during pregnancy:

1. Diet- the most important thing in the treatment of GDM

• Easily digestible carbohydrates are completely excluded from the diet: sugar, jam, honey, all juices, ice cream, pastries, cakes, baked goods made from high-grade white flour; rich baked goods (buns, buns, pies),
• Any sweeteners, for example, products containing fructose (sold in stores under the “diabetic” brand) are prohibited for pregnant and breastfeeding women,
• If you have excess body weight, then you need to limit all fats in your diet and completely exclude: sausages, sausages, sausages, lard, margarine, mayonnaise,
• Never go hungry! Nutrition should be evenly distributed over 4 to 6 meals throughout the day; breaks between meals should not be more than 3-4 hours.

2. Physical exercise. If there are no contraindications, then moderate physical activity for at least 30 minutes daily, for example, walking, swimming in the pool, is very useful.

Avoid exercises that increase blood pressure and cause uterine hypertonicity.

3. Diary self-control, in which you write:

• blood sugar in the morning before meals, 1 hour after each meal during the day and before bedtime - daily,
• all meals (in detail) - daily,
• ketonuria (ketones or acetone in urine) in the morning on an empty stomach (there are special test strips for determining ketone bodies in urine - for example, Uriket, Ketofan) - daily,
• blood pressure (BP should be less than 130/80 mm Hg) - daily,
• fetal movements - daily,
• body weight - weekly.

Attention: if you do not keep a diary, or do not keep it honestly, you are deceiving yourself (and not the doctor) and risking yourself and your baby!

1. If, despite the measures taken, blood sugar exceeds the recommended values, then it is necessary to start treatment with insulin (for this you will be referred for a consultation with endocrinologist).
2. Don't be afraid to prescribe insulin. You should know that insulin addiction does not develop, and after childbirth, in the vast majority of cases, insulin is discontinued. Insulin in adequate doses does not harm the mother; it is prescribed to maintain her full health, and the baby will remain healthy and will not know about the mother’s use of insulin - the latter does not pass through the placenta.

CHILDREN and GDM:

The timing and method of childbirth is determined individually for each pregnant woman. No later than 38 weeks of pregnancy, the obstetrician-gynecologist conducts a final examination of the mother and child and discusses the prospects for childbirth with the patient. Prolonging pregnancy beyond 40 weeks with GDM is dangerous; the placenta has few reserves and may not withstand the stress of childbirth, so earlier delivery is preferable. Gestational diabetes in itself is NOT an indication for cesarean section.

GDM after childbirth:

• following a diet for 1.5 months after childbirth,
• insulin therapy is canceled (if any),
• control of blood sugar in the first three days (normal blood sugar after childbirth: on an empty stomach 3.3 - 5.5 mmol/l, 2 hours after meals up to 7.8 mmol/l),
• 6-12 weeks after birth - consultation with an endocrinologist to conduct diagnostic tests to clarify the state of carbohydrate metabolism,
• women who have had GDM are at high risk for developing GDM in future pregnancies and type 2 diabetes in the future, so a woman who has had GDM needs to:
• - follow a diet aimed at reducing body weight if it is excess,
• - increase physical activity,
• - plan subsequent pregnancies,
• Children from mothers with GDM have an increased risk of developing obesity and type 2 diabetes throughout their lives, so they are recommended to have a balanced diet and sufficient physical activity, and supervision by an endocrinologist.

If GDM is detected, patients must completely stop using:

• all sweet products (this applies to both sugar and honey, ice cream, sweet drinks and the like);
• white bread, pastries and any flour products (including pasta);
• semolina;
• semi-finished products;
• smoked meats;
• fast food products;
• fast food;
• fruits containing a lot of calories;
• lemonades, juices in packages;
• fatty meat, jellied meat, lard;
• canned food, regardless of their type;
• alcohol;
• cocoa;
• cereals, diet bread;
• all legumes;
• sweet yoghurts.

You will also have to significantly limit your use of:

• potatoes;
• butter;
• chicken eggs;
• baked goods from uneatable dough.
• Products from the list of prohibited foods should be completely excluded from the diet. Even their small consumption can lead to negative consequences. Potatoes, butter, eggs and baked goods are allowed to be consumed in very limited quantities

What can pregnant women eat with gestational diabetes? The above products can be replaced:

• hard cheeses;
• fermented milk cottage cheese;
• natural yoghurts;
• heavy cream;
• seafood;
• green vegetables (carrots, pumpkin, beets, unlike cucumbers, onions and cabbage, must be consumed in limited quantities);
• mushrooms;
• soybeans and products made from it (in small quantities);
• tomato juice;
• tea.

There are several diet options that can be followed for gestational diabetes, but a low-carbohydrate diet is excluded.

This is due to the fact that if there is insufficient carbohydrate intake from food, the body will begin to burn fat reserves for energy.

The following products must be included in the diet:

• whole wheat bread;
• any vegetables;
• legumes;
• mushrooms;
• cereals - preferably millet, pearl barley, oatmeal, buckwheat;
• lean meats;
• fish;
• chicken eggs - 2-3 pieces/week;
• dairy products;
• sour fruits and berries;
• vegetable oils.

In most cases, doctors prescribe to their patients a diet containing more carbohydrates and moderate amounts of protein. Preference is given to unsaturated fats, the consumption of which, however, must also be limited. Saturated fats are completely excluded from the diet.

Sample menu for pregnant women with gestational diabetes:

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