hi girls,
i am a regular visitor of this site. i am due in september. really nice to read all ur discussions. i got lots of information. my friends keep asking me if i feel any movements of the baby, but still i am not. i am scared. i even asked the doctor about it. she said there is nothing much to worry. i have to go for the fifth month scanning in another 15 days. niki replied. Hi gals, i ve to start with insulin, once a day at night as my morning sugars r not in controll regularly. I was very very scared but my dr has made things easy for me. lets see what happens tonight. Good luck to u all...... vidhya replied. I had my surprise BABY SHOWER this weekend. I wasnt planning to have one now and rather have it after the baby is born. Since i didnt want everyone to know that i was have GD and couldnt eat sweets or cake etc. but few of my friends who knew about my GD and my husband had planned one at my friend's house. i was so thrilled and couldnt believe my eyes. Also we had planned on buying our baby stuff and setting our nursery this weekend, since toys-r-us had a good baby sale this weekend. we found a crib, stroller/car seat, swing and a few towels and onesies etc. got some cute outfits for our baby and some cute toys in the shower. now i cant wait to use them....:-) I'm just so excited to go home set up crib & swing tonight. belly-rubs to all of you girls. vidhya replied. Hi Niki, really sorry for this late response regarding your fasting sugar level. I've never had a problem with the morning sugar level so far, my suggestion would be that you should go for a walk after dinner and then not take anything heavy as your bedtime snack. try taking a glass of milk or something that is less in carb like saltine crackers. I'm sure you'll be able to control it within a couple of days using trial & error with different foods. Dont worry too much, just try and be happy. All this is for your sweet angel, i cant wait to see the little peanut. have about 7 more weeks to go. niki replied. the primary goal in treating GDM is to achieve and maintain maternal euglycemic
levels to improve the outcome for both mother and fetus. Management of GDM
includes diet theraphy, exercise, and insulin therapy if necessary. In humans, the placentas physiologic
role is to a transport nutrients and waste products between the mother and
fetus, b synthesize and secrete hormones, and c maintain an immunologic
barrierThe placenta also ensures the separate development of the fetus by
acting as a screen between the mother and the fetus

During pregnancy, hormonal changes play an important physiologic role in
maintaining a constant supply of glucose to the growing fetusInitially,
hormonal changes occur that result in the shift of metabolic products eg,
glucose from the mother toward the growing fetusMoreover, the rising
concentrations of hormones further enhance fetal nutrition through increasing
release of fatty acids and conversion of amino acids to glucose by a process
known as gluconeogenesis

During a normal pregnancy, there is a gradual increase in insulin resistance
Although most pregnant women are able to maintain normal blood glucose levels,
some pregnant women are unable to maintain euglycem aWomen who are
genetically disposed to gestational diabetes mellitus GDM are unable to
secrete sufficient insulin to meet their requirements during pregnancy or exhibit
an exaggerated insulin resistance or a combination of these defects.[


During the fasting state in GDM, severe insulin resistance is characterized by an
overproduction of glucose by the liver; this is the major cause of fasting
hyperglycemiaDuring the fed state in GDM, severe insulin resistance is
characterized by a decrease in insulin-mediated glucose uptake by muscle. This
is responsible for the excessive increase in postprandial blood glucose levelsDietary
management of GDM requires nutritionists who comprehend not only the
maternal metabolic changes that occur in a normal pregnancy but how these
metabolic changes alter the requirements for insulinMANAGEMENT OF GDM

Management of GDM is complex and varies depending on the womans physical,
psychological, cultural, and educational needs] The patient needs to acquire
the knowledge and skills regarding diet, blood glucose monitoring, insulin
therapy, and exercise to participate in the management of GDM] Education
is very important in ensuring a healthy outcome for the mother and fetusand
the nutrition counselor registered dietitian can assume a responsible role in this
educational process. The approach to managing GDM includes a combination of
diet, exercise, intensive insulin therapy, and determination of multiple daily blood
glucose levels]The goals of nutritional counseling include providing the necessary nutrients for
fetal development and maintenance of maternal health, maintaining
normoglycemia, preventing ketosis, and achieving an appropriate weight gain.Nutritional Prescription

For GDM, the nutritional prescription should satisfy the minimum requirements
for pregnant women] Weight gain during pregnancy should be based on
prepregnancy weight eg, body mass index. For example, obese women should
gain approximately 7 kg, and women who are underweight should gain up to 18
kg when they become pregnantThe
recommended distribution of total caloric intake is a 35% to 45%
carbohydrates; b 20% to 25% protein; and c 35% to 40% fatWhen
carbohydrate intake is limited, postprandial blood glucose levels are lower
compared with diets higher in carbohydrate content. Complex carbohydrates are
recommended because simple sugars have the tendency to increase
postprandial blood glucose levelsSupplemental iron is recommended for women who are at risk for an iron
deficiency, usually at a level of 30 mg/dayOther vitamin and mineral
supplements should be prescribed according to the womans needsand
should include 1200 mg calcium and 400 [micro]g folate.Factors That Affect Blood Glucose Levels

The primary goal of GDM is to achieve and maintain euglycemia throughout
pregnancy to improve the outcome for both mother and fetus] Many factors
affect blood glucose levels* Stress eg, physical and psychological

Rationale: Physical eg, pregnancy and psychological stress can aggravate
glucose intolerance in the morning through elevated levels of cortisol and
norepinephrine.

* Time of day

Rationale: The circadian rhythm of hormones eg, cortisol affects blood glucose
levels. Higher levels of serum free cortisol in the morning result in greater glucose
intolerance in the early morning. Later in the day, a higher carbohydrate intake
can be tolerated.


* Exercise

Rationale: Exercise helps to lower blood glucose levels by increasing muscle
uptake of glucose.

* Amount of carbohydrate consumed

Rationale: Simple sugars cause the blood glucose level to peak within 1 hour
compared with complex carbohydrates, which cause the blood glucose level to
peak within 2 hours. Simple sugars are easy to digest, have a low satiety value,
and are usually in a liquid form eg, fruit juices, milk. Complex carbohydrates
require more time to be digested, have a high satiety value, and are not in liquid
form eg, vegetables, bread.Glycemic index is a term that refers to the percentage increase in the blood
glucose level after consuming a food compared to glucose] The glycemic
index of a food is influenced by the characteristics of the food or meal. Some of
the factors include processing, preparation, storage, physical form, and ripeness
of the foods.[Also, the glycemic response varies considerably within the
same individual and between individuals. Therefore, it is important for each
patient to determine her own glycemic index by monitoring food intake and
postprandial blood glucose levels]Basic Dietary Guidelines
* Avoid sugar and foods high in sugar

Rationale: Sugar and concentrated sweets usually have a high caloric content,
are low in nutrients, and cause hyperglycemia in GDM. Many foods that contain
high amounts of sugar are also high in fat eg, ice cream, donuts, sweet
rolls.* Avoid foods rich in sugar and/or fat

Rationale: Such foods cause a rapid rise in blood glucose levels and may have a
high fat content, which contributes to excessive weight gain.

* Eat small frequent meals

Rationale: When small frequent meals are consumed, postprandial
hyperglycemia and preprandial starvation ketosis are avoided.


* Eat a small breakfast

Rationale: A small breakfast that is low in carbohydrates <10% is
recommended because blood glucose levels can be high in GDM.
NIKI replied. Hi Aruna, Good that u r in controll of sugars before pregnancy. For me it has come at such a stage that even though i know it is all good diet etc.... i get disappointed as i am losing weight. i can dr only on tuesday now/ Also at this stage of pregnancy when U have to change anything physically or mentally it is very very difficult. Now ive lost all faith in Drs. & have faith just in God. I hope He will do all well. Priya replied. Hi Nikki,
My glucose test showed the glucose count to be 170. And hence doctor has told me to do 3 hr test now. Yes I am keeping myself out off tention. But need to work on it more..
How much was ur count intially? My iron also gone down to 10.9 so DR, told me to start iron suppliments.
How are you doing with U rsugar count. What precautions are U taking?
Please let me know.
My mom in india is little bit worried as no one had this problem in our family in preganancy before. I have told her not to worry !!
Anyways, the article is very helpful. I shall be doing the three hr test on Wed. Tuesday I have appoinment with my doctor. The reason why i was feeling thursty was diabetis.
You also told me that U used to get up in nights for water.
Anyways, Let us hope that I should be able to contrtol my sugar soon!
Take care and have a good weeekdn.
Priya