Gestational diabetes (EN) Gestational diabetes (EN)

What is diabetes?

Diabetes is a condition where your blood sugar level is too high. During your pregnancy, your blood glucose level must stay within a normal range as much as possible.
If you have diabetes, the amount of glucose (sugar) in your blood is not properly regulated. The level of glucose in the blood is controlled by a hormone called insulin. Under the influence of insulin, glucose is absorbed into the body cells. When glucose is burned in your cells, the stored energy is released.

What is gestational diabetes?

Hormonal changes during pregnancy mean the body's cells are less sensitive to the effect of insulin. This happens in every pregnancy. The pancreas normally produces more insulin, which prevents blood sugar levels from rising. In the case of gestational diabetes, this process does not happen sufficiently, causing the glucose level in the blood to become too high.

Gestational diabetes usually develops in the second half of pregnancy. The OGTT (Oral Glucose Tolerance Test) is usually administered during this period to check whether your blood sugar level is too high, both before and after consuming a certain amount of sugar. 

How does gestational diabetes develop?

The following can increase the risk of gestational diabetes:

• excess body weight;
• family members with diabetes;
• emotional stress;
• physical strain;
• gestational diabetes in a previous pregnancy.

These can also be reasons to perform the OGTT sooner or later.

What are the effects of gestational diabetes?

For the baby

Your baby receives nutrients from your blood through the placenta. If you have gestational diabetes, your baby may grow too fast, causing him or her to be overweight at birth (macrosomia). This can cause problems during the delivery.

If your glucose levels are too high in the last period of your pregnancy, it can lead to an increased insulin release in your baby. After birth, the glucose supply is cut off abruptly, and your baby's blood glucose level can then drop too low.
To reduce these risks, it is important to regulate the mother's blood sugar level as early as possible.

For the mother

Gestational diabetes is a warning for the future.

If you have gestational diabetes, you have a 50% chance of developing type 2 diabetes within 5 to 10 years. The risk of developing gestational diabetes in a subsequent pregnancy also increases.

You can limit the risk of diabetes by:

1. sufficient exercise;
2. a healthy diet;
3. maintaining a healthy weight (appropriate for your age and build).

Treatment during pregnancy

During your pregnancy, you will be supervised by the internist, the diabetes nurse and the dietician. They will help keep your blood glucose at the right level.
The diabetes nurse will give you a blood glucose meter which allows you to check your blood glucose levels yourself.
Most of the time, you can keep your blood glucose level stable by watching what you eat. The dietician will help with that. If, despite a healthy diet and sufficient exercise, you are unable to keep your glucose level stable the internist will discuss with you whether it is necessary to start taking insulin. We suggest you read the 'Gestational diabetes and nutrition' leaflet.

The diabetes nurse

The diabetes nurse will provide information about gestational diabetes and show you how to use the blood glucose meter. This will give us a good picture of your blood glucose and help us to treat your gestational diabetes better. The diabetes nurse will stay in touch with you for the duration of the treatment.

How often should you measure blood glucose?

Make a day curve twice a week:

• One curve on a weekday;
• One curve on the weekend.

If necessary, make a day curve three times a week.

What are the target blood glucose levels?

Target value before breakfast: < 5.3 mmol/l
Target value 1.5 hours after a meal: < 7 mmol/l

Setting the fixed doses of short-acting insulin

The insulin used is NovoRapid (clear liquid).

• If your glucose value is regularly above 7 after a meal: Start with 2EH NovoRapid at the same meal the following day.
• If you are unsure about increasing the insulin or have any other questions, contact your diabetes nurse.

Setting the fixed doses of long-acting insulin

• If the measured blood glucose value is higher than 5.3 mmol/l before breakfast, talk to your diabetes nurse about starting intermediate or long-acting insulin.

Insulatard is prescribed for this (cloudy insulin, use at approx. 22:00). Shake 10 times before use so that the insulin becomes cloudy.

If necessary, this is started at 4EH.

• If your glucose value is regularly above 5.3 mmol/l before breakfast, increase your Insulatard dose in consultation with the diabetes nurse.

Injection schedule for short-acting insulin:

If your blood glucose level is elevated after a meal, extra short-acting insulin may be injected at that point. This is called "adjustment".

The following standard advice applies to this adjustment:
> 8 mmol/l:     +1 unit of novorapid
> 9 mmol/l:     +2 units of novorapid
> 10 mmol/l:   +3 units of novorapid

What to do in case of hypoglycaemia?

Hypoglycaemia is a condition in which your blood glucose level is too low. You can recognise this by the following symptoms:

• Sweating;
• Shaking;
• Palpitations;
• Dizziness;
• Easily irritated and sudden mood changes (like suddenly getting angry);
• Lack of concentration;
• Headache;

A low blood glucose level can be normal. Hypoglycaemia is only treated if it is caused by the use of insulin.

If you have signs or symptoms of hypoglycaemia, you should measure your blood glucose. If your blood glucose is lower than 3.5 mmol/l, we recommend that you take 15–20 grams of glucose such as:

• 2–4 tablets of dextrose (e.g., Dextros, take note of the size of other brands), or 30 ml syrup, possibly diluted with water.

Starting insulin

Insulin is started if your glucose levels continue to deviate and diet and lifestyle adjustments do not help. Insulin will not harm you or your child.

Treatment during childbirth

Gestational diabetes may mean that you have to give birth at the hospital. After childbirth, we will regularly check you and your baby's blood glucose levels. After the birth, the umbilical cord will be cut and your baby will receive its glucose through breast or bottle feeding. If your baby's blood sugar level drops, he or she will receive extra nutrition to prevent this as much as possible.

If the extra nutrition is not sufficient, the paediatrician will temporarily take over the care.

If you took insulin during your pregnancy, you can usually stop taking it during labour. This is done in consultation with the internist, gynaecologist or diabetes nurse.

After the delivery

In most cases, your blood glucose level will be normal 24 hours after the delivery. After the delivery, you must stop injecting insulin. This will be discussed with you before the delivery.

1. After you have given birth, you must make daily curves every two weeks.
2. You will have a telephone consultation with the internist around six to eight weeks after the delivery.
3. If your blood glucose level is above 10 mmol/l in the weeks after the pregnancy, please contact your diabetes nurse.

The future

You will have an increased risk of gestational diabetes in future pregnancies. As such, you should be tested at an early stage in the next pregnancy: in week 16 or 17. If the sugar test (OGTT) does not yield any abnormal values, it will be repeated at 28 weeks.
For the first five years after you give birth, your doctor will check your blood glucose levels every year. We recommend that you make an annual appointment for this yourself. Choose, for example, the month of your child's birth to have this check-up every year.

Measuring equipment

You will be authorised to order the materials, such as test strips and lancets, from the mail-order company. Depending on your health insurer, you may be required to pay a personal contribution.

Contact

If you have any questions about your nutrition or your blood sugar levels remain too high (above 7 mmol/L an hour and a half after a meal), then please contact your dietician.

Zwolle

Dietetics
+31 38 424 53 27 (available Monday–Friday from 08:30 to 17:00)

Meppel

Dietetics
+31 522 23 33 38 (available Monday–Friday from 08:30 to 17:00)

If you are unable to make your appointment, let us know as soon as possible and we will schedule a new one.

Deze brochure is ook beschikbaar in Nederlands: 'Zwangerschapsdiabetes'.