Gestational Diabetes: How Did I End Up With Gestational Diabetes?

I am 38 years old and 32 weeks pregnant. I had a one hour glucose test a couple of weeks ago and the result was 162. I had a three hour glucose test last week and the doctor's office said that one of the four readings was a little high, putting me in the category of borderline diabetic. They suggested that I meet with a dietician and have my blood tested at my regular visits. I have none of the usual risk factors for diabetes and I eat a healthy diet. I am somewhat embarrassed by this diagnosis. How could this happen to me when I do everything right?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Please don't feel the least bit guilty or embarrassed by such a diagnosis. Nothing you did or ate or eat causes gestational diabetes. Pregnancy puts a high demand upon the kidneys and insulin resistance increases due to placental hormones.

Three percent of all pregnant women have gestational diabetes -- about 135,000 annually. Women who have a pregnancy after 35 are a bit more prone to development of this condition.

You are right -- your one hour is elevated, but two of the four readings on the three hour must be abnormal to meet the criteria for gestational diabetes.

I just returned from an excellent conference and the numbers have changed slightly according to Steve Gabbe, a world expert on gestational diabetes. The new parameters are as follows:
Fasting: 95 mg/dl
1-hour: 180 mg/dl
2-hour: 155 mg/dl
3-hour: 140 mg/dl

This will identify more women but decrease the risks to the babies.

He also said that if a woman has one abnormal reading, his recommendation would be to have her avoid concentrated sugars, eat a healthy diet and be aware that this might possibly become an issue later in life. In other words, she should be tested periodically.

Your risk of fetal morbidity, and mortality would not be significantly increased with one abnormal reading. A visit to a nutritionist would be a good idea if he or she was fluent in the condition and recommendations which apparently yours was not. The diet is a 2000 to 2200 calorie, high complex carbohydrate, low concentrated sweets, high fiber diet. Check ketones at home or at the office to make sure you are not metabolizing fat. If ketones are present, make sure you get an evening snack before bed.

I would review your lab results in light of these new readings. Tell your provider that these are the recommendations of the 4th International Workshop Conference on Gestational Diabetes.

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