Gestational Diabetes: Managing Gestational Diabetes

At 28 weeks of pregnancy I was diagnosed with gestational diabetes. The three-hour test results were: fasting, 84; one-hour, 236; two-hour, 216; and three-hour, 165. My test at 31 weeks was: fasting, 84; and one-hour, 148. For the last two weeks I have had ketonesin my urine. I am following the diet but feel worse than ever. How can I effectively manage my gestational diabetes?

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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

The goal of good gestational diabetic management is to maintain normal blood glucose levels, prevent ketones and improve outcomes for baby and for yourself (including feeling good).

To avoid ketones, it is important to eat small meals throughout the day and remember a bedtime snack -- with a good complex carbohydrate such as whole-wheat bread and a protein). If you are spilling ketones in the morning, you may even have to eat a snack in the middle of the night. Increasing protein can also help stabilize glucose levels. Never go more than five hours without eating.

Follow a 2,000 to 2,400 calorie per day diet if your pre-pregnant weight was within 10 percent of your ideal body weight. If you were overweight, fewer calories -- but enough to prevent ketones -- should be taken in. Some studies have shown that ketones can be detrimental to developing brain cells.

I would say that your test at 31 weeks is a bit high for the one hour. It could be that you may need to add some insulin or more food to your regimen, but it would be a good idea to see an endocrinologist or an obstetrician with much experience in managing gestational diabetes. Also a return visit to the nutritionist would be in order.

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