November is National Diabetes Awareness Month and we’re raising awareness not only about Type 2 diabetes, but also prediabetes, gestational diabetes and the autoimmune disease-Type 1 diabetes.

I recently chatted with a few women who were diagnosed with gestational diabetes midway through a pregnancy. Women are typically screened for GD somewhere around the 25th week of pregnancy. This involves drinking a very sugary beverage, waiting a bit, then having blood drawn. This provides a way to assess how well one’s body is able to regulate blood sugar levels. While the procedure isn’t painful, it sure can be unpleasant! That sugary drink is not particularly pleasant for many women. (I didn’t mind it terribly, but people with nausea that persists past the first trimester often dread the glucose screening as it makes nausea worse, and downing the syrupy Tang-like drink can be a challenge.

What is Gestational Diabetes?
Gestational diabetes (sometimes shortened to GD) occurs when a woman’s blood sugar rises abnormally and dangerously high during pregnancy. The pancreas produces insulin which keeps blood sugar in a normal range, but during pregnancy, hormones produced by the placenta can in some cases render insulin less than effective, leading to GD.

GD can be managed through dietary changes in some cases (avoiding high-glycemic foods, like sugar and simple carbs and eating lots of protein), but some women have to take oral medication or give themselves  insulin injections to maintain a stable glucose level. Women with GD have to monitor their blood sugar regularly at home. Risks of having gestational diabetes include having a larger than normal baby, leading possibly to a C-section, and having a higher chance of developing type 2 diabetes later on.

If a woman “fails” the initial GD glucose tolerance screening(ie if her blood sugar is too high), she will then have a second test measuring glucose levels over several hours to see how and when the levels change. The results of this second test determine if she is diagnosed with GD or not.

Many women “fail” the initial screening but “pass” the second, and are not considered to have GD. This has happened to quite a few of my friends, and it was a relief to know that they didn’t have to make any major changes for the remainder of the pregnancy. But for others, like Sara, the second test confirmed the results of the initial screening and she was diagnosed with gestational diabetes. I know Sara through an online community of women who had experienced infertility and miscarriage, and for her, this diagnosis made her feel “like I was ‘broken’ in yet another way”. She finally had a pregnancy that was lasting, and now there was yet another bump in the road. Sara was surprised by the diagnosis because she had no family history of diabetes, and is a very slim woman.

“I was told that I had a risk of having a large baby, which was laughable”, says the very petite project manager, then 38 years old.

“The worst part about the diagnosis was that I developed an enormous craving for pancakes soon after, and the fact that I couldn’t eat them was so hard! I made my husband promise me pancakes as my first postpartum meal (there’s a cafe across the street from the hospital that’s open 24 hours a day). I still remember that first bite of syrup-soaked delicousness!”

The best way Sara managed her GD was to eat lots of protein, a tip she got from a co-worker who has type 1 diabetes.
Sara’s case was mild enough that she discovered that if she ate enough protein, she could eat almost anything in moderation. For example, she added almond butter to her beloved smoothies. The only thing that made her blood sugar skyrocket no matter what was pasta, so she avoided it completely.

In the end, Sara delivered a very healthy 6 pound 6 ounce baby girl at 38 weeks. In her next pregnancy, she did not develop gestational diabetes and now has two healthy little girls, ages 3 and 6.

Gestational diabetes. Leah experienced gestational diabetes with her second son's pregnancy, but not the first or third. She was able to manage GD with strict diet.

Leah & babies 2 & 3. Photo courtesy of Love Letters to Tucson

Leah Noreng has 3 sons and when pregnant with her second, at age 32, she was diagnosed with GD. She was in disbelief at the diagnosis, because she didn’t have it during her first pregnancy and, like Sara, had no risk factors. But she finally accepted that she had to make some changes, and said goodbye to her beloved ice cream. She too managed her GD through diet, and says she never felt hungry–she ate carefully planned meals and snacks on a strict schedule. She kept her glucose levels in check rather easily and delivered a 7 pound, six ounce baby at 37 weeks–vaginally and unmedicated. “He was the smallest of my three”, she chuckles. Like Sara, her next pregnancy did not result in a GD diagnosis.

Rebecca had a fairly normal pregnancy with her daughter, S, but “massively failed” the GD test when pregnant with her son O.  Her docs first had her try oral medication, but she was swiftly switched to insulin injections, self-administered four times a day. O was born at a normal weight but with immature lungs which may or may not have been related to her GD. Rebecca checks her blood sugar annually, and it’s now back to pre-diabetic levels. She did have a GD risk factor of being overweight, and says that “now I have to get really serious about diet and weight loss”, as her GD history, in addition to being overweight, increases her risk of getting type 1 diabetes, as mentioned above.

Cassandra, a freelance musician and teaching artist,  had two risk factors for gestational diabetes. Her paternal grandfather was diabetic, and she is overweight. Unlike the three women above, Cassandra had GD with both pregnancies, but was able to manage her glucose levels entirely through diet. While she found the diagnosis frightening, and the process of establishing a healthful diet arduous and at times frustrating, once she got the hang of it, she found both the diet and the blood sugar monitoring fairly simple. The doctors’ appointments proved stressful during her second pregnancy, since she had a toddler to care for, and she already felt confident in her ability to manage her glucose levels. Her first birth was induced because she went past her due date, and the healthy baby weighed 6 pounds, 15 ounces. Her second delivery was free of interventions, and the 8 pound, 4 ounce infant was perfect.

Gestational diabetes complicates pregnancy and can seriously compromise the health of both mother and infant. In the situations above each woman took the test, no matter whether she had risk factors for GD, and with the help of medical advice, was able to manage their gestational diabetes. Four different stories, but having caught  happy endings all around. Thank you for sharing, Sara, Leah, Rebecca, and Cassandra!