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Gestational diabetes

Diabetes comes in different forms and although the two main types are type 1 and type 2, there is a type that can only develop during pregnancy.

Brief introduction

Insulin is a hormone that is produced by the pancreas. One of the most important functions of insulin is to lower your blood sugar. During pregnancy, the body becomes increasingly insensitive to insulin, which means that your insulin requirements can be two or three times higher. In the majority of cases this is handled by the pancreas producing more insulin, ensuring your blood sugar remains normal. In 1-2% of all pregnant women, the pancreas is unable to produce sufficient insulin. That is when gestational diabetes develops.

What happens to the baby?

The sugar passes to the unborn baby via the placenta. High blood sugar levels could lead to the baby growing more quickly than would normally be the case. After being born, the baby’s blood sugar could be too low. Poorly controlled diabetes could also cause problems for the new-born baby, such as reduced lung maturity or an increased risk of infection.

Treatment

Gestational diabetes is detected through repeated blood sugar tests at the maternity clinic.
Diabetes is always treated with dietary advice, physical activity, and possibly insulin. Sahlgrenska University Hospital offers special care during pregnancy to women who have diabetes type 1 or type 2. This also applies to gestational diabetes.
If you have been told by the maternity clinic that you have gestational diabetes, follow the advice and instructions below.

It is important that you read the information and watch the films listed. Go through the following:

- Instruction film about how to control your blood sugar
- If you need more information
- Follow-up after a blood sugar test
- Film in which a dietician explains about diet and exercise
- Written advice from a dietician
- Advice if you have been put on medication - If your glucose tolerance is impaired

Your midwife at the antenatal clinic will provide you with initial information about the disease and about changing your lifestyle in terms of diet and physical activity. You will also be given a blood sugar meter.

Instruction film in Arabic  العربية

Instruction film in English

Instruction film in Polish - Polski

Instruction film in Somali - Soomaali

Instruction film in Simplyfied Chinese 中文

Instruction film in Turkish - Türkçe

 

After you have checked your blood sugar

After you have checked your blood sugar for a week, you can book a video call with a midwife using the “Mitt Vårdmöte VGR" app. On the app you search for (SU) Sahlgrenska University Hospital Specialist Maternity Care Clinic Östra (SU), diabetes midwife. You and the midwife will then go through a plan for future tests and check-ups.


Film - The dietician explains

Film about gestational diabetes and dietary treatments in Arabic (العربية)

Film about gestational diabetes and dietary treatments in English

Film about gestational diabetes and dietary treatments in Farsi (فارسی)

Film about gestational diabetes and dietary treatments in Polish (Polski)

Film about gestational diabetes and dietary treatments in Simplified Chinese (中文)

In the film, dietician Veronica Broström talks about the causes of gestational diabetes, what it could lead to, and how it can be treated through diet and exercise. The film is not subtitled. You can read the dietician’s advice under the heading “Gestational diabetes – diet therapy” below.

Gestational diabetes – diet therapy

Why does gestational diabetes develop? Pregnancy hormones cause your insulin requirements to increase significantly during pregnancy and your body becomes even more insensitive to insulin. This is known as insulin resistance. Your insulin requirements during pregnancy could treble. Insulin requirements begin to rise early on in pregnancy but about halfway through the pregnancy there is often a sharp increase. Insulin requirements are greatest around weeks 30 – 35. After giving birth, your requirements will fall significantly and return to the prepregnancy level. In most cases a woman’s blood sugar level returns to normal after giving birth. There are only a small number of women who continue to have elevated levels and develop type 2 diabetes. As there is a small risk of developing type 2 diabetes, blood sugar levels are measured for a number of days after pregnancy, and you will have a check-up at your health centre after a year.

Why is it important to have a normal blood sugar level?

High blood sugar in a mother is passed to the unborn baby via the blood in the umbilical cord. The baby’s insulin production increases to cope with their high blood sugar levels. As insulin is a growth hormone, the baby could grow too quickly and become large. A large baby increases the risk of a more complicated birth. Keeping the blood sugar level within the target range minimises the risk of rapid growth. It is not a problem if the level falls outside the target range now and then.

Target levels

Morning, fasting: 5.3 mmol/l
Before a meal: 6 mmol/l
After a meal (1h): 8 mmol/l

Diet and exercise – important forms of therapy

Many people manage to keep their blood sugar at a satisfactory level with the aid of diet and exercise. Others also need medication.

Exercise

Exercise is extremely effective! It increases your body’s insulin sensitivity, which helps keep down your blood sugar levels. You should ideally exercise every day. Walking for 20 or 30 minutes can reduce your blood sugar for 10-16 hours.
Diet When you evaluate each meal from a blood sugar point of view it is easy to exclude too many foods and eat smaller and smaller portions to maintain a normal blood sugar level. If there is less and less food on your plate, you should contact us. Starving yourself is not the aim! 

Meals and insulin


Insulin is not enough to cope with large meals.
An important part of diet therapy is to eat smaller meals but more often. You still have the same requirements overall, but they are spread out across several smaller meals.
Carbohydrates in your diet have the greatest effect on blood sugar. Carbohydrates can be found mainly in pasta/potatoes/rice, bread, grain, certain dairy products, and fruit.
Despite this, it is important not to exclude carbohydrates as they are the fuel that keeps your body going. During pregnancy you have a minimum carbohydrate requirement of 150-175 g per day.
You should instead reduce the amount of carbohydrate in each meal and spread it out over several meals.
Slow rises in blood sugar
Insulin resistance during pregnancy means that the insulin in your body works extremely slowly. The aim therefore is for the blood sugar response from meals to be slow.

When you eat, you can slow down your blood sugar response in the following ways.
Food consistency (chewy vegetables, seeds/nuts, wholemeal bread)
Protein – eggs, meat, fish, chicken, and cheese. A meal with a carbohydrate source and a protein source always produces a better blood sugar response than if your meal only includes a carbohydrate source.
Fat – in the form of an oil-based dressing on your salad or a high-fat yoghurt
Acid – in a vinaigrette dressing or in sourdough bread

It is the entire composition of the meal that is the deciding factor not just individual ingredients.
The following are a number of examples of foods that could result in your blood sugar rising more quickly and which you need to be more aware of:

Bread: Preferably wholemeal bread with whole grains and seeds. It does not need to be sugar-free but ideally with a low sugar content (5-6 g sugar/100g bread). Crispbread could be difficult. Although it is rich in fibre, it dissolves quickly in your stomach. If possible, you should opt for a sandwich with more substance and with butter or margarine. Protein and fat have a slowing effect.
Cereals: Often eaten with milk/yoghurt, which are liquid carbohydrates. Dried fruit is particularly problematic. Nuts and seeds in a cereal mixture could slow down the rise in your blood sugar.
Porridge: The consistency of porridge results in a rapid increase in your blood sugar. Even here you can try adding nuts/seeds, which could slow down the rate at which your blood sugar rises.
Fruit/berries: You are generally permitted to eat a normal portion of fruit or berries although this is also highly individual. One portion of fruit or berries is equivalent to approximately what you can hold in the palm of your hand. Unpeeled fruits, such as apples and pears, usually result in a slower rise in blood sugar than if you eat peeled fruits, such as bananas and melons. If you combine fruit with a protein source, such as cottage cheese, curd, or hard cheese, the rise in blood sugar is slowed down. Fruit together with nuts also produces a slow rise in blood sugar. Juice produces a very rapid rise in blood sugar and is difficult to slow down.
Dairy products: Milk as a drink is very problematic. This also applies to oat milk and rice milk. A small amount of milk in a cup of coffee or tea is often the best. A soya drink could be easier.
In the first instance always choose natural yoghurt/soured milk. In most cases, yoghurt with a higher fat content, such as Greek or Turkish yoghurt, is better. Variants that are higher in protein, such as cottage cheese, curd, and Skyr, will slow down the rise in your blood sugar.
Other drinks: Coffee and tea do not increase your blood sugar. If you need to sweeten, use sweeteners. Even very small amounts of honey/sugar affect your blood sugar more than you think. Sweet cordial and soft drinks do not work at all. Choose light or zero alternatives.
Cakes/buns/sweets/ice cream: Some people cut out sweet things altogether. Others continue to eat sweet things in small amounts. Sugar-free alternatives could work a little better although they still have a significant effect on your blood sugar.

Do you have any questions? If you need extra support from a dietician you can make an appointment for a video call with a dietician via the “Mitt Vårdmöte VGR” app. On the app you search for (SU) Sahlgrenska University Hospital, Specialist Maternity Care Clinic Östra (SU), dietician.

If you are on medication If you have been told that you will be put on medication, you can prepare yourself by checking out information aimed at patients and watching the films we have made available. The information provided depends on the medication you will take:

Fiasp https://www.medicininstruktioner.se/novo/fiasp/
Toujeo https://www.medicininstruktioner.se/sanofi/toujeo/
Other drugs https://www.medicininstruktioner.se/kategori/diabetes/

PONCH Study


This study is aimed at women with gestational diabetes (GDM) or who have had GDM during a previous pregnancy. The aim is to increase our knowledge of how different factors can affect the unborn baby and how the pregnancy can affect the future health of both mother and child. Our hope is that our research will have an impact on healthcare provision in the future, as well as clinical care of women with GDM, both before and after giving birth.
If you would like to take part, please contact gravidstudien@gu.se


Updated: 2021-05-05 16:26