Gestational diabetes, What to do after pregnancy?

Gestational diabetes is an abnormal increase in blood glucose during pregnancy due to an increase of insulin resistance due to hormonal changes thereof, hyperglycemia during pregnancy is generally transient , however , up to 70% of women who have had gestational diabetes develop type 2 diabetes within 10 years after pregnancy , especially for women who have risk factors may persist with high blood sugar or gestational diabetes again in the next pregnancy.
 

If you have had gestational diabetes should test blood glucose fasting six weeks after childbirth, if the blood glucose level is above 126 mg, the glucose test should be repeated to confirm the diagnosis diabetes mellitus . If the result is less than 126, but greater than or equal to 100 , a test of glucose tolerance by 75 g oral glucose sample.
What is the tolerance test glucose orally ?
If you had a test tolerance to oral glucose during pregnancy, then you already know how this test is performed . This test involves swallowing a drink containing 75 grams of glucose and blocks eight hours of fasting , a sample of fasting glucose is taken , then an hour later , a sample , and a final sample two hours after glucose intake .
 

As evidence of oral glucose tolerance interpreted ?
Values ​​if you are diabetic are different from those used during pregnancy. If your level of blood glucose is greater than or equal to 200 mg after 2 hours of the test , you are considered diabetic and your doctor will continue to treat the way it used during pregnancy or to switch to a new one that is best for the levels of blood glucose . If you need more than 20 units of insulin in late pregnancy , the physician may continue to insulin, but at lower doses . If glucose test two hours is between 140 and 199 mg is considered abnormal and this condition is known as glucose intolerance , and possibly a doctor may choose to continue your treatment with metformin alone is the medicine used to prevent diabetes type 2 . proof If glucose tolerance is normal ( glucose to two hours less than 140 mg ) , repeat the test every year.
If the test of glucose tolerance obvious that you have diabetes or glucose intolerance , it is important to continue or start a diet and exercise to help control glucose levels in the blood. The return to a normal weight will reduce the chances of developing type 2 diabetes.

About diet for gestational diabetes

There is much evidence to support that high blood glucose levels in gestational diabetes, even at levels considered normal times , may have adverse effects on the baby . Diabetes people
If you have been diagnosed with gestational diabetes, your doctor has probably already talked about starting a diet and want to learn more about your diet . First, you should know that there are guidelines established by the American Diabetes Association ( ADA) to provide guidance on what a diet during pregnancy should contain for someone with gestational diabetes. people best
 

According to the ADA , a good diet for gestational diabetes should control the consumption of carbohydrates and promote appropriate weight gain during pregnancy , in order to achieve the levels of normal blood glucose and prevent ketosis . Ketosis is the presence of ketones in the blood that occurs when a person is fasting for a prolonged period of very high levels of ketones can be toxic , making the blood more acidic and may damage organs like the kidneys and liver. best
The meal plan should fit the weights, quarter , tastes and habits of each pregnant woman. Ideally, you should provide the nutrients and calories , depending on the period of pregnancy , allowing a complete diet for normal fetal development. Diabetes people best
 

Current ADA guidelines recommend less than 7 to 10 % of daily calories from saturated fats, which raise LDL ("bad cholesterol" ) cholesterol. Saturated fats are found in foods such as fatty meat , chicken skin , full of low -fat dairy products , butter and fast food meals . In addition , reduce the consumption of trans fats , known as partially hydrogenated oils. Reduce fat intake may contribute to modest weight loss . Diabetes people best
 

Protein intake should be maintained in the range of 15-20 % of total calories . Low -fat options , such as low -fat dairy products , legumes, fewer birds skin , fish and lean meats are recommended. Similarly, six ounces of protein per day is recommended to maintain the cholesterol content in the range . A serving of chicken, fish or lean meat is about the size of a deck of cards. Diabetes people best
Carbohydrate choices should come from whole grains or bread , pasta , rice , legumes, fruits and vegetables. Increasing fiber in the diet is a general recommendation for the general population and not specifically for people with diabetes. Lots and type of calories from carbohydrates affected and reflected in weight control and blood sugar . Just learn to read food labels for total carbohydrate instead of sugar , because labels provide good information for the control of blood glucose. Diabetes people best
It also recommends limiting consumption of foods high in calories and low in nutritional value, including those high in sugar such as granulated sugar, powders and soft drinks, candy , nuts , cookies , cakes, pies , sauces , jams , ice cream, meals of milk and canned fruit . Foods containing sugar should be replaced by other sources of carbohydrates ( like potatoes ) instead of just adding them to meals. Diabetes people best
 

Pregnant women treated with insulin, foods are divided with a snack at night to prevent hypoglycemia. The best diet is one that provides the needs of pregnancy, but does not lead to excessive weight gain or high blood sugar . Diabetes people best
From the second quarter of 300 kilocalories per day are added. You should not use a total caloric value of less than 1,700 calories. A dietitian can help you make the decision on how to balance your diet with carbohydrates, proteins and fats. Diabetes people best

Oral medications for gestational diabetes

Treatment for gestational diabetes aims to keep glucose levels equivalent to those of pregnant women who have gestational diabetes blood. Although insulin is still the treatment of choice for women with gestational diabetes mellitus, has some drawbacks , including that given by injection and cause weight gain . Furthermore, it does not address the fundamental problem of these women is insulin resistance , a condition in which the body's cells become resistant to the effects of insulin resistance and this is a risk factor for the development of diabetes . diabetes
 

Metformin is an oral medication for the treatment of gestational diabetes. As expert studies have shown, this is an option for effective and safe treatment during pregnancy , with the advantage of insulin that women can have a better grip, insulin sensitivity is improved and n is not associated with increased weight or hypoglycemia. diabetes Oral
 

Metformin acts to increase insulin sensitivity in the liver and therefore decreases the release of glucose and glucose production by the liver. Metformin also increase insulin sensitivity in muscle , enhancing glucose utilization activity . You can also have unknown effects, such as loss of appetite and decreased glucose uptake in the intestine. The main side effects that may occur with metformin are diarrhea and intestinal or abdominal discomfort up to 20-30 % of people who use it can also cause fever , chills , malaise , drowsiness , painful urination , back pain and muscle pain or cramps. diabetes
 

Less common side effects include anxiety, confusion , cold sweat, chest discomfort , increased appetite , headache , dizziness , nausea , shortness of breath , chest tightness , nightmares , and tremors. Most of the side effects of metformin does not usually need medical treatment because they usually go away as your body adjusts to the medication . Your doctor can tell you how to prevent or reduce some of these troublesome side effects. If these effects persist it may need to stop taking metformin and start insulin . diabetes
 

The metformin dose to be recommended during pregnancy vary from 1.000 mg to 2500 mg per day . So far, he has found no difference in the rate of complications for mother and child before and after the delivery period in relation to insulin, and greater acceptance by pregnant women. For the benefits that can be produced using metformin is recommended as a treatment for gestational diabetes with insulin or as an alternative treatment will be most useful in cases where pregnancy rejects the use of insulin, for cultural reasons or economic . Oral

Are you at risk of gestational diabetes?

Gestational diabetes (GD ) is a condition characterized by glucose intolerance with different degrees of severity as the first time during pregnancy , and may or may not be resolved after that. Their presence may be suspected if the pregnant woman has or has had some of the factors that are considered at risk of developing the disease during pregnancy.
 

Pregnant women were classified into three groups at risk for gestational diabetes :
• Low risk : pregnant women with low- risk ethnic group (mainly white ) , normal, or less than 25 years old weight, no history of diabetes in first-degree relatives (father, mother and siblings ), normal weight (index body mass of less than 25 kg/m2) before pregnancy , no history of poor pregnancy outcomes, such as abortion or the loss of a baby before birth. Must meet to be considered low risk All of these conditions .
• Moderate risk : pregnant women who do not meet the criteria of low or high risk .
• High risk: pregnant women with high-risk ethnic group (eg , African Americans , Hispanics / Latinos, and Native Americans) , severe obesity, history of diabetes in first-degree relatives , gestational diabetes or glucose intolerance during previous pregnancy , history of large baby at birth ( a baby of less than 4 kg ) or glucose in the urine at this time. Other conditions were also identified as risk factors for developing GDM , including systemic hypertension , history of the death of the baby in the uterus and increase the amount of amniotic fluid in the past or present.
 

For many years , we have used risk factors to determine which women should be screened for gestational diabetes. Before 2011 , was conducted screening pregnant women at high during the first prenatal visit between 24 and 28 weeks gestation in women at low risk or moderate risk ; and even among high-risk women who had a normal result on the first visit . However, the risk classification is not currently used for the detection of gestational diabetes during pregnancy. The experts concluded that , due to the epidemics of obesity and diabetes mellitus in the world is preferable to perform a test for fasting glucose and glucose OGTT to all women women in their first prenatal visit, regardless of the risk . 

This is not to say that no matter if you have a high risk or not; if it belongs to the high-risk population , of course , you have an increased risk of gestational diabetes and the need to follow a proper diet and exercise during pregnancy to reduce the risk to a minimum.

What is the treatment for gestational diabetes?

Gestational diabetes (GD ) is hyperglycemia ( high blood glucose ) that occurs during pregnancy and disappears after delivery in general. Gestational diabetes is caused by insulin resistance ; Insulin is the hormone that regulates glucose in the body. If your doctor performed the diagnosis of gestational diabetes is important to begin treatment as soon as possible to avoid adverse consequences for you and your baby. diabetes
 

The goal of treatment of gestational diabetes is to maintain blood glucose at the desired level and this is achieved through the implementation of a plan of diet and changes in lifestyle , including physical activity and treating insulin . The benefits of treatment of gestational diabetes mellitus are well documented in studies in several countries , where the majority of pregnant women were treated with a feeding program and changes in lifestyle. For this reason , your doctor should refer you to a nutritionist , once he or she makes the diagnosis of gestational diabetes. During weight gain during normal pregnancy is recommended 25 to 35 pounds for women of normal weight; 25-29 pounds for overweight women, and 11 to 20 pounds for obese women . If you have gestational diabetes, you can not raise a maximum of £ 7, according to some experts , which is impossible without the help of professionals. diabetes
Regarding physical activity, moderate physical activity is recommended. Moderate physical activity, such as brisk walking , gardening , walking home and housework , active participation in games and sports with children , moderate construction tasks . This should be enough to significantly speed up the heart rate for at least 30 minutes a day, but the frequency of appropriate duration , intensity and type of exercise has not been determined . Some small studies suggest that exercise reduces fasting and after glucose concentrations and food may reduce the number of women with gestational diabetes requiring insulin treatment. diabetes
 

Treatment of GDM aims to maintain the blood glucose levels that minimize the risk of adverse effects during the period around birth , but there is no evidence that the benefits of treatment clearly outweigh the disadvantages. The glucose target actually recommended : fasting glucose or below 95 mg , one hour after ingestion of glucose at or below 140 mg , and two hours after ingestion of glucose or below 120 mg . If nutrition and physical activity care can not maintain adequate glycemic control , treatment should be intensified to include drug therapy for appropriate health professional . So if you do not want to take insulin during pregnancy , you should stick faithfully to your diet program and exercises prescribed by your doctor . 

But you should not be afraid of insulin, because insulin is the first-line treatment in GDM and your doctor will give you an individualized insulin levels to achieve target blood glucose .
In recent years, professionals talk a lot about the use of oral medications (including glibenclamide and metformin) for the treatment of gestational diabetes due to significant decrease in processing costs . However, oral medications are not approved by the Food and Drug Administration for use during pregnancy so far. Finally , before you start any treatment for gestational diabetes, the most important thing is to make the correct diagnosis of the disease with the most common diagnostic criteria .