What is it?
Also called “gestational carbohydrate intolerance”, “abnormal carbohydrate metabolism” or type 3 diabetes, gestational diabetes is a transient condition that occurs and is diagnosed only during pregnancy. The word “diabetes” was used (instead of “glucose intolerance”) so that insurance companies would cover costs. GD is quite different than “true” diabetes (which comes with its own set of risks in pregnancy).
Type 1 diabetes lends itself to extreme variations in blood sugar levels, whereas as GD there are normal or elevated levels of insulin and normal glucose metabolism in early pregnancy. Both types 1 and 2 can damage mom’s kidneys and circulatory system, but this damage is not seen with GD. The diagnosis of GD is based largely on lab values.
(Varney 353, Frye DT 311-313)
According to Anne Frye, GD is a “diagnosis in search of a condition…another example of normal pregnancy physiology being construed as pathology”. Gail Hart, in her latest Research book (2005) feels the same. The diagnosis of GD as a “disease” is based on ever-changing lab values that do not take into consideration that a pregnant woman’s blood sugar levels run higher than when not pregnant, and that in general women metabolize sugar much differently when pregnant.
(Frye DT 316)
(Hart Research Updates 2005)
Who is at risk?
According to Varney, all women should be screened at 28 weeks regardless of any risk factors. ACOG says that women who are low risk do not need to be screened. Those who are at risk should be screened at the first visit, at 28 weeks and at 34-36 weeks. Risk factors include: any family history of diabetes, history of previous unexplained stillbirth, poor OB history, previous birth of 9 lb. (or more) baby, nonpregnant weight of more than 180 lbs., recurrent yeast infections, recurrent glucose in urine not associated with diet, GD in previous pregnancy, over age 25, preeclampsia or chronic hypertension, polyhydramnios. Also considered high risk are women who are Hispanic, African American, Native American and Asian.
(Frye DT 314)
How is it treated?
Like many pregnancy complications, GD can be “controlled” with an adequate but not restrictive diet. This means getting rid of refined carbs, increasing complex carbs, lots of small meals throughout the day as well as moderate, regular exercise. Calories and protein are still very important, and the woman can add enough extra protein to provide 1 g/protein for each pound of body weight. Weight gain and salt should not be restricted. The woman should continue taking her fasting blood sugar and 2 hours after each meal. If there is not a change for the better, insulin may be needed and she may have true diabetes.
Vitamin B6, as well as supplemental chromium can be used. Chromium can be taken a few times a day or with every meal, depending on how the woman feels best.
(Frye DT 322)
What are the associated complications?
There is debate on what the risks are to mom and baby when speaking of gestational diabetes, and not true diabetes that happens during pregnancy (there is definite risk to mom and baby with this scenario, and all sources seem to agree that this is true).
Gail Hart describes GD as a “process” and not a disease, one that does not harm mothers or babies. She agrees that a true diabetic has risks and will show signs and symptoms in every way of being diabetic. The GD mom that is labeled as such just because of a lab value (who shows no other signs or symptoms) is at no extra risk. Her baby is likely to be larger than 9 lbs., and that baby has the same risks that all larger babies have (higher c-section rate, shoulder dystocia, long labor, higher risk of hypoglycemia after birth). Hart feels that the only risk to a mom with GD is being called a “gestational diabetic” because she may be placed on a restrictive diet that will cause problems like PIH, preeclampsia and preterm birth. (Hart 2005)
Varney instructs the midwife to be alert for polyhydramnios after 28 weeks in the mom with GD, and to instruct her to perform kick counts daily. The risk of GD and perinatal mortality only increase when the mom also develops PIH or preeclampsia. (Varney 355) The mother faces long-term risks, having a greater chance of GD in later pregnancies and a higher risk of diabetes mellitus in later life. (Varney 353)
Myles writes, “the strongest evidence suggests that fetal macrosomia and cesarean section rates are increased”. Also, there appears to be a link with the raised glucose levels in utero and the development of diabetes in later life. Women that have GD may develop type 2 when they are older. (Myles 345)
Despite all the controversy, the one thing we know to do to “treat” carbohydrate intolerance is to focus on diet. Protein is important, as are limited carbohydrates (and even then, only complex carbs) and the virtual elimination of refined sugar and sugars in general. If you are struggling with sugar issues, this diet should help you feel better and help control your glucose readings.
Murray, Michael, N.D. Diabetes and Hypoglycemia-How You Can Benefit from Natural Methods.
Diet Modification Plan for Carbohydrate Intolerance
Good choices (protein and low-glycemic index options):
raw agave nectar
unsweetened almond milk
sprouted grains (breads, cereal, crackers)
peppers, tomatoes, avocados
legumes (peas, beans, lentils)
Poor choices (high sugar/carb content, high glycemic-index choices):
white flour (bread, crackers)
potatoes, root vegetables (celery, squash), corn
citrus fruits, bananas, figs/dates, grapes, raisins, mangoes (any high-glycemic fruit)
refined sugar, sweets of any kind
honey, jams, jellies
Be sure to eat protein every 2 hours.
Helpful supplements include prickly pear juice, chromium piccolinate, B vitamins (particularly B6). Also helpful is cinnamon, stevia and coconut oil. Guava has been shown in studies to reduce blood sugar levels.
A tea made of string bean skins (1 cup 3X day) will provide inulin, a precursor to insulin. Cucumbers are nourishing to the pancreas, and liver (fresh or in capsules) can help with insulin. (Diagnostic Tests, 321)
Exercise!! Even walking 20 minutes a day will help your body regulate carbs better.