Gestational diabetes

Personal solutions for everyday life.
Gestational
diabetes

Gestational diabetes
Approximately 3% of women develop diabetes during their pregnancy. This is called
Gestational diabetes. Gestational diabetes is a form of diabetes that usually starts
in the second or third trimester (that is, after the first 12 weeks). It happens when
the body can’t control its own blood glucose level (this can also be referred to as the
blood sugar level). This is thought to be a result of the hormones produced during
pregnancy blocking the action of insulin in the body. Insulin is responsible for
controlling blood glucose levels. In women who develop gestational diabetes, there
is not enough extra insulin produced to counteract this blocking effect.
Keeping blood glucose down
It’s important to control the level of glucose in your blood during pregnancy. If
there’s too much glucose in your blood, your baby’s body may start to make insulin
to try to cope with it. This extra insulin can make the baby grow larger, making
delivery more difficult, and potentially cause injury to both mother and baby.
Also, a baby who is making extra insulin may have low blood glucose when he or
she is born, which can affect him or her in the first few hours of life.
Your specialist diabetes team will help you control your blood glucose. In general,
you’ll be given advice and support to monitor your blood glucose, eat healthily, and
exercise. If your blood glucose levels are still too high, you may need to start insulin.
Your specialist diabetes team
A diabetes team is a group of healthcare professionals with specialist knowledge and
experience of supporting people with diabetes. For example, teams may include family
doctors, hospital specialists, specialist diabetes nurses, and dieticians.
If you are pregnant and have diabetes, the diabetes team is extended to include
healthcare professionals with particular knowledge of how diabetes can affect a
pregnancy, such as a specialist diabetes midwife and obstetrician. In this leaflet, this
extended diabetes team is called a specialist diabetes team.

Checking your blood glucose
People with diabetes learn to check their own blood glucose levels. You’ll be given
the equipment you need to do this and taught how and when it should be done.
You’ll also be told the target blood glucose you’re aiming for, and how this is
affected by food and exercise. Sometimes women with gestational diabetes have
blood samples sent to a lab for glucose tests.
Your specialist diabetes team will explain what your blood glucose should be. Keep a
note of it below.
Your blood glucose levels
Your fasting blood glucose
should be:
1-2 hours after food, your
blood glucose should be:
You should also be offered regular urine tests to check for protein, and blood
pressure checks during your pregnancy. You may also be offered a late scan to check
the size of your baby (this depends on the arrangements for scans in your area).
Eating healthily
You should be given advice about eating healthily by a dietician or specialist
diabetes nurse. In general, try to eat fruit, vegetables and low-fat dairy products. Cut
out sugary, high-fat foods such as cakes and biscuits.

Folic acid
Keep taking your folic acid every day during the first 12 weeks of your pregnancy.
Medication
If you follow the advice of your specialist diabetes team but your blood glucose
levels are still too high, you may need to start insulin. Your specialist diabetes team
will explain how to take the insulin and what its effects will be.
In particular, when you’re starting on insulin you should be given advice about
hypoglycaemia (having ‘a hypo’ see the box opposite). This is when your blood
glucose drops to a low level (usually under 4 mmol/l).
If you drive, you need to inform the DVLA
that you have gestational diabetes and are
taking medication. You will be able to
continue driving unless you have ‘disabling
hypoglycaemia’ - your specialist diabetes
team can advise you on this. If your
treatment carries on for longer than
3 months, you need to contact the
DVLA again to let them know.

Coping with hypos if you’re taking insulin
Hypoglycaemia (‘a hypo’) is when your blood glucose drops to a low level
(usually under 4 mmol/l)
• Check your blood glucose regularly
- always check it before doing something where you may put yourself or others
at risk if you become drowsy or faint (e.g. driving)
- always check it before doing a long session of exercise
• Carry something that will give you a quick burst of glucose if you feel a hypo
starting, such as:
- half a glass of sugary drink, or
- three glucose tablets (which are available from the pharmacy), or
- a glucose gel that can be placed in your mouth, inside your cheek
• Afterwards, eat a carbohydrate snack (such as a sandwich)
• Let your specialist diabetes team know if you start having hypos
• If you start having frequent hypos, you must stop driving. You must not start
again until your family doctor or specialist confirms that you are OK to start
driving again
Exercise
Regular exercise can help keep your blood glucose stable. And, of
course, it’s also good for you in general. Your specialist diabetes
team can give you advice on what’s best for you.

During labour
During labour, your blood glucose levels will be monitored closely by your specialist
diabetes team. You may need to have an insulin infusion during labour (this is
where a continuous amount of insulin is fed into your blood through a tube).
Women with diabetes sometimes have larger than average babies, and you may
need to be induced (so labour is started earlier than normal) or have a Caesarean
delivery. This will be discussed with you in the final weeks of your pregnancy.
After the birth
Your baby will have a heel prick test to check his or her blood glucose level. Your
team will want to monitor the baby’s blood glucose levels closely for the first 24
hours, and this may mean that he or she is taken to the special care baby unit. Your
baby isn’t being tested for diabetes during this time, but is being monitored to see if
extra feeds are needed to stabilise the blood glucose levels.
You probably won’t have diabetes after you’ve given birth, but you may be asked to
monitor your blood glucose. And if you’ve been taking insulin, you should be able to
stop after the birth.
You should be offered a repeat blood test some time in
the 6 weeks after the birth to check that your blood
glucose levels have gone back to normal.
The timing of this test will depend on the
arrangements in your area.
Breast-feeding
Breast-feeding is generally thought to be best for babies,
and there’s no reason why you shouldn’t breast-feed
your baby if you’ve had gestational diabetes.

In the future
If you’ve had gestational diabetes, it’s more likely that
you’ll develop it again in future pregnancies. You also have
a higher chance of developing type 2 diabetes if you’ve
had gestational diabetes. To help guard against this, eat
healthily and include some physical activity in your day.
Aim to do 30 minutes of exercise that leaves you slightly
out of breath at least five times a week. You should have a
follow up appointment with your doctor for tests to rule
out diabetes after your baby is born.

Other information
Other leaflets in this series include
specific explanations of some of the
terms used here. Leaflets on blood
testing, hypos, travel, impact on sexual
health, driving and employment, illness,
and complications may be particularly
helpful for you. Ask your diabetes team
for the ones you want.
Further information is available from
Customer Care
Contact numbers and notes
Lilly UK Answers
Lilly House
Priestley Road
Basingstoke
Hampshire RG24 9NL
Tel: (01256) 315000
www.lillydiabetes.co.uk/patients
Provided as a service for patient care
UKDBT01179 June 2012