- Gestational Diabetes Mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy.
- Risk factors include glycosuria, age over 30 years, obesity, family history of diabetes, past history of GDM or glucose intolerance, previous adverse pregnancy outcome and belonging to a high-risk ethnic group.
- The recommended screening test for GDM is performed at 26-28 weeks’ gestation
- The diagnosis of gestational diabetes mellitus at any time during pregnancy is based on any one of the following values: (a) Fasting plasma glucose 5.1–6.9 mmol/l ; (b) 1-h post 75g oral glucose load ³0 mmol/l*; (c) 2-h post 75g oral glucose load 8.5–11.0 mmol/l .
Discussion
The placenta secretes high levels of hormones that inhibit insulin, plus enzymes that destroy insulin. Therefore it is 100% normal for pregnant bodies to have higher blood glucose levels. However in 2014 the guidelines for blood sugar levels in pregnant women changed to expect BSLs to be lower, causing up to 18% of pregnant women to be classified as gestational diabetic – many of whom would be otherwise healthy. Unfortunately the research studies these guidelines are based on which show adverse events of babies from pregnant women with higher BSLs, did not screen out women who may have been undiagnosed pre-diabetic or insulin resistant before pregnancy which does increase risk. A 2019 study showed these changed guidelines showed no reduction in adverse outcomes, however these guidelines continue…
Pressuring women to have abnormally low morning BG levels (through too much exercise, eating less food, or insulin medication), will increase the mother’s risk of developing a rising blood pressure, pre-eclampsia, and intra-uterine growth restriction (IUGR) due to low calorie intake causing low blood volume. To maintain an optimal blood volume to sustain a healthy placenta and pregnancy, women need to eat sufficient calories, protein and salt. (Check out the Brewers Pregnancy Diet for more info).
The Glucose Tolerance Test (GTT) requires the pregnant woman to fast for at least 12 hours which is a completely abnormal state for the pregnant body to be in, while expecting a normal result. This is madness. In fact, when a pregnant woman wakes up during the night (eg to urinate), she should be having a snack.
Meanwhile the GTT is highly inaccurate… In his chapter on “Diabetes Mellitus”, Dr. Daniel W. Foster said that the GTT is so unreliable, it should never be used in clinical practice, and it should ONLY be used for research purposes. Influences such as diet, age, stress, fever, infection, overwork, lack of exercise, illness, and worry can easily cause false positives. Any stress can provoke a flood of adrenaline which in turn releases glucose and blocks insulin release, resulting in unusually high recordings of glucose levels.
According to Foster in Harrison’s Principles of Internal Medicine, 75 percent of clients shown by the GTT to have “impaired glucose tolerance” (a possible tendency for diabetes) never actually develop diabetes. The implication is that positive GTT results are accurate only 25 percent of the time.
Alternatives to the GTT
HBA1C test:
- This test measures the level of blood sugar that the red blood cells have been exposed to for the past 3 months, and how the mother’s body is processing her BG levels when she is eating her normal, hopefully healthy, diet, rather than what her BG levels are like when she is being pressured into undergoing extended fasting, followed by an intense carb-loading drink. It does not require fasting, and is not influenced by adrenaline.
Self-monitoring blood glucose levels:
- Structured monitoring of blood glucose can help you see how food/ drink, physical activity and medications affect your glucose levels, detect blood glucose levels that might be out of your range, and see a pattern in your blood glucose levels.
- A blood glucose monitoring kit is available from pharmacies and includes:
~Blood glucose meter
~Lancet device with lancets, and
~Blood glucose strips.
Best times to self-test are:
~Before breakfast (fasting)
~1-2hrs after the first bite of each meal
~Before bed
~Before rigorous exercise
If you consent to the Glucose Tolerance Test:
- It is highly advised that you be on a preparatory diet containing 250-300g carbohydrate for three days before testing; otherwise a decreased carbohydrate tolerance may be observed, known as “starvation diabetes”.
- Eat a small snack with protein, plus a small portion of carbohydrates every 60 minutes during waking hours for the 3 days before the test. eg. starchy vegetables (eg potatoes), fruits, whole grain bread and pasta, rice. These carbohydrates help the liver store glycogen in preparation for the all-night fast imposed by the GTT protocol. This glycogen reserve can then stabilize the blood sugar during fasting. Without carbohydrate loading, you exhaust your liver’s storage of glycogen overnight and may test out with a diabetic curve when, in fact, you are not diabetic at all, you’re just temporarily glycogen-depleted.
- Schedule your appointment so that you are fasting the bare minimum of time necessary and not one minute more. If not scheduled in the morning, you may need to set an alarm to eat during the night (if you don’t normally wake up to pee!).
- Schedule your appointment during a time when there is likely to be less traffic on the roads, or have a friend drive you so you are not stressed with road rage.
- Leave any children that you have with a baby-sitter, friend or relative, at home.
- During the time before and between blood draws, do something very relaxing–listening to relaxing music, reading something relaxing, drawing, crocheting, cross-word puzzles, meditation, yoga, doing some abdominal breathing, or whatever relaxes you.
- In the 5 minutes before each blood draw, listen to some calming music, or a guided relaxation – there are plenty on Insight Timer app, YouTube or Spotify. Take deep abdominal breaths, and focus on helping all of the muscles in your body go completely limp.
Dietary and exercise guidelines for a healthy pregnancy:
- Eat 1.22g/kg of bodyweight of [complete] protein* p/day in early pregnancy and 1.52 g/kg in late pregnancy
a woman who started her pregnancy at 68kg would need 83 g of protein in early pregnancy and 104g of protein/day in late pregnancy. To simplify, just round it to >80 g in early pregnancy and >100 g in late pregnancy. - Eat complex carbohydrates that are low GI and high in fibre.
- Avoid sugar and refined carbs, eg. white bread, pastries, white rice, white pasta, instant oats, sweets, sodas.
- Eat low GI fruits and vegetables (non-starchy).
- Eat healthy fats like avocado, olive oil and coconut oil.
- Make sure to salt all foods to taste with sea salt or Himalayan salt which include minerals, not table salt!
- Eat small, frequent meals throughout the day.
- Eat a snack if you wake during the night.
- Do not consciously restrict weight gain.
- Exercise for min. ½ hr every day. eg. walking, swimming, yoga.
- Notice foetal movements and keep a record via a kick chart if you have any concerns.
*Protein suggestions:
- Nuts and seeds
- Legumes and pulses – Black beans, Navy beans, Kidney beans, Soybeans, Green beans, Pinto beans, Fava beans, Adzuki beans, Chickpeas, Lentils, Peas, Peanuts
- Hemp protein powder (contains the highest amount of plant based albumin which helps build blood volume!)
- Organic tofu
- Organic, free range eggs (contains albumin which helps build blood volume)
- Deep sea / cold water fish – eg. Atlantic salmon, silver warehou, mackerel, trout, cod, herring, mullet, taylor, trevalley and sardines to reduce amount of mercury. Avoid shark (flake) and billfish (swordfish, marlin) due to high mercury
- Organic meat
Supplements to help reduce blood sugars:
- Chromium 400mcg/day
- Magnesium 400mg/day
- Alpha lipoic acid 100-500mg/day
- Zinc 15-30mg/day
- Selenium 50-100mcg/day
- B6 100mg/day
Hypoglycaemic Foods & Spices:
- Ginger – decreases fasting blood glucose, significantly improves HBA1c, significantly decreases insulin values.
- Black cumin – decreases fasting blood glucose, significantly improves HBA1c.
- Cinnamon – decreases fasting blood glucose, significantly decreases insulin values.
- Fenugreek seeds – decreases fasting blood glucose, improves HBA1c.
- Apple cider vinegar – decreases fasting blood glucose, improves HBA1c.
Pregnancy-safe Hypoglycaemic Herbs:
- Gymnema* sylvestris (aka *“Sugar destroyer”) – decreases fasting blood glucose, significantly improves A1c, significantly decreases insulin values, delays glucose absorption, regenerates beta cells in the pancreas.
- Galega officinalis (Goat’s Rue) – promotes insulin secretion, inhibits the transport of glucose in the cells.
- Silybum marianum (St May’s Thistle) – improves insulin sensitivity, significantly reduces fasting blood sugar levels and HBA1c.
Get in contact if you would like a naturopathic appointment to help deal with your GDM!