What is diabetes?
Diabetes is a chronic (long-lasting) condition that occurs when the body cannot produce enough insulin or cannot use insulin. Insulin is a hormone produced in the pancreas that is needed to move glucose (sugar) from the blood into the body’s cells, where it is used for energy. When insulin is missing or not working properly, glucose remains in the blood. That’s why diabetes is diagnosed by observing high levels of glucose in the blood.
Over time, the high levels of glucose in the blood (known as hyperglycemia) can cause damage to many tissues in the body, leading to the development of disabling and life-threatening health complications.
Type 1 diabetes
In Type 1 diabetes, the body’s immune system attacks the insulin-producing cells in the pancreas. As a result, the body can no longer produce the insulin it needs. Why this occurs is not fully known or understood. The disease can affect people of any age, but it usually occurs in children or young adults. People with this form of diabetes need insulin every day in order to control the levels of glucose in their blood. Without insulin, a person with type 1 diabetes will not survive. But with daily insulin treatment, regular blood glucose monitoring, healthy eating and maintaining healthy lifestyles, people with type 1 diabetes can lead normal, healthy lives.*
Type 2 diabetes
Type 2 diabetes is the most common type of diabetes. It usually occurs in adults, but is being seen more in children and adolescents. In type 2 diabetes, the body is able to produce insulin but becomes resistant to the insulin so that the insulin no longer works properly. Over time, insulin levels may become too low to be effective. Both the insulin resistance and low insulin levels lead to high blood glucose levels.*
Unlike people with type 1 diabetes, many people with type 2 diabetes may not require daily insulin treatment to survive. The essential treatment for type 2 diabetes includes adopting a healthy eating plan, increasing physical activity, managing body weight and taking diabetes medicines if needed. A number of pills or tablets as well as injectable therapies including insulin when needed, are available to help control blood glucose levels for people with type 2 diabetes.
Sometimes, blood sugar levels are higher than normal but not high enough to be considered diabetes. This is called prediabetes and it puts you at a greater risk for developing type 2 diabetes and heart disease.
If you have been told you are at risk for diabetes or have prediabetes, know that you can take action to help prevent or delay type 2 diabetes. Making some lifestyle changes now, can help you avoid or delay the onset of type 2 diabetes and other health complications such as heart disease, down the road. It’s never too late to start.
If your doctor has said you have prediabetes, make sure to get tested every year or two to check for diabetes. And follow the recommended guidelines to help prevent type 2 diabetes: lose weight if you need to, exercise, and eat healthy.
Gestational diabetes is a type of diabetes or high blood glucose that is first detected during pregnancy. If you have been told you have gestational diabetes, you are not alone. The International Diabetes Federation (IDF) estimated in 2015 that 1 in 7 births worldwide is affected by gestational diabetes*. This makes it one of the most common health problems during pregnancy.
You may be nervous, scared, or even angry about your diagnosis. These feelings are normal. But the fact is women of all backgrounds and with all types of food/exercise habits can develop gestational diabetes. Remember, your diagnosis is not your fault. Following your doctor's care plan will help keep you and your baby safe.
The other good news is that most women with gestational diabetes don't continue to have diabetes after their baby is born. Gestational diabetes tends to go away after the delivery of the baby. However, once you've had gestational diabetes, you do have a higher risk of getting it again during a future pregnancy: studies have shown that about 1 out of 3 women that have gestational diabetes get it again in future pregnancies†; you are also at risk for developing type 2 diabetes later in life.
What causes gestational diabetes?
Doctors don't know exactly what causes gestational diabetes, but they have some clues.
Your placenta supports and feeds your baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of your insulin, making the insulin less effective.† Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy, resulting in high levels of glucose in the blood if not controlled.
Some women are at higher risk for developing gestational diabetes:
- If overweight before pregnancy
- If older than 25 years
- If they have had gestational diabetes in a prior pregnancy
- If diabetes runs in their family
- If they are of African-American, Asian, Hispanic or Native American descent
How is gestational diabetes diagnosed?
Most women receiving good prenatal care are routinely tested for gestational diabetes between weeks 24-28 of their pregnancies. If you are at high risk for developing gestational diabetes, your doctor may check earlier and/or more than once during your pregnancy.
The test for gestational diabetes involves drinking a sweet drink provided by your doctor and having a blood test taken an hour later to see how your body handled the sugar. If the result shows that your blood glucose is elevated, you will be asked to have a second test done. This involves drinking more sweet drink after an overnight fast and repeating a series of additional blood tests. If your blood glucose remains elevated and confirms a diagnosis of gestational diabetes, your doctor will talk to you about a treatment plan for gestational diabetes.
Why is it important to treat gestational diabetes?
As a mom, your instinct is to protect your child. It’s important to treat gestational diabetes as soon as it is diagnosed for your health and your baby’s health. If gestational diabetes is untreated, these problems can occur:
- An increased chance of delivering a large baby weighing more than 9 pounds (4 kg), a condition known as macrosomia. This increases the chance
- of difficulty and injury during vaginal birth, and
- of a cesarean section. (C-section)
- A high risk for pre-term birth and breathing problems (respiratory distress) for your baby
- A high risk for low blood sugar (hypoglycemia) in your baby soon after delivery
- A higher chance of preeclampsia for you (high blood pressure and liver or kidney problems)
Following your doctor’s care plan and managing your gestational diabetes carefully, can help to greatly reduce the risk of these complications.
How do you treat gestational diabetes?
If you are diagnosed with gestational diabetes, you may be surprised that the steps to control it are usually not complicated.
- The first thing your doctor will recommend is a healthy, carbohydrate-controlled diet and exercise. In many cases, these steps will be enough to manage your blood glucose levels for the rest of your pregnancy.
You may need to work with a registered dietitian to create a healthy eating plan for you. The dietitian can teach you how to control the amount and types of carbohydrates you eat as a way to help control your blood sugar while still meeting the needs of your growing baby. You may also be asked to keep a food journal and track your weight.
- You may need to check your blood glucose daily at home, using a blood glucose meter. This may sound a little scary, but there is help with modern, easy-to-use glucose meters for home use. Your health care team can recommend one and show you how to use it. Testing your blood glucose will help you and your doctor manage your gestational diabetes.
- It is common to have to check your blood glucose four or more times a day, usually fasting and then 1 to 2 hours after meals. Your doctor or health care professional will tell you how often to test and your goal range. Don’t forget to keep a record of your blood glucose tests, including when you test, what your result is, and whether it was before or after eating, and how long after eating.
- Whether or not you have gestational diabetes, exercise during pregnancy will help your body use its own insulin better and control your blood glucose level. Shoot for 30 minutes a day, 5 days a week. Many pregnant women enjoy brisk walking or swimming, but if you have another activity or exercise routine you prefer, ask your doctor to be sure you can continue with it.
At your obstetrician visits, your blood pressure and urine may be checked. You will also discuss your blood sugar levels with your doctor, as well as what you have been eating, how much you have been exercising, and how much weight you have gained. Your growing baby will also be monitored closely. All of this will help determine if the treatment plan is working and when changes may be needed.
If changing the way you eat and exercise does not keep your blood glucose levels in check, your doctor may recommend diabetes medicines, including insulin shots, for the rest of your pregnancy.
Taking medications (tablets/pills, insulin)‡
If your doctor prescribes pills or insulin, keep in mind that it’s not a sign that you’ve failed to manage your gestational diabetes. The fact is your body may simply not be able to make enough insulin on its own to handle what your body needs as the baby grows. It’s important to follow your doctor’s recommendations to protect both you and your baby. Once you’ve given birth, chances are you can stop taking the diabetes medicine.
If your doctor says you need insulin, it means taking it by injection or other device like an insulin pump. A family member can learn how to do this with you and help you take your insulin as prescribed. The good news is that today, the small, thin needles made for taking insulin help make the injections virtually painless.
*IDF Diabetes Atlas (7th Ed.) (2015). Brussels, Belgium: International Diabetes Federation.
† A1c/eAG – ADA Diabetes Advisor series www.diabetes.org – accessed May 30, 2017.
‡ Portion Guide – Canadian Diabetes Association: www.diabetes.ca. Accessed May 30, 2017.