Defeating Gestational Diabetes Mellitus

Name: Sunila Kelkar Age: 40 yearsOccupation: Assistant Editor, Diabetes Health magazineDiagnosis shockI was diagnosed with gestational Diabetes mellitus (GDM) in my 6th month of pregnancy. I was advised by my obstetrician to undergo the oral glucose tolerance test (OGTI). This test involved giving a fasting blood sample and then ingesting an oral glucose solution. I gave another blood sample two hours later. My fasting blood sample was within range but the two-hour blood sample was 150 mgldL. I repeated the test the next day which confirmed the same result and I was diagnosed with gestational Diabetes mellitus.I have been immersed in the world of Diabetes management for the past seven years but the diagnosis was a shock to the system. I knew all of the facts and figures regarding gestational Diabetes mellitus yet I needed to take a moment to accept my diagnosis and seek help..Seek professional helpMy obstetrician had indicated that I would need insulin. One of the advantages of being a part of the healthcare system was that I was not confused as to where to go to seek help. I consulted an endocrinologistwhose calm and steady approach reassured both my husband and me that we could overcome this slight bump in the road to parenthood.My endocrinologist put me in touch with a Diabetes educator and set up a Whatsapp group to monitor my blood sugar levels in real-time. I was instructed to check my sugar levels six times a day - before and after breakfast, lunch and dinner using a blood glucose monitor at home and send the numbers through Whatsapp. I have been prescribed insulin Detemir. Even though I had the theoretical know-how about self-monitoring blood sugar levels and injecting insulin, I had no practical experience. The Diabetes Educator at Chellaram Hospital - Diabetes Care and Multispeciality, Ms Nikita Sarkar, proved invaluable here. She educated me with a demonstration regarding monitoring my sugar levels and injecting insulin. My first dose of insulin was set at 8 units at bedtime. I would send my six blood sugar readings and my insulin dosage would be titrated daily. In the last week of pregnancy, my insulin dosage was down to 2 units.I also consulted a registered dietician who provided me with a customised diet to ensure my blood sugar levels did not spike. This diet took into consideration my likes and dietary requirements and ensured that I enjoyed my meals while receiving the required nutrition and avoiding blood sugar spikes.Seek personal helpI discussed my diagnosis with my parents and in-laws to help them understand that I would not be eating for two. Having this open and honest discussion helped my mother and mother in law accept my nutritional needs. My husband was extremely supportive and took overensuring that every meal was adequate and nourishing. Discussing my diagnosis openly and honestly helped me cope mentally with it. There was no pressure to eat more or eat certain foods as is normally seen in Indian households. This helped me stay positive and joyful in the latter part of mypregnancy.Modifying my routineDuring my pregnancy, I was advised not to exercise so the onus of managing my blood sugar levels fell on my diet. My Diabetes meal plan followed simple guidelines like:• Watching my portion size• Eating a variety of foods, including fresh . fruits, vegetables and whole grains• Limiting fat intake and reducing 30 per cent calorie intake dailyKeeping in constant touch with my healthcare team helped me stay motivated and ensured I received optimal care.Post deliveryAfter delivery, I had normal blood sugar levels and did not require further treatment with insulin. My blood sugar levels were checked the day after delivery to ensure that the readings are normal or near normal. I was informed that although GDM was resolved after delivery, it may recur in subsequent pregnancies and increase the risk of Type 2 Diabetes by 30 per cent later in life. I was advised to continue regular follow up to rule out the development of Diabetes in future.My adviceIf you are in the high-risk category, simple steps can help reduce your risk of getting GDM:• Talk to your doctor to help you prepare yourself physically, mentally and emotionally.• Have your blood sugar tested early even before you get pregnant to see if it is in the normal range.• A healthy food plan will supply you and your baby with sufficient nutrition while keeping blood sugar levels within target.• Discuss with your doctor what healthy weight gain is for you during your pregnancy.• Talk to your health care provider about designing a safe exercise routine.It is important to pursue a healthy lifestyle by maintaining optimal body mass index by consuming a healthy diet and exercising regularly. This will prevent the risk of GDM in a future pregnancy and of youdeveloping Type 2 Diabetes in the later stage of life.Proper prenatal care and careful blood sugar monitoring are essential to reduce the risk of GDM. Set up a healthcare team comprising an obstetrician, endocrinologist /diabetologist, dietician and Diabetes educator. These experts will prove invaluable to help you and your spouse navigate through a healthy and happy pregnancy.

Defeating Gestational Diabetes Mellitus

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