Gestational Diabetes – How to bring fasting levels down?

posted 4 years ago in Pregnancy
Post # 3
Member
1081 posts
Bumble bee
  • Wedding: June 2012

@BeccaBee83:  Honestly, I wouldn’t worry *that* much about it, because getting your sugars too low is way more of a problem than them being a little too high.  If you were to add more insulin, you run the risk of getting hypoglycemic in the middle of the night, which is not good.  Definitely stick to what your doctors recommended.  One thing you could try is a little more exercise, as exercise will help to re-model the cells that have become insulin resistant (but once again, don’t over-do it because you don’t want to get hypoglycemic). 

Here’s a little article for you: http://www.diabetesincontrol.com/articles/64-feature-writer-article/14343-exercise-benefits-for-gestational-diabetes

I would talk to your doctors about maybe starting an exercise regimen and see what they recommend.  Even activities as simple walking can be beneficial.

Another thing you might want to ask your doctors about (if you haven’t already) is a referral to a dietician, who can help you come up with the best foods and amounts to eat to keep your blood sugar in the best ranges. Good luck! 🙂

Post # 4
Member
46 posts
Newbee
  • Wedding: February 2008

If your post-meal numbers are in range, that’s a good start!

Fastings are the hardest to control because you can’t control it with exercise and you’re really fighting the release of hormones overnight – it’s nearly impossible to win. I was misdiagnosed with GD very early in my pregnancy because I took the glucose test when I was really sick (but passed the 3-hour when I retook it at 25 weeks), so I have about 15 weeks of experience with it! So here are a few things that might help (or might not … GD varies by individual!)

– Don’t go too long without food. Usually a good window from the last time you ate to the time you test your fasting is 8-9 hours (probably not more than 10 hours, you’re pregnant!). Some do well with a bit more or less, so this is just a general guideline. I wish I had known this before! I’d either “fast” for too long or not enough time and my numbers used to be just around 91 or 92, but got within range once I figured this out.

– Have a decent night snack of about 2 carb servings with 1 protein serving. The protein keeps you stable overnight, and the carbs give your body the energy it needs while you sleep. If you don’t eat enough, your body thinks it’s starving and your pancreas releases glucose to compensate. Some people do well with sugary and fatty carbs (like ice cream), but what worked for me was eating more fiber at night, so I eat a string cheese, FiberOne brownie, fiber gummies, and a tablespoon of chia seeds soaked in water. A TON of fiber!

Again, it really varies by person so you’ll have to figure out what works for you. When you change something, only change one thing at a time, e.g. change your fasting times in increments of 15 minutes, or change something about your snack, so you can figure out what’s working. If something works, keep the same thing for a couple of days.

Yes, it’s really frustrating, and sometimes, no matter what we do, nothing will work except for medication. I was also put on insulin for fasting numbers just slightly over 90 (and it’s ridiculous to think about it now since I was misdiagnosed), and it definitely affected my daytime numbers … I’d gotten 60s after meals! So if your medical team ever brings up insulin for your fasting, it’s really just all you can do. Try not to stress about it and you and baby will be fine! Good luck!

Post # 5
Member
1081 posts
Bumble bee
  • Wedding: June 2012

@mizjl:  Gestational diabetes is an insulin-resistant problem, not a glucose problem per-se.  The only reason insulin is given to help control blood glucose levels is because your pancreas thinks it is producing enough for what you eat, but your tissues have lost their sensitivity to it, so you need even MORE insulin to get the glucose moved from the blood into the tissues.  The pancreas does NOT secrete glucose, it secretes glucagon when it senses low blood sugar, which tells the liver to produce glucose and release it.  This usually functions just fine in people with GD and Type 2 diabetes because their pancreases are intact (unlike in Type 1 diabetes where the pancreas is shot, so it doesn’t produce insulin or glucagon).  You are right that this will occur if you get too low, but the problem lies in the fact that when the liver puts out this glucose, the tissues still aren’t very good at absorbing it so the blood sugar level can return to normal, so it ends up overcompensating and you get the higher “fasting” blood sugar.  Whereas if the muscle cells did their job at absorbing glucose properly, the fasting number would decrease, which is why it IS a good idea to exercise and it can be highly beneficial and help tremendously with the fasting glucose.  

Insulin is actually NOT the best choice for controlling blood sugars, but unfortunately it is the only choice for pregnant women since all of the oral medications that are usually used to treat this type of diaetes will also affect the baby.  Gestational diabetes is very similar to Type 2 diabetes, where your pancreas and insulin secretion are fine, but it is your tissues that don’t respond as well to the insulin you naturally produce, so if you give a little extra it helps move a little more of that glucose into the tissues and out of the blood.  

The reason exercise might work for you is because repetitive muscle contractions increase the amount of glucose transporter receptors on surface of skeletal muscle cells (insulin is also supposed to signal the glucose transporters to go to the surface, but in GD and Type 2 diabetes, this mechanism doesn’t work as well).  The exercise-induced movement of these glucose transporters uses a completely different mechanism than the insulin pathway, so it should still be functioning just fine in your cells.  The pathway that stimulates the cells to put out more glucose receptors is the exact same pathway that is targeted by the drug Metformin, which is usually prescribed to people with Type 2 Diabetes first since it works so well! But since you’re pregnant, you can’t take Metformin, so exercising is, in a sense, the same thing as taking Metformin.  

So you can change around your food as much as you like, but exercising would probably be the single most effective thing you can do to get your glucose numbers in check.  

(Sorry if that was all hard to understand. I’m a medical student that has studied this over and over again. I would ask your doctors if you have questions but you can always PM me as well and I can try and help you out).  

Post # 6
Member
5014 posts
Bee Keeper
  • Wedding: September 2013

Another suggestion for exercise. My FI is a type 1 diabetic and exercise makes a huge difference in his A1C and BG numbers. Good luck!

Post # 7
Member
46 posts
Newbee
  • Wedding: February 2008

@cowgirlace:  Oh, definitely, exercise helps control blood sugar levels in general. I was told by my diabetes nurse to actually walk after meals to help keep my numbers down before. Sorry, I’m not a medical professional so terms I was using are way off, so I was just going off what I remember from my Maternal Fetal Medicine doctor and endocrinologist. The endo was the one who told me that exercising after my night snack would burn off the energy I need throughout the night, which is why he suggested to eat as close to bedtime as possible. Based on my research, exercise, especially resistance training, helps increase insulin sensitivity, which is why I was told to do at least 30 minutes of activity each day – it keeps BS levels stable, along with eating regularly at about every 2-4 hours with protein/carb balance, so our numbers don’t spike and crash constantly.

 

Fastings are a different animal and not as easy to manage as daytime numbers. If/when we eat during the day, we can exercise to keep numbers down, but overnight while we sleep, we rely on our bodies to stay stable and not crash, but process the carbs enough that it gets lower, with minimal movement for the most part. That’s why for some people, night snack matters, but for others, nothing helps and we need meds as a last resort. From what I was told, low blood sugar is bad for the mom, but high blood sugar is also not ideal for baby because it’s the high BS that causes all the GD risks – macrosomia, jaundice, low blood sugar at birth, and in RARE cases of uncontrolled BS, *trigger* stillbirth. Again, I’m just going off what I was told when I was first diagnosed.

 

@BeccaBee83: Part of the frustration of GD moms with whom I’ve come in contact is that we’re held at much more stringent standards than Type 1 and Type 2 diabetics. My strict MFM wanted my fastings under 90 (I was even told that 60-90 was “ideal” … 60 is LOW!) and postprandials to be 120 after ONE hour, and this is not uncommon. Some are allowed to go up to 95 or even 100 for fastings, then 140 after an hour (or 120 after two hours). Even so, these numbers are lower than non-pregnant people, who can be up to 110 for fastings and 140 two hours after a meal.

 

I struggled with the fact that I was put on insulin for getting 91 and 92, when I knew that other moms were allowed to even go up to 95! So yes, your fastings are a little high – again, for “normal” pregnant women, whatever that is – but they’re not TOO high that it’s crazy dangerous. I do have a friend who also had GD and her fastings would be a bit over 100 toward the end of her pregnancy and she was also put on insulin for about a month before she gave birth, and her baby girl was born perfect, no blood sugar issues (or any health issues for that matter), and nursed like a champ. This same friend told me that her OB informed her that not too long ago, 10-15 years, I think, as long as pregnant women were under 120 for fasting, they were okay, but the standards have become more restrictive and yep, so difficult for us. But we do the best we can, right?!

 

I hope you at least feel better that you’re not alone! Since technically “passing” the 3-hour, I’m no longer GD, but my OB still asked me to check fastings twice a week, and every time I have to prick myself with the lancet, I feel a little rush of panic. Pregnancy is hard enough on its own, and add GD into the mix, it makes it that much more frustrating because it’s different for everyone and it’s emotionally and mentally exhausting. It’s like a game with have to win, and we hope it ends when the baby is born. We’re at a higher risk for Type 2 somewhere down the line, so I feel like I’m doomed to fail! Anyway, this got long and I apologize, but again, there’s a lot of us out there so try a few things that people suggest and I hope something works for you!

ETA: I was put on insulin right away as well because my medical team didn’t do oral meds like Metformin and Glyburide, both of which increase your body’s sensitivity to insulin. I’ve read of women who do both oral meds and insulin to boost their effectiveness, but it’s pretty controversial because there are studies that oral meds cross the placenta in very small amounts. So again, you’re not alone about the insulin, and it’s great that your doctor is even concerned about adding more insulin that can affect your daytime numbers since it backfired on me!

Post # 9
Member
818 posts
Busy bee
  • Wedding: July 2013

I’m 33wks on saturday and they want my numbers to be:

<95 – fasting

<120 – 2 hrs after meals

I test 5 times a day- fasting, 2hrs after breakfast,lunch,dinner and then at bedtime. I am supposed to have 16 carb choices a day so about 240 carbs a day. And I am supposed to snack about every 2-3 hrs after a meal including after dinner, which I normally eat right before bed because we eat dinner pretty late most of the time. I have only had my fasting numbers below 95 maybe once? I struggle with that too. I do take insulin each night but it seems to affect my daytime numbers more than the fasting. I go next Wed to speak with the endo so we shall see what she wants to change as I worry my day time numbers will get too low and my fasting is still higher than she wants. And I agree it is very frustrating, especially remembering to bring food everywhere as most food you don’t know what has what in it and you wanna keep your numbers in a good range, plus remembering to test, and blah blah blah very stressful I think. Good luck, I hope you get it figured out soon.

Post # 11
Member
216 posts
Helper bee
  • Wedding: May 2013

A good light exerciee is low impact yoga, it was suggested to my mother when she was first dignoised with diabetes before they determined she was actuallu type 1, they also suggested deep breathing and meditation to help relieve stress on the body. So maybe that’s worth a try, my mom said it helped her alot if nothing more than to help her be calm going through a big transistion period.

Post # 12
Member
818 posts
Busy bee
  • Wedding: July 2013

@BeccaBee83:  I am taking Humulin N insulin pen. I had a dietician that went over how many carbs and calories, foods I should be eating, not eating etc… You shopuld get set up with one too if you haven’t already. A carb choice in diabetic speak is a food that has 15 grams of carbohydrates. So I can have 16 food items with about 15 grams of carbs per day. I really would get set up with a dietician because they will be able to help you sooo much with meal planning.

Post # 14
Member
1760 posts
Buzzing bee
  • Wedding: June 2013

@BeccaBee83:  I’m 36w and have GD… so hopefully less than 4 weeks until I’m done with this ‘fun’ GD experience. There really isn’t much you can do about resting blood sugar levels except control when you eat/drink before bed. Or have the dr adjust your insulin. We’ve adjusted my insulin levels 3 times in the last 2 1/2 months. And I will probably be adjusted again on 6/4 when I see them again. I have 2 fast acting shots a day, and 1 long lasting shot overnight. My obgyn explained it best, you can eat the same thing for dinner and lunch and your body responds better to one and not the other because of our changing hormones, and not to stress out. However my amniotic fluid levels rose last week so now we have to watch it even closer. Good luck!

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