How to Control Blood Sugar Level in Pregnancy
Whether you have diabetes before you become pregnant or you develop gestational diabetes, it is important to control your blood sugar levels during pregnancy. Working closely with your medical team, you should use proper diet and moderate exercise to help keep your blood sugar levels in check. If diet and exercise can’t bring your blood glucose levels under control on their own, your doctor may prescribe medication such as metformin or insulin injections.
Method One of Three:
Eating a Nutritionally Balanced Diet Edit
If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels.
You’ll also need to be more closely monitored during pregnancy and labour to check if treatment is working and to check for any problems.
Checking your blood sugar level
You’ll be given a testing kit that you can use to check your blood sugar level.
This involves using a finger-pricking device and putting a drop of blood on a testing strip.
You’ll be advised:
- how to test your blood sugar level correctly
- when and how often to test your blood sugar – most women with gestational diabetes are advised to test before breakfast and one hour after each meal
- what level you should be aiming for – this will be a measurement given in millimoles of glucose per litre of blood (mmol/l)
Making changes to your diet can help control your blood sugar level.
You should be offered a referral to a dietitian, who can give you advice about your diet, and you may be given a leaflet to help you plan your meals.
You may be advised to:
- eat regularly – usually three meals a day – and avoid skipping meals
- eat starchy and low glycaemic index (GI) foods that release sugar slowly – such as wholewheat pasta, brown rice, granary bread, all-bran cereals, pulses, beans, lentils, muesli and porridge
- eat plenty of fruit and vegetables – aim for at least five portions a day
- avoid sugary foods – you don’t need a completely sugar-free diet, but try to swap snacks such as cakes and biscuits for healthier alternatives such as fruit, nuts and seeds
- avoid sugary drinks – sugar-free or diet drinks are better than sugary versions; be aware that fruit juices and smoothies contain sugar, too, and so do some “no added sugar” drinks, so ensure you check the label or ask your health care team
- include lean – not fatty – sources of protein in your diet, such as fish
It’s also important to be aware of foods all pregnant women should avoid, such as certain types of fish and cheese.
Physical activity lowers your blood glucose level, so regular exercise can be an effective way to manage gestational diabetes.
You’ll be advised about safe ways to exercise during pregnancy. Read about exercise in pregnancy for more information.
A common recommendation is to aim for at least 150 minutes (2 hours and 30 minutes) of moderate intensity activity a week.
This is any activity that raises your heart rate and makes you breathe faster, such as brisk walking or swimming.
You may be offered medication if your blood sugar level is not under control a week or two after changing your diet and exercising regularly, or if your blood sugar is very high. This may be tablets – usually metformin – or insulin injections.
Your blood sugar level can increase as your pregnancy progresses, so even if your blood glucose levels are well controlled at first, you may need to take medication later in pregnancy.
These medications will be stopped after you give birth.
Metformin is taken as a tablet up to three times a day, usually with or after meals.
Side effects of metformin can include:
Occasionally a different tablet called glibenclamide may be used.
Insulin may be recommended if:
- you can’t take metformin or it causes side effects
- your blood sugar level isn’t controlled with metformin
- you have very high blood sugar
- your baby is very large or you have too much fluid in your womb (polyhydramnios)
Insulin is taken as an injection, which you’ll be shown how to do yourself. Depending on the type of insulin you’re prescribed, you may need to inject yourself before meals, at bedtime, or on waking.
You will be told how much insulin to take. Blood sugar levels usually increase as pregnancy progresses, so your insulin dose may need to be increased over time.
Insulin can cause your blood sugar to fall too low (hypoglycaemia). Symptoms of low blood sugar include feeling shaky, sweaty, hungry, turning pale, or finding it difficult to concentrate.
If this happens, you should test your blood sugar – treat it straight away if it’s low. Find out how to treat low blood sugar.
You’ll be given information about hypoglycaemia if you’re started on insulin.
Monitoring your pregnancy
Gestational diabetes can increase the risk of your baby developing problems, such as growing larger than usual.
Because of this, you’ll be offered extra antenatal appointments so your baby can be closely monitored.
Appointments you should be offered include:
- an ultrasound scan at around weeks 18-20 of your pregnancy – to check your baby for abnormalities
- ultrasound scans at weeks 28, 32 and 36 – to monitor your baby’s growth and the amount of amniotic fluid, and regular checks from week 38
The ideal time to give birth if you have gestational diabetes is usually around weeks 38 to 40.
If your blood sugar is within normal levels and there are no concerns about your or your baby’s health, you may be able to wait for labour to start naturally.
But you’ll usually be offered induction of labour or a caesarean section if you haven’t given birth by 40 weeks and 6 days.
Earlier delivery may be recommended if there are concerns about your or your baby’s health, or if your blood sugar levels haven’t been well controlled.
You should give birth at a hospital where health care professionals are available to provide appropriate care for your baby 24 hours a day.
When you go into hospital to give birth, bring your blood sugar testing kit and any medications you’re taking with you.
Usually you should keep testing your blood sugar and taking your medications until you’re in established labour or you’re told to stop eating before a caesarean section.
During labour and the birth, your blood glucose will be monitored and kept under control. Some women may need a drip of insulin to control their blood sugar levels.
You can usually see, hold and feed your baby soon after you’ve given birth. It’s important to feed your baby as soon as possible after birth (within 30 minutes) and then at frequent intervals (every 2-3 hours) until your baby’s blood sugars are stable.
Your baby’s blood sugar level will be tested starting two to four hours after birth. If it’s low, your baby may need to be temporarily fed through a tube or a drip.
If your baby is unwell or needs close monitoring, they may be looked after in a specialist neonatal unit.
Any medication you were on to control your blood sugar will usually be stopped when you give birth. You’ll usually be advised to keep checking your blood sugar for one or two days after you give birth.
If you’re both well, you and your baby will normally be able to go home after 24 hours.
You should have a blood test to check for diabetes 6 to 13 weeks after giving birth. This is because a small number of women with gestational diabetes continue to have raised blood sugar after pregnancy.
If the result is normal, you’ll usually be advised to have an annual test for diabetes. This is because you’re at an increased risk of developing type 2 diabetes – a lifelong type of diabetes – if you’ve had gestational diabetes.
Down’s pregnancy blood test on trial
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A simple blood test during pregnancy which can detect Down’s syndrome in the developing foetus is to be trialled by the NHS.
It could significantly reduce the number of women needing invasive testing, which can cause miscarriage.
The study at Great Ormond Street Hospital will assess how and when the blood test could be introduced across the NHS.
In the UK, 750 babies are born with Down’s syndrome each year.
All pregnant women in the UK are offered screening for Down’s syndrome.
Currently a woman’s risk is assessed, based on her age, an ultrasound scan and markers in the blood. Those deemed at high risk of a child with Down’s are offered an invasive test.
It involves using a needle to take a sample of either placental cells or of the fluid that bathes the baby – but this procedure carries a one-in-100 chance of miscarriage.
The aim is to reduce the number of women having the invasive testing by more accurately assessing the risk.
The new blood test, which is already available privately, looks for tiny fragments of DNA from the placenta and the foetus floating in the mother’s bloodstream.
Down’s syndrome is caused by an extra copy of a massive stretch of DNA – a part or even all of chromosome 21. The test can analyse the free floating DNA for extra copies.
It is thought to be 99% accurate. Those with a positive result will still be offered the invasive procedure to confirm the result.
Prof Lyn Chitty, from Great Ormond Street who is leading the trial, told the BBC: “It could very significantly reduce the number of invasive tests and increase detection, this is seriously exciting stuff and it would be great to get it into the NHS.
“What we are trying to do is give information on how and when to introduce it into the NHS.”
The NHS National Institute for Health Research funded trial will analyse the scale of the benefit and the best way to inform mothers and train staff, including midwives, about the test.
“One of the very important aspects of our study is looking at ways to ensure women understand the test and the implications of the results so that they can choose whether or not to have it,” she said.
‘Earlier and safer’
Dr Anne Mackie, from the UK National Screening Committee, said: “Early indications suggest that using Non-Invasive Prenatal Testing (NIPT) to screen women who are found to be at a higher risk of having a baby with Down’s syndrome would enable earlier and safer detection of the condition.
“[We have] been working in close collaboration with Great Ormond Street Hospital for Children, particularly in looking to ensure the new test does not affect the quality of the current service offered to pregnant women.”
Carol Boys, the chief executive of the Down’s Syndrome Association said: “We would be delighted if tests which lead to miscarriage were discontinued.
“We understand that the new test is approximately 99% accurate for those women who have already been established as having a high chance of carrying a baby with Down’s syndrome, and are interested to see if that accuracy is maintained in women where this has not already been established. The studies for this are still under way.”
She said the information and education provided to women and health professionals would be important.
Agharti Diabetes Diet Team
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