Tuesday, December 14, 2010

Is Gestational Diabetes Really Diabetes?

Sometimes when women are diagnosed with high blood sugars during pregnancy, that is, with gestational diabetes, their doctors are so casual that they could wonder whether gestational diabetes is really diabetes. After all, some doctors say, you will probably be fine after you deliver, just keep your sugars in control for the time being. The problems is that uncontrolled blood sugars during pregnancy can be the first sign of a kind of diabetes that is neither type 1 nor type 2 called LADA.

While obstetricians will insist that expectant mother's keep their blood sugars in check, after delivery the follow up care for women who have gestational diabetes is usually minimal. There might be one HbA1C reading to make sure it's below 7, and maybe a finger stick or two to make sure the fasting sugars aren't too high. One or two "clean" tests and the diabetes case is closed.

The problem is that women who get gestational diabetes tend to be "blood sugar impaired," but not fully diabetic. Some research published in late 2008 found that women who have diabetes during pregnancy have most but not all of the same genes found in type 2 diabetics of both sexes. They will have normal fasting blood sugars because their beta cells get around to churning out enough insulin to take care of the glucose released from food at night, but they do not make enough insulin to keep blood sugar levels low in the 2-3 hours after meals.

High post-prandial, or "after-meal," sugars can do just as much damage as high fasting sugars, but most doctors never test for them. Over time they can poison the remaining beta cells so that they stop making insulin, leading to diabetes that is only detected after it has done damage.

And, just as some women who have an Rh+ blood type have trouble bearing an Rh- baby, sometimes pregnancy triggers a series of autoimmune reactions that cause a kind of diabetes known as LADA (latent autoimmune diabetes in adults). It's something like juvenile diabetes in adults (and I have it, myself, obviously not because I got pregnant, which would no doubt get me an appearance on Oprah). Both men and women can get the condition, initiated most often by pregnancy in women or a viral infection in men.

Fasting blood sugars are fine because the pancreas retains its ability to produce some insulin, slowly. It just can't produce enough insulin quickly to keep blood sugars down after meals. The problem is, those high blood sugars after meals eventually "burn out" beta cells so blood sugars are high all the time.

If you are a new mother who had gestational diabetes, what should you do? To make sure you don't have LADA or type 2 diabetes that just happened to begin when you became pregnant, test your blood sugars about 2 hours after you eat, at least 3 or 4 times. If you get a reading of over 200 mg/dl (11 mM), first, make sure you didn't just happen to have sugar on your hands. But if you get two readings over 200 mg/dl, see your doctor about follow-up care.

Recent reader questions:

Q. What are acceptable levels for gestational diabetes?

A. I'm assuming you mean blood glucose levels. Blood sugars too high during pregnancy can harm both mother and child, producing unusually large babies and causing difficult delivery. Expectant mothers who have gestational diabetes or any other kind of diabetes should be under a doctor's care, but generally, mothers want to keep their sugars under 125 mg/dl (7 mM) at all times, not just fasting. This gets tricky as you eat for two, but the result is an easier birth and a healthier baby.

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