Gestational Diabetes??

Question

Ok so today I got a phone call from the nurse at the doctors office telling me that I failed my 3 hour test.. She said that 3 of the 4 came back elevated, and that the worse out of all was the one that was up to 244 "my sugar level" I did everything I was suppose to and still I failed. I am really nervous about the health of our baby now.. I have read and heard from many people that this pregnancy related complication can cause you to have an extremely large baby.. And that it can cause other health issue if it isnt well watched for the remainder of the pregnancy.. I have a home health nurse coming out to get me all set up with my equipment to start testing my self.. I have to test 4 times a day atleast, and watch what I eat.. Does anyone know what I can eat if anything. I was to no high carbs and no sugar, but what else do I need to watch out for? Please anyone that has had this tell me what you did.. I want to get a start on things now before the nurse shows up...

Answer 1

Diabetes and the Gastrointestinal Tract

James D. Wolosin, MD, FACP, and Steven V. Edelman, MD

Gastrointestinal (GI) disorders are common among all people, including those affected by diabetes. At some point in any patient's life, the chances that he or she will develop a GI tract problem, be it peptic ulcer disease, gallstones, irritable bowel syndrome, food poisoning, or some other malady, are extremely high.

As many as 75% of patients visiting diabetes clinics will report significant GI symptoms. The entire GI tract can be affected by diabetes from the oral cavity and esophagus to the large bowel and anorectal region. Thus, the symptom complex that may be experienced can vary widely. Common complaints may include dysphagia, early satiety, reflux, constipation, abdominal pain, nausea, vomiting, and diarrhea. Many patients go undiagnosed and under-treated because the GI tract has not been traditionally associated with diabetes and its complications.

Both acute and chronic hyperglycemia can lead to specific GI complications. Diabetes is a systemic disease that may affect many organ systems, and the GI tract is no exception. As with other complications of diabetes, the duration of the disorder and poor glycemic control seem to be associated with more severe GI problems. Patients with a history of retinopathy, nephropathy, or neuropathy should be presumed to have GI abnormalities until proven otherwise, and this is best determined by asking a few simple questions. (See "Patient Information".)

Many GI complications of diabetes seem to be related to dysfunction of the neurons supplying the enteric nervous system. Just as the nerves in the feet may be affected in peripheral neuropathy, involvement of the intestinal nerves may lead to enteric neuropathy. This is a type of autonomic or "involuntary" neuropathy and may lead to abnormalities in intestinal motility, sensation, secretion, and absorption. Different nerve fibers can either stimulate or inhibit intestinal motility and function, and damage to these nerves can lead to a slowing or acceleration of intestinal function, giving rise to a variable symptom complex. This article will highlight the most common GI disorders seen in people with diabetes.

The Esophagus and Stomach in Diabetes
Gastroparesis
Diabetic gastroparesis is a condition in which emptying of food from the stomach is delayed, leading to retention of stomach contents. This may cause bloating, early satiety, distention, abdominal pain, nausea, or vomiting. Gastric stasis may lead to worsening gastroesophageal reflux along with symptoms of heartburn and mechanical regurgitation of gastric contents. In addition, fatty foods and very fibrous foods normally exit the stomach slowly and may be poorly tolerated.

The diagnosis of gastroparesis is often suspected on the basis of symptoms alone. Upper GI endoscopy is helpful to rule out anatomic obstruction of the stomach or duodenum but does not provide an accurate physiological assessment of gastric emptying. Upper GI barium studies may confirm delayed gastric emptying with a dilated atonic/aperistaltic stomach with retained gastric contents. However, the upper GI series is more commonly nondiagnostic because liquids may empty normally from the stomach in spite of severe abnormalities in the ability to empty solid materials from the stomach into the duodenum.

The nuclear medicine gastric emptying test is the best confirmatory test for evaluation of gastroparesis. A test solid-food meal containing a technetium isotopic tracer is ingested, and scintography is used to quantitatively measure the rate of gastric emptying. This test is highly sensitive and specific, although false positives and negatives may occur in response to medications that accelerate or slow the rate of gastric emptying. When performing initial diagnostic testing, it is best to measure gastric emptying rates when patients are off of medications that may affect the rate of gastric emptying.

Several different treatments may provide benefit in the management of diabetic gastroparesis. Consumption of frequent small meals may provide some symptomatic relief. Avoidance of high-fat and high-fiber foods may be beneficial as well. It is common to recommend a liquid diet during an exacerbation of gastroparesis. As symptoms worsen, parenteral hydration and alimentation may be required. Nasogastric tube suction may also be used during severe episodes.

Numerous medications have been shown to provide some benefit in the treatment of gastroparesis. Metclopropamide (Reglan) is a dopaminergic antagonist that enhances gastric emptying and has primary antiemetic properties. Unfortunately, it crosses the blood-brain barrier and causes frequent neurological side effects, such as sedation, tremor, confusion, dystonia, and, at times, tardive dyskinesia, which may or may not reverse after the drug is stopped.

Cisapride (Propulsid) is a prokinetic agent that is very effective at facilitating gastric emptying. Pharmacological tolerance, a problem common with metclopropamide, does not seem to occur with cisapride, and patient acceptability is excellent.

The Food and Drug Administration (FDA) has recently placed severe restrictions on the use of cisapride because of the potential for cardiac dysrhythmias due to prolongation of the QT interval. This is of particular concern when the medication is taken with agents that delay the metabolism of cisapride, such as erythromycin, clarithromycin, fluconazole, idinavir, and other agents that inhibit the cytochrome P34A system. The medication is contraindicated in any individual with a prolonged QT interval, and an electrocardiogram should be checked in all individuals in whom therapy with cisapride is being considered. Concomitant administration of agents that can prolong the QT interval are to be avoided. Clinically, this problem occurs infrequently, especially when the prescribing guidelines are followed. At this time, cisapride is available only through the FDA directly and only for patients who have failed other therapies and meet strict criteria for use of the drug.

Domperidone (Motilium) is another dopaminergic antagonist similar to metclopropamide that accelerates gastric emptying but does not cross the blood-brain barrier and has very few side effects. It is not yet available in the United States but is available in Mexico and elsewhere.

Erythromycin has unique properties that stimulate gastric motility and may be beneficial in selected individuals. It functions as an agonist of motilin and enhances gastric emptying. Unfortunately, erythromycin has many potential side effects including nausea and may not be well tolerated.

Nonspecific antiemetic agents including prochlorperazine (Compazine) and promethazine (Phenergan) often can provide symptomatic relief of nausea and vomiting. There appears to be no substantial benefit for the preferential use of the more expensive 5HT3 receptor antagonists such as ondansetron (Zofran) or dolastetron (Anzemet).

Recently, a novel approach to refractory gastroparesis has been to use an implantable gastric pacemaker. It has long been recognized that many patients with gastroparesis have abnormal electrical gastric rhythms that may or may not correlate with delayed gastric emptying. Surgical placement of a gastric pacemaker has been shown to accelerate gastric emptying and provide symptomatic relief in a small number of patients in preliminary uncontrolled clinical trials.

Smoking cessation, light postprandial exercise (such as walking), and dietary manipulation (such as eating multiple smaller meals and avoiding high-fiber and fatty foods) can also improve gastric emptying. Most importantly, careful attention to blood glucose control is essential and can have a tremendous impact on gastroparesis.

Ulcer disease
Ulcer disease is a common problem in patients with or without diabetes and affects up to 10% of the population at some time during their lives. Acid irritation of the stomach or esophagus leads to heartburn, indigestion, and a burning sensation in the upper abdomen, or dyspepsia.

Helicobacter pylori, the bacteria responsible for most duodenal ulcers and many gastric ulcers, is no more common in patients with diabetes than in the general population. In fact, diabetes itself does not increase one's risk of developing ulcers. Individuals with ulcers and ulcer-like symptoms are treated in the same fashion regardless of whether or not they have diabetes.

Treatment is geared toward suppression of gastric acid secretion with antisecretory medications (i.e., H2 receptor antagonists or proton pump inhibitors). If H. pylori is present, it will usually be treated with a specific antibiotic regimen along with anti-secretory agents. Common antibiotic regimens include a 2-week course of amoxacillin (Amoxil)/clarithromycin (Biaxin), metronidazole (Flagyl)/clarithromycin, metronidazole/tetracycline, or metronidazole/amoxacillin.

In individuals with gastro-esophageal reflux, eradication of H. pylori may result in worsening symptoms because acid secretion increases after this bacteria-related gastritis resolves. Many individuals with reflux will require therapy with proton pump inhibitors to control symptoms. These provide effective relief of symptoms in >80% of affected individuals as opposed to the H2 receptor antagonists, which provide symptomatic relief in ~50% of individuals with reflux disease.

Candida infections
Patients with diabetes may develop yeast infections in the GI tract, especially when glycemic control has been poor. Yeast infection in the mouth (thrush) is characterized by a thick white coating of the tongue and throat along with pain and burning. If the infection extends further, candida esophagitis results, which may cause intestinal bleeding, heartburn, and difficulty swallowing.

Oral candida can readily be diagnosed by physical examination, but candida esophagitis will usually require endoscopy for accurate diagnosis. Treatment is highly effective and is focused on the eradication of the yeast infection with antifungal medications such as nystatin (Mycostatin), ketocanazole (Nizoral), or flucanazole (Diflucan).

The Small Intestine in Diabetes
In some cases of longstanding diabetes, the enteric nerves supplying the small intestine may be affected, leading to abnormal motility, secretion, or absorption. This leads to symptoms such as central abdominal pain, bloating, and diarrhea. Delayed emptying and stagnation of fluids in the small intestine may lead to bacterial overgrowth syndromes, resulting in diarrhea and abdominal pain.

Metclopropamide and cisapride may help to accelerate the passage of fluids through the small intestine, whereas broad-spectrum antibiotics will decrease bacterial levels.

Diagnosis can be quite difficult and may require small-bowel intubation for quantitative small-bowel bacterial cultures. Breath hydrogen testing and the [14C]-D-xylose test may be helpful in diagnosing bacterial overgrowth as well. All of these tests are somewhat cumbersome, and an empiric trial of antibiotics is often the most efficient means of diagnosing and treating this condition.

Numerous antibiotic regimens have been shown to be effective, including 5- to 10-day courses of tetracycline, ciprofloxin, amoxacillin, or tetracycline. A short course may provide prolonged relief, but typically, additional courses of antibiotics are required when symptoms recur in several weeks or months.

At times, enteric neuropathy may lead to a chronic abdominal pain syndrome similar to the pain of peripheral neuropathy in the feet. This condition may be very difficult to treat but will sometimes respond to pain medications and tricyclic antidepressant medications, such as amitryptilline (Elavil). Unfortunately, narcotic addiction may be common in patients with chronic painful enteric neuropathy.

Individuals with diabetes also have an increased risk of celiac sprue. In this condition, an allergy to wheat gluten develops, leading to inflammation and thinning of the mucosa of the small intestine. Why this association occurs is not clear. However, sprue may lead to diarrhea, weight loss, and malabsorption of food.

This condition responds well to a gluten-free diet, but patients may have difficulty adhering to such a diet. Diagnosis can be made with endoscopic biopsy of the small intestine or with serological evaluation for anti-endomysial and anti-gliadin antibodies.

The Colon in Diabetes
Limited information is available regarding the effects of diabetes on the large intestine. We do know that enteric neuropathy may affect the nerves innervating the colon, leading to a decrease in colon motility and constipation. Anatomic abnormalities of the colon, such as structure, tumor, or diverticulitis, should be excluded with a barium enema or colonoscopy.

Fiber supplementation with bran or psyllium products, as well as a high-fiber diet, increases the water content of the bowel movement and may relieve constipation. Mild laxatives and stool softeners will often help as well. In addition, cisapride accelerates colonic movement and may increase the frequency of bowel movements.

Diabetic Diarrhea
Patients with a longstanding history of diabetes may experience frequent diarrhea, and this has been reported to occur in up to 22% of patients. This may be related to problems in the small bowel or colon. Abnormally rapid transit of fluids may occur in the colon, leading to increased stool frequency and urgency. In addition, abnormalities in the absorption and secretion of colonic fluid may develop, leading to increased stool volume, frequency, and water content.

Diabetic diarrhea is a syndrome of unexplained persistent diarrhea in individuals with a longstanding history of diabetes. This may be due to autonomic neuropathy leading to abnormal motility and secretion of fluid in the colon. There are also a multitude of intestinal problems that are not unique to people with diabetes but that can cause diarrhea. The most common is the irritable bowel syndrome.

The workup and treatment of diarrhea is similar in patients with or without diabetes. If the basic medical evaluation of diarrhea is nondiagnostic, which it frequently is, then treatment is tailored toward providing symptomatic care with antidiarrheal agents such as diphenoxylate (Lomotil) or loperamide (Immodium). Fiber supplementation with bran, Citrucel, Metamucil, or high-fiber foods may also thicken the consistency of the bowel movement and decrease watery diarrhea. In addition, antispasmodic medicines such as hyosymine (Levsin), dicyclomine (Bentyl), and chordiazepoxide (Librax)/clindinium (Clindex) may decrease stool frequency.

Sometimes an empiric trial of antibiotics and/or pancreatic enzymes is warranted because pancreatic exocrine insufficiency and bacterial overgrowth may be the etiology. More recently, the 5HT3 receptor antagonist alosetron (Lotronex) has been used effectively for the treatment of diarrhea-predominant irritable bowel syndrome. Tincture of opium and paregoric have also been used to improve the quality of daily life in some cases. Finally, in severe cases, injections of octreotide (Sandostatin), a somatostatin-like hormone, have been shown to significantly decrease the frequency of diabetic diarrhea. Obviously, in these severe cases, referral to a gastroenterologist is indicated.

The Pancreas in Diabetes
Pancreatic exocrine dysfunction occurs in up to 80% of individuals with type 1 diabetes but is rarely significant enough to lead to any clinical problems with digestion. The pancreas has a tremendous reserve, and a modest reduction in pancreatic enzyme secretion rarely leads to difficulty in digesting or absorbing carbohydrate, fat, or protein.

The exocrine pancreas may also be affected in some patients with type 2 diabetes but to a lesser extent. Individuals who have secondary diabetes because of severe pancreatitis or surgical removal of the pancreas usually have more severe symptoms of pancreatic exocrine insufficiency. Treatment with pancreatic enzyme replacement therapy is usually effective. A trial of oral enzyme replacement therapy can be done safely for diagnostic and therapeutic purposes.

The Liver in Diabetes
Although liver function tests are commonly abnormal in patients with diabetes, it is unclear whether this is a reflection of the underlying obesity that is so common in patients with type 2 diabetes or whether it is an effect of poorly controlled diabetes. Fatty infiltration of the liver (nonalcoholic steatohepatitis) is common in obese individuals (up to 90%) as well as in type 2 diabetic individuals (up to 75%). People with type 1 diabetes in very poor control may also develop this syndrome, although it is much less common.

Fatty infiltration of the liver may lead to tender hepatomegally, elevated liver enzyme tests, and abdominal pain syndromes. Occasionally, this may progress to fibrosis and cirrhosis of the liver.

The diagnosis is usually suspected on the basis of the clinical presentation but can be confirmed with abdominal ultrasonography and, if needed, percutaneous liver biopsy. Metabolic abnormalities such as hemochromatosis and infectious etiologies such as viral hepatitis need to be excluded as part of the evaluation.

Therapy is geared toward improving glycemic control and instituting a low-calorie, low-fat diet. Caloric restriction will lead to weight loss, better glycemic control, lower serum triglycerides and cholesterol, and improvement in the fatty infiltration of the liver. Ursodiol (Actigal) may provide some benefit in the treatment of hepatic steatosis.

Diabetic patients seem to have an increased incidence of gallstones and gall bladder problems, but these, much like fatty infiltration of the liver, are primarily related to the obesity associated with type 2 diabetes and not to the diabetes itself. Obesity leads to secretion of bile by the liver that is supersaturated with cholesterol, leading to crystallization and stone formation. Typical symptoms of biliary colic include intermittent right upper abdominal pain, jaundice, or pancreatitis.

In the past, patients with diabetes have been instructed to have surgery for asymptotic gallstones because of a concern for an increased risk of complications from gallstones, such as infection, pancreatitis, or rupture of the gall bladder. However, more recent experience with modern medical and surgical care indicates that this is no longer the case. Thus, patients with diabetes and gallstones should be managed in a fashion similar to nondiabetic patients. Surgery is generally recommended only for those individuals whose gallstones are causing symptoms.

Conclusions
GI problems in diabetes are common but not commonly recognized in clinical practice. The duration of diabetes and the degree of glycemic control are major determinants in the incidence and severity of GI problems. The entire GI tract can be affected, including the mouth, esophagus, stomach, small intestine, colon, liver, and pancreas, leading to a variable symptom complex.

The workup starts with a thorough patient history and appropriate laboratory, radiographic, and GI testing. In addition to pharmacological therapy, glycemic control and dietary manipulation play an important role in managing GI disorders in people with diabetes.

Answer 2

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Answer 3

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Answer 4

Were you diagnosed before you got pregnant? When the diabetes is diagnosed during pregnancy, then this is the first of two types of gestational diabetes, called Type A1. This is if and when diet correction is enough to control blood sugar levels. The second type is when diet modification is not enough to do the job.

What then is the second type of gestational diabetes? Type A2 is the other kind. When diet change is not enough, then insulin treatment and/or other medications are required. There are various things to do to control this type of diabetes. The treatment is a combination of careful food choices and exercise. Sometimes insulin injections are necessary as previously mentioned. You have other options to take control of Gestational Diabetes.

Gestational diabetes diet? At best, experts do not agree on what is the best diet. You will be in the best position to find out what works best for you. It is a matter of wise choice of foods. Then monitor your body's response to each type of food.

The gestational diabetes diet will let you look for ways and means of healthy eating that allows you eat the food you enjoy. For instance, a low-fat diet will be good if you love spaghetti and bread if you don't mind not having butter that much. Also, a low-carb diet will be the choice if you can't live without meat but don't care for bread. Now if you can't give up a certain food, then start on a diet counting calories and measuring portions.

The diabetes routine during pregnancy should fit your own needs and experience. If this is your first time, you may want more information. Here are some gestational diabetes diet principles to bear in mind when you are in this condition.

The Diet

This is for those who are pregnant or planning to be pregnant.

1. Because there is a risk for neural tube defects in babies when the woman has diabetes, it is vital to start taking folic acid supplement before conception. Check with the doctor how much you should take.

2. Before conception, try to lose weight but stop as soon as you're pregnant.

3. Visit a dietitian to discuss such dietary essentials as pregnancy craving for food, nibbling or snacking in relation to blood glucose, changes to food intake and options to keep away from high blood glucose level in the morning. This is common occurrence in pregnancy.

4. Carb-counting will provide flexibility. This will make the diet a great way to manage the blood glucose because you will know what to eat and when to eat. To learn how to do carb-counting, a nutritionist should be able to start you in the right direction.

Eating the right kinds of foods that will suit your lifestyle is also allowed in the gestational diabetes diet. For instance, if you go to school or work in an office, check whether the foods you eat are available at work or you may have to pack up a lunch to take with you.

If you need information, please visit this site:

http://www.free-symptoms-of-diabetes-alert.com

Answer 5

Gestational Diabetes can result in a bigger baby, but usually if it is not controlled adequately. Basically what you are going to be doing is watching your blood sugars as well as your diet to maintain control of them.
Here is the Diabetes Association's site on Gestational Diabetes. It should answer any questions that you have , and give you ideas on how to minimize risks to yourself and your baby.

http://www.diabetes.org/gestational-diabetes.jsp
Hope this helps.

Answer 6

I am writing to tell you what an incredible impact these methods had on my life! I have had type 2 diabetes for 27 years. For me, the worst part of this horrible disease is the severe pain I constantly get in my feet. The pain is so bad that I avoid standing and walking as much as possible. I've got to tell you that within the first month, my feet stopped hurting altogether and I can now walk totally pain free.

Believe it or not, I even danced at my niece's wedding last month, something I have not done in a many years. I've been following the book for six months now and my blood sugar is well within normal range. I feel great!

I recommend you use the Type 2 Diabetes Destroyer to naturally reverse your diabetes.

Answer 7

I had gestational diabetes, too. Everything worked out just fine - healthy baby and all.

They should give you a meal plan to follow. I had a meal plan. Basically, you want to make sure that you keep your sugar levels pretty even throughout the day. Don't let them go up too high and don't let them drop too low. The way I did this was by eating smaller portions more often through out the day. I basically ate every two or three hours but I paid close attention to what I ate and how much I ate. You need a good balance of proteins and carbs.

As long as you keep up with your sugar levels (check 4 times a day as recommended) and report any abnormalities (sugar consistently too high or low) to your doctor, you will be fine. The doctor will know exactly what to do to keep your baby safe.
My sugars kept creeping up, so my dr. prescribed glyburide (a pill) twice a day.

My baby didn't get too big. She was and is perfectly happy and healthy and it only took me a couple of days to get used to testing my sugar and eating according to the meal plan.

It was really kind of a blessing in disguise now that I look back on it because it taught me how to eat a healthier diet and take better care of myself.

Good luck and don't worry!

Answer 8

Here you can find a very effective natural treatment for diabetes: http://diabete-cure.gelaf.info

Diabetes can be "reversed" or go into "remission". I believe that what that is is decreasing the need to take medications. A person who has diabetes will always have it... but there are cases where a type 2 can either reduce medications or even eliminate them... but will still need to watch diet, get plenty of exercise and keep their weight down. This is called management and control. However, that does not mean that there will never be one. Research has taken huge advances and the more scientists learn about it, the higher likelihood that a cure might come about someday.
While I did recently read an article that stated gastric lap band or gastric bypass MAY be a potential cure, more research is needed and even if this one day is a cure, it would only be effective on type 2s who are obese since neither of those procedures are performed on people who are of normal weight or body mass. Stem cell transplants are still highly controversial and most likely, have a long way to go before it is approved as a diabetes cure by the FDA. Since the vast majority of diabetics are type 2 (roughly 90%), those of us who are type 1 seem to get lost in the shuffle. EMT type 1 for more years than I care to remember, use a pump. Let me add that when I mean diabetes can be controlled and managed without medication but with diet, exercise and weight control, I'm referring to type 2. This is not an option for type 1s, who must take insulin, either by injections or a pump, to survive.

Answer 9

This usually clears up once the baby is born. The baby could have elevated blood sugar when he or she is born, but this too, usually clears up soon after the baby is delivered. It can cause the baby to be a little bigger than he or she normally would have been, but to say 'extremely large', is an exaggeration. Whoever told you to avoid carbs and sugar was completely right. Infection & stress can also cause your blood sugar to elevate, therefore, the best thing you can do is calm down & follow your doctor or nurse's instructions. This is fairly common, and the OB/GYN doc's and nurses' today are fully knowledgeable of how to handle this. So long as you follow all the instructions given to you from a qualified medical professional, things should turn out just fine. Try to relax, this is not your fault, it just happens sometimes. Congrats on your new baby to be!

Answer 10

this means while pg you will be this way and when you are 50 or so you will probably end up being diabetic if you dont' watch the diet. the first thing to do. is eat alot of veggies and keep out fried foods. you can eat fruit but dont' drink juice. testing blood is a must. keep it by 100 or lower. that is normal blood surgars. if you are upset or anything it will shoot up basket ball games can do that to you stress can make sugar go up. if they say between this and that over 100 sure you can but its damage eventually over 100. if you go to specialist (diabetic_ they will tell you about this and that mostlikely they will tell you what i am. don't eat any or much startch. its very high in sugar no drinks (pop) and use equal for the fake sugar. it will help. yes it can hardm the baby if you aren't careful. you must probably have diabetics in the famly if not you will have them starting with you sometime in your life. be careful take care.

Answer 11

This Site Might Help You.

RE:
Gestational Diabetes??
Ok so today I got a phone call from the nurse at the doctors office telling me that I failed my 3 hour test.. She said that 3 of the 4 came back elevated, and that the worse out of all was the one that was up to 244 "my sugar level" I did everything I was suppose to and still I failed. I...