Type II Diabetes and Gestational Diabetes are considered to be separate conditions, but Gestational Diabetes may actually be the first sign of Type II Diabetes manifestation. This is different from diabetes in pregnancy in which a person with diabetes becomes pregnant. With Gestational diabetes, an abnormal blood sugar manifests itself for the first time.
As long as the body can produce sufficient insulin to meet its needs, blood sugars are normal. During pregnancy, the body needs much more insulin, and the increased need for it coupled with a limited capacity to produce that much insulin can lead to the first high sugars the patient will ever experience. It can also be thought of as Prediabetes revealing itself at a time of increased need for insulin production. Gestational Diabetes can cause problems for the baby including premature birth and high birth weight for babies born at the appropriate time. If not properly treated, it can increase the risk of fetal death. Pregnant women need much more insulin. In fact, as the pregnancy proceeds the amount of insulin they need can increase three or four fold. If they cannot meet their high demand for insulin, the sugars will start to rise. About 90% of the time, the sugars revert to normal after the pregnancy.
Because Gestational diabetes places the baby at such a high risk, it must be discovered early and treated very aggressively. Obstetricians routinely check all pregnant women for this condition in the seventh month by giving them sugar and seeing if they are about to get their sugar down to normal. The pregnant woman and her baby have the same blood sugar level. If she consumes carbohydrates but cannot produce enough of her own insulin to get the sugar down to normal, the baby will use its own developing beta cells (in its own pancreas) to produce insulin to treat their shared blood sugar. Her baby’s insulin would help her blood sugar come down, but itbe at risk for complications. Because the baby is so much smaller than she is, it will be exposed to extremely high levels of insulin which may delay lung maturity, increase its size, and increase its risk for death. When women become pregnant, their sugars are normally lower than before and they need much tighter control than that of a woman with diabetes who was not experiencing gestational diabetes. She and her physician should try to keep her sugars as close to that of a normal pregnant woman as possible. They need to learn how to check their sugar, chart it about four times per day, and stick to their diet. If they consume too many carbohydrates the sugar will increase. If they have inadequate amounts of carbohydrate they may develop acetone which can hurt the baby. If while consuming an appropriate amount of acetone, the sugars increase beyond our established goals, insulin is recommended. By taking injectable insulin the baby does not need to over-produce insulin to her mother’s blood sugar, and thereby put itself at serious risk. Ultrasounds are used to follow the baby’s growth. If it grows at a rate that is too fast, even if sugars are normal, insulin would be indicated.
When the pregnancy is completed, the extra insulin resistance dissipates and most women return to the blood sugar levels they had prior to becoming pregnant. All these women should maintain a healthy diet after the baby’s birth, and about 10% of them will develop frank diabetes in which they will require insulin or pills to maintain normal blood sugars for the rest of their lifetime.