Stephen J. Schueler, M.D.

Overview Incidence Risk Factors Symptoms Evaluation Treatment questions for doctor specialist Home Care diet self monitoring taking control warning signs Prevention Outlook Complications Underlying Cause

Diabetes in Pregnancy Home Care

Home care for gestational diabetes includes:

  • Nutritional counseling from a registered dietician
  • Avoid caffeine.
  • Avoid alcohol.
  • Stop smoking.
  • Avoid exposure to secondary smoke.
  • Keep a diabetes diary:
    • Check your blood sugar every day.
    • Keep a log of your results.
  • Follow an exercise plan for women developed with your doctor.
  • Follow your diabetes diet.
  • If you have high blood pressure:
    • Learn how to take your blood pressure.
    • Check your blood pressure every day.
  • Maintain good oral hygiene:
    • Brush your teeth after meals and at bedtime.
    • Floss your teeth every day.
    • Gargle with dilute saltwater three times per day.
  • Wear a Medic Alert bracelet at all times.
  • Take prescribed medications as directed:
    • Don't skip doses of your medication. This makes them less effective.
    • Be aware of the common side effects that may be caused by your medication.
  • Learn everything you can about gestational diabetes:
    • The more you know about your condition, the easier it will be to participate with your doctor in making treatment decisions.
    • Ask your doctor about good sources for information.
    • Write down questions to ask your doctor.

Diabetes in Pregnancy Diet

It is important to follow a healthy diet if you have gestational diabetes.

Obtain nutritional counseling from a registered dietician. This person can help you develop specific meal plan that is based on your height, weight, and activity level.

Total Calories
Your daily intake of calories should allow you to maintain a healthy weight. Total calorie requirements vary according to your weight, height and activity. Your doctor and dietitian will recommend a total daily calorie requirement that is right for you.

Carbohydrates should account for 55-60% of your total calories. Carbohydrates include sugars, starches, and fiber. Whole grains, fruits, vegetables and fiber, are better sources of carbohydrate than sugars. Dietary fiber has been shown to prevent constipation, reduce the risk of colon cancer and reduce cholesterol levels. A healthy diet contains 20-35 grams of fiber per day.

Protein should account for 10-20% of your total calories. Those who have normal kidneys should consume about 50 to 60 grams of protein per day. Those who have kidney disease should consume no more than 45 grams of protein per day.

Total Fat
Fat should account for less than 30% of your total calories. Consume only unsaturated fats that are low in cholesterol. About 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil. Cholesterol intake should be limited to less than 300 milligrams per day.

Consider replacing sugar with artificial sweeteners. Saccharin (Sweet-n-Low), aspartame (Equal), and sucralose (Splenda) are acceptable alternatives.

Sodium intake should not exceed 3,000 mg per day. Those who have high blood pressure, heart disease, kidney disease or liver disease should consume no more than 2,000 mg of sodium per day.

Vitamins and Minerals
Regular prenatal vitamins

Diabetes in Pregnancy Self Monitoring

Self monitoring is important for those with gestational diabetes.

Blood Testing for Glucose

  • Monitor your blood glucose as directed.
  • Learn to use your glucose monitor correctly.
  • Daily home glucose monitoring is essential.
    • Try to keep your glucose level before meals between 70-110 mg/dl.
    • Two hours after meals, your glucose level should be less than 140 mg/dl.
  • Check your blood sugar before operating a motor vehicle. Raise your blood sugar level by eating, if it falls below 70 mg/dl.
  • Carefully monitor your blood sugars when you are ill. Blood glucose increases when you are ill or have an infection.

When to test your blood glucose:
  • Before meals
  • Before bedtime
  • 1-2 hours after meals
  • 2-3 A.M., at least one night per week

Other reasons to test:

Urine Testing for Ketones
In the past, urine testing was very useful and important. With the availability of rapid blood sugar testing, urine testing is usually not necessary. The main reason to perform this test is to check for early ketoacidosis. Small or trace ketones may mean nothing or represent the beginning of ketoacidosis. If you find this result, then perform the ketone test again in several hours. Notify your physician immediately if you discover moderate to large ketones present in your urine.

Diabetes in Pregnancy Taking Control

The successful treatment of gestational diabetes requires your participation. Here are answers to some important questions.

Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.

How can you participate in your health care?
To participate you must:

  • Learn to take responsibility for your own health.
  • Learn to partner with your doctor.
  • Learn how to make active decisions about your health.

How can you learn what you need to know?
  • Educate yourself.
  • Be skeptical: Learn to separate fact from fiction.
  • Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
  • Be careful about where you get your health information.
    • Some of the best sources for health information on the web are professional societies and non-profit organizations.
    • Ask your doctor what he or she recommends.
  • Examine the credentials of the authors.
    • If you are reading about symptoms and disease, your best source is a licensed physician.
    • Pay attention to when the content was last updated.
    • Make sure the person is not just trying to sell you something.

Important questions you need to answer:
  • What things in your control can increase your risk for disease?
  • What can you do to decrease this risk?
  • What are vaccines and how can they help you?
  • How do your lifestyle choices increase your risk for disease?
  • How can you reduce stress?
  • What minor health problems can you treat at home?
  • When is a medical problem "serious"?
  • When should you call the doctor?

How can you find the right doctor?
Key points:
  • Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
  • Establish a relationship in advance with your doctor.
  • Make sure you are comfortable with your primary care physician.
  • The internet contains many resources where you can do research to locate the doctor that is best for you.
  • You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
    • Be open-minded, and allow your doctor to know you well. This will improve communication.

Important information you need to make your decision:
  • Physician credentials:
    • Internship and residency training is usually best from respected institutions, universities, and major hospitals.
    • Look for board certification in the specialty.
    • Ask about membership in medical societies.
  • Community and professional reputation are also important.
    • Are other patients happy with the doctor?
    • Has the doctor been disciplined by hospitals or agencies?
    • How long has the doctor been in practice?
    • In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
  • Does the doctor communicate well? Are your questions answered during busy times?
  • Does the doctor welcome you to help make decisions about your care?
  • Is the doctor available when you need care?
  • What is the doctor's after-hours coverage?
  • Is he or she a member of a large group?
    • Do the doctors' cross-cover one another?
  • Where do they admit patients?

What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:
  • How will this help me?
  • How much will it cost?
  • Is it covered by your insurance?
  • What are the potential side effects and risks?
  • What are my alternatives?

For tests, remember to ask:
  • Is it done in the office or at another facility?
  • Is it painful?
  • How will the results of this test influence my care?

For surgery or other procedures, remember to ask:
  • How long will it take to heal?
  • How many cases has the doctor done?
  • What would your doctor do if he or she were the patient?
  • Where is it done?
  • Who will perform it?
  • What are the doctor's qualifications?

What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
  • To be spoken to in words that you understand
  • To be told what's wrong with you
  • To know the benefits of any treatment and any alternatives
  • To know what a treatment or test will cost
  • To share in treatment decisions
  • To read your medical record
  • To refuse any medical procedure

What should you do before an office visit?
  • Bring all important medical information with you to the visit.
  • Make sure you can answer questions about the following:
    • Allergies and side effects to medicines
    • Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
    • Insurance information
    • Marital and sexual history
    • Past injuries and hospital stays
    • Past medical problems
    • Past surgeries and operations
    • Pre-visit questionnaires
    • Use of tobacco, alcohol and drugs
    • Work history

What should you expect from the visit?
  • You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
  • Bring along a book or toys for the kids. You may also have to wait during busy times.
  • Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
  • Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
  • Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
  • Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
  • If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
  • Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?
Every year many people become ill because of problems with medications.

Remember to ask:
  • What side effects to expect.
  • What drug interactions are possible.
    • Find out if a new medicine reacts with those that you are taking now.
    • Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
    • Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
  • Make sure you can drive or operate machines safely while taking a medicine.
  • Ask your doctor how much a prescription costs.
    • Is there a less expensive option or a generic version?

What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do these things?

Other important points:
  • Be sure you understand your treatment plan.
  • Stick with the treatment plan and allow time for improvement.
  • Don't stop medicines when you feel better; check with your doctor first.
  • Call your doctor if your condition is becoming worse.
  • Your doctor should tell you what to expect and when to follow-up or call the office.

Diabetes in Pregnancy Warning Signs

Notify your doctor if you have gestational diabetes and any of the following:

Continue to Diabetes in Pregnancy Prevention

Last Updated: Feb 23, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
Copyright DSHI Systems, Inc. Powered by: FreeMD - Your Virtual Doctor

PubMed Diabetes in Pregnancy References
  1. Allen SR. Gestational diabetes: a review of the treatment options. Treat Endocrinol. 2003;2(5):357-65. [15981952]
  2. Forsbach-Sanchez G, Tamez-Perez HE, Vazquez-Lara J. Diabetes and pregnancy. Arch Med Res. 2005 May-Jun;36(3):291-9. [15925019]
  3. Jacobson GF, Ramos GA, Ching JY, Kirby RS, Ferrara A, Field DR. Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. Am J Obstet Gynecol. 2005 Jul;193(1):118-24. [16021069]
  4. Kelly L, Evans L, Messenger D. Controversies around gestational diabetes. Practical information for family doctors. Can Fam Physician. 2005 May;51:688-95. [15934273]
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