To drink or not to drink: Glucola and Gestational Diabetes
Most mothers these days have a plethora of information at their fingertips. A simple search will bring you to many opinions on Glucola and the evil (or not) in it. If any of you are like me, you get tired of figuring out fact from fanaticism. So let’s break down this post into some hardcore facts: What is gestational diabetes? I eat well. I follow the Whole30, paleo, Trim Healthy Momma or fill in the blank diet and I am low risk. Why should I test for gestational diabetes? Let’s start with Diabetes 101 Diabetes 1 – childhood or diabetes caused by a genetic or physical damage or defect. However, without a scientific breakthrough, it cannot be cured. Their body doesn’t produce insulin. By monitoring your diet, they can control how much insulin they need by regulating how much sugar they have ingested. However, they need artificial insulin to live. Diabetes 2- This is diet/lifestyle diabetes. While, I think we can all have predispositions to different problems in life, this is typical caused by you or me. This is caused by learned eating habits. It is caused by sedentary lifestyles. This person has made choices to be diabetic…. Whether intentional or not. There can be a point where you damage the pancreas and other organs to a point not being able to completely heal them. The pancreas (an organ behind the stomach) releases insulin to help your body store and use the sugar and fat from the food you eat. Diabetes occurs when one of the following occurs:
When the pancreas does not produce any insulin
When the pancreas produces very little insulin
When the body does not respond appropriately to insulin, a condition called "insulin resistance"
When you eat or drink, a lot of your food is broken down into a simple sugar called "glucose." Glucose gives energy to your body. Insulin is released by the pancreas to regulate how much sugar you have. The more sugar you have, the more insulin is released to help your body push more glucose into the cells including fat cells. Excess glucose is also stored in the liver. Gestational diabetes is triggered by pregnancy. Hormone changes during pregnancy can affect insulin's ability to work properly. The condition occurs in approximately 4% of all pregnancies.
Normal pregnancy physiology. The body needs to enhance nutrient delivery to the baby. So lactogen, estrogen and progesterone counter act the function of insulin. The placenta also makes potent enzymes which destroy insulin. The mother’s system secretes more insulin to make up for it. So baby wants glucose to grow, mom is producing more insulin than pre-pregnancy to keep blood sugars level. The baby has a glucose level about 20-40 points lower than mom. If mom’s sugar levels are averaging 20-40 points higher than they should, then babies are averaging 20-40 points higher than they should. Extra glucose crosses the placenta to the baby, however extra insulin does not. This causes fat growth in a baby which causes a big baby. Which is why midwives say, “Protein make strong babies, carbs make fat babies.” Can you see a woman that is even borderline or normal before pregnancy in her blood sugar, may not be able to handle the extra insulin and glucose exchange in the body at pregnancy? Her body may over-react or not be able to keep up with pregnancy changes regardless of diet. Can you see the extra strain on the liver which can lead to a higher risk of pre-eclampsia due to diet or high blood sugar? Also certain illnesses can affect your body’s ability to produce insulin, as well as, too much stress in your life. There are also many pregnancy physiological changes that we still do not understand. Things that affect glucose levels:
Caffeine and smoking cause the liver to release glycogen and cause a flooding to the system all at once.
Being overweight can cause decreased insulin receptors. This is why the physiological changes during pregnancy can cause a higher chance of gestational diabetes in obese women. Also, this can occur in women that are not overweight but consume high amounts of refined foods and sugars.
GD and Risks for baby: Tremors, respiratory distress, listlessness, abnormal crying, feeding difficulties, possible convulsions, brain damage, shoulder dystocia, hyperbilirubinemia, polycythemia, obesity, hypocalcemia, and fetal malformations
GD and Risks for mom: pyelonephritis, pre-eclampsia, polyhydramnios, C-section, post-partum hemorrhage, post-partum endometritis, diabetes type 2, placenta deterioration
Being informed on the Different Types of Tests:
This section is what has caused a many a mom to rev up her fingers to post about the dangers of Glucola testing.
What is Glucola? It is basically a drink with 50, 75 or a 100 grams of dextrose which is corn sugar combined with preservatives, oils to mix flavors, dyes and a few other items to make the GD concoction which is plastered with a "do not consume in pregnancy" label. However, to be fair, pregnancy vitamins have the same warning. I am not going to be one to argue this is a healthy addition to your diet. However, I wonder how many women downed a Sonic cherry limeade and have complained about this drink. Just food for thought :) After consuming this drink, blood levels are tested at fasting, 1 hr, 2 hr, and/or 3 hr increments. Though the 50 gram load usually consists of one 1 hour blood test. The 2 main concerns regarding this test is the ingredients in the drink itself and the sugar overload for moms that normally don’t have a lot of sugar or processed foods.
There are several other tests options. Juice, a meal, and jelly beans are a few I have heard of. We historically have offered a 50 grams of juice test in place of the Glucola. Benefits are that it is a more natural dietary intake.
Another form of testing is monitoring your normal blood sugar through a week with your normal diet at different times during the day. This is done with a glucometer. This is probably the most accurate testing of your blood sugar levels. This is also the most time intensive.
Another option: 50 grams of straight dextrose mixed into water. No chemicals, dyes or preservatives.
Why are we going to the 50 grams on non-gmo dextrose or monitoring option?
I used to be a firm believer in natural food blood testing until hearing a podcast on diabetes testing. You cannot compare apples to oranges. All the studies were done on dextrose, not natural sugar. All the levels determined to be normal were on dextrose not natural sugar. It can be possible to have a “within normal” result from natural sugar and still be diabetic. We cannot take dextrose sugar levels and call our natural sugar or diet results within normal range. We don’t have a normal range blood sugar study for natural sugars or diet in pregnancy established for GD. Since, we are not a fan of all the additives in the Glucola, we have decided to offered straight 50 grams of powdered dextrose to be added to water and tested as normal. Our moms can also choose to do glucometer monitoring.
We believe in informed consent as well as waivers, when appropriate. In our practice, we allow a lot of freedom to mom in the choices in her care. We also believe in the midwife’s choice and informed consent with risks she takes and support each practice being comfortable with their own policy. There are risks for undiagnosed GD for both mom and baby. If a mom is choosing to waive out of a test, or choosing a test that is not optimal for true results, she must do so recognizing she takes responsibility for those risks. Also, a mom should consider the benefits of finding out that you have GD. She has the opportunity to drastically change her diet and lifestyle to have the most optimal birth outcome for her and her baby. The next step is glucometer monitoring. It will become very clear quickly with glucometer monitoring if she truly has GD or not. If she does, she can learn what triggers her body’s sugar responses and how best to bring it until control, if possible, through diet and lifestyle. Ignoring that a problem exists will not change the effects on her or her baby’s body.
Preparing for a glucose test:
You should eat about 150 grams of carbs each day 3 days prior to the test. It prepares your body for the sugar overload. Increasing your exercise revs up your system. Most doctors assume that Americans are getting plenty of carbs. However, if a woman isn’t eating that way, then her body isn’t used to the sugar. The argument could be made that, “I don’t eat high carb, so the test is inaccurate or not relevant to my diet.” But remember, your body IS making more glucose. Your body is having to make more insulin. That will increase through the 3rd trimester as baby’s growth is vital. We must see how you, your pancreas, your hormones, your placenta and your liver is handling it.
To do or not to do the Glucola testing? Honestly, I feel that is a question you must answer. My job is to give you the opportunity for informed consent. Resources: Understanding Diagnostic Test in the Childbearing Year by Anne Frye, A Midwife’s Handbook by Constance Sinclair,