Blood sugar in pregnant women: the norm, what to dowith increased blood glucose, treatment of gestational diabetes

Update: October 2018

A woman in an interesting position is completely new.
ecosystem designed to function for 9 months
aim to make a new life without destroying its own. One of the important
the problems of the pregnant woman and her attending physician becomes saving
optimal constancy of the internal environment (with small allowable
fluctuations).

During pregnancy it is undesirable to have anemia, persistent
increase blood pressure, pathological changes
hepatic tests, blood clotting, renal glomerular
filtration and potassium levels. Equally important is to ensure normal
carbohydrate metabolism, since its significant fluctuations can
affect the conditions of uteroplacental blood flow,
provoke changes in the development of the fetus or adversely affect
the state of blood flow and the nervous system of the woman herself.

Blood sugar is supported by several mechanisms. AT
primitive reading is a complex of proinsular hormones and
insulin against contrainsular hormones. First sugar levels
roughly speaking reduce. ATторые препятствуют этому. ATо время
pregnancy metabolic processes are more stressful and can
ease to fail. AT частности отмечается физиологическое
decreased tissue insulin sensitivity
for the development of carbohydrate metabolism disorders.

  • Only about 10% of all carbohydrate metabolism disorders,
    registered in women in a position that existed even before
    onset of an interesting position 1 or type 2 diabetes
    (pre-gestational).
  • 90% of deviations in carbohydrate metabolism are newly acquired,
    associated with pregnancy.

TOогда исследовать глюкозу крови

AT принципе при постановке на учет в женской консультации по
about the onset of pregnancy to all the ladies, along with other
blood sugar (standard
biochemical analysis). Usually, this happens for workers on time.
up to 12 weeks. AT общем же данный параметр должен быть оценен у
women in terms of up to 24 weeks without fail. No
special consultation of an endocrinologist for examination or
detection of deviations is not required.

With the purpose of the study and the evaluation of its results
able to handle a gynecologist or a therapist. By standard
blood plasma from a vein is examined (although quite often laboratories
give conclusions on the analysis of serum, which may entail discrepancies
в интерпретации показателя Sahara). AT идеале забор крови натощак.
But it is possible to study during the day without regard to eating
(it is likely to require fasting glucose control).

ATарианты исследования

ATесь скрининг гипергликемии беременных может быть разделен на
two stages. The following can be performed on the first
research:

  • ATсем дамам в интересном положении во время первичного обращения
    to the gynecologist or therapist for the first 24 weeks is determined
    on an empty stomach sugar venous plasma.
  • ATместо этого может определяться гликированный гемоглобин 
    (HbA1c). Алтернативный вариант —  определение плазменного
    venous blood sugar throughout the day. The last indicator is
    only indicative and requires control on an empty stomach level
    Sahara.

ATторой этап выполняется, если ранее не определялась гликемия или
at the first stage, pathological deviations in the analyzes did not appear.
For this, between 24 and 28 gestational weeks is performed
control glucose sensitivity. AT некоторых ситуациях (высокие
risks of diabetes in a pregnant woman, signs of diabetic fetal fetopathy)
The test can be completed before 32 weeks.

Tolerance Test Procedure

  • Venous blood sampling is carried out in tubes with preservative.
  • Three days before the test, you need food in the usual
    mode without restrictions on carbohydrates (at least 150 grams per day) and
    to experience the usual physical exertion.
  • At dinner the day before the examination a woman should eat
    30-45 grams of carbohydrates. After that, food is required to refrain
    no less than 8 hours.
  • In the morning on an empty stomach venous blood is collected. AT случае соответствия
    sugar levels manifest diabetes (7.0 mmol per liter or higher)
    the test does not continue.
  • Дается углеводная нагрузка (75  грамм безводной глюкозы
    pour and stir in a glass of water and then drink five
    minutes)
  • Two hours later, blood is re-taken.
  • AT процессе исследования нельзя есть, курить, давать физическую
    load.

Testing is contraindicated in the case of manifest sugar
diabetes, glucose absorption disorders (exacerbation of pancreatitis,
dumping syndrome, condition after gastrectomy) or during its
intolerance.

Norm of blood sugar in pregnant women

  • The emptying sugar of venous plasma is 3.57 + – 0.49 mmol per
    liter
  • Glycemia an hour after eating (postprandial) 7.8 mmol per
    liter
  • Гликированный гемоглобин (HbA1c) на 20%<нормы
    non-pregnant

ATиды углеводных нарушений у беременных:

  • Manifest diabetes will be if it is first identified during
    of pregnancy.
  • Gestational diabetes mellitus – a disease characterized by
    high sugar levels on the background of pregnancy, but excellent
    laboratory criteria for manifest diabetes (sugar below
    diabetic, but above normal).

The dangers and consequences of gestational diabetes

  • for the mother: the risks of developing type 2 diabetes, obesity,
    cardiovascular pathologies, preeclampsia on the background of this and subsequent
    pregnancies;
  • for the fetus: diabetic fetopathy, asphyxia and hypoxia in
    childbirth, skeletal and central nervous system injuries during childbirth, postpartum level drop
    sugars and insulin jump, hyperbilirubinemia, respiratory
    distress syndrome, death in childbirth.

Scanty gestational diabetes
make it a problem that’s very important
timely identify by laboratory parameters and separate from
first emerged on the background of pregnancy full sugar
diabetes.

Laboratory signs of manifest diabetes (new norms
Sahara)

  • fasting glucose is equal to or greater than 7.0 mmol per liter,
  • venous blood plasma sugar at an arbitrary time of day is equal to
    or more than 11, 1 mmol per liter,
  • glycated hemoglobin is equal to or greater than 6.5%,
  • sugar venous plasma 2 hours after the carbohydrate load (in
    test for glucose tolerance) is equal to or more than 11.1 mmol
    per liter.

If there are no characteristic diabetic symptoms (dry
mouth, thirst, increased urination) to verify the diagnosis
glycemia control is carried out twice.

Laboratory criteria

Algorithm for the diagnosis of manifest and gestational diabetes

Чтобы  зафиксировать гестационный сахарный диабет у
pregnant, enough for any period to reveal one abnormal
Criterion of the following:

  • Glycemia of the venous plasma on an empty stomach is more than or equal to 5 mmol per
    liter, но менее 7,0 милимоль per liter.
  • Glucose Tolerance Test (24-28 weeks of gestation) glucose
    venous plasma:

    • after 60 minutes less than 10 mmol per liter,
    • спустя 2 часа менее 8,5 ммоль per liter.

Does diabetes cause symptoms in pregnant women?

Manifestations of diabetes in this category of patients may
be as typical, bright, for example, when manifest form: dryness
mouth, increased thirst, excessive urination, itchy skin or
mucous and extremely scarce (with gestational form). The higher
the level of glucose in the blood, the longer the periods of its rise, the
big changes occur in the body, the higher the risks
ketoacidosis and organ damage (visual impairment, edema,
trophic and immune changes, heart and vessel problems).

How to behave

Women are shown moderate oxygen loads (walking,
плаванье) порядка двух с половиной часов в  день.

A rational diet for gestational diabetes is also
an important component of risk reduction.

  • Fully sugar should be excluded from the diet.
    glycemic index (high rate of cleavage and absorption
    Sahara). See tab. below.
  • Fats are limited.
  • The entire volume of food is evenly distributed to 3-4 intake in
    day.

Attention is paid to the calculation of calorie:

  • If before the pregnancy the woman had a normal weight,
    she relies 30 kilocalories per kilogram of weight per day,
  • Ladies, whose weight was 120-150% of the ideal, kalorazh
    придется ограничить 25 ккал на кг в day.
  • If the weight exceeds 150% of ideal body weight, calories
    reduced to 12-15 per kg of weight.
  • Little ladies (less than 80% of ideal weight) should receive
    about 40 kcal per kg. weight daily.

Changing calorie and depending on the period of gestation. As
fetal growth, it increases from 4 months to 150 kcal, from 5 to 9 months
for the same amount. For example, let’s say that 150 kcal is about
60 grams of bread or 100 grams of cottage cheese.

Nutrition for gestational diabetes should take into account
recommendations on the ratio of the main components: proteins, carbohydrates
and fat.

  • Carbohydrates should take 40-45% of the diet,
  • Proteins – 20-25%,
  • Fats of about 30%.

Mandatory food additives such as potassium iodide (for
prevention of thyroid abnormalities in the pregnant woman and the fetus, for
prevention of miscarriage) at a dose of 200-250 mcg.

Since most anti-insulin hormones are produced
in the human body in the morning, the main part of the carbohydrate
food load should fall on the afternoon. With
this fast-absorbing carbohydrates should be excluded from
diet.

Menu for gestational diabetes

  • It is worth regularly to eat protected carbohydrates (cereals,
    vegetables, pasta). They should take up to 6 servings per day.
  • Fruit is about 5 servings per day, taking into account caloric and
    digestibility of carbohydrates from them.
  • Double protein intake is required.
    give preference to low-fat varieties of red meat, pork,
    rabbit, birds. With отсутствии аллергии показаны также яйца и
    a fish. Protein – at least 2 servings per day.
  • No need to avoid dairy products. Yoghurt, cheese,
    milky products – up to 3 servings daily.
  • Fats (animal and vegetable) must be balanced.
    It is worth avoiding refractory fats.
  • It is advisable to limit pastries and pastries in which
    много легкоусвояемых сахаров and fat.

What you need to know about carbohydrates

List of foods with a glycemic index

Sugar is found in almost all plant foods. 
(excluding nuts, consisting mainly of fats and mushrooms, consisting of
from pectins), as well as in milk and its liquid derivatives.

For sugars that can be eaten without restriction
their is fiber (dietary fiber). Cellulose swells in
stomach, quickly gives a feeling of fullness and does not affect the sugar in
blood.

Counting accounts for those carbohydrates that are digested. Easy
simple carbohydrates are absorbed into the blood (glucose, fructose). They
contained in grapes, grape juice, raisins, fruits and berries,
honey, jam, confectionery, sweet drinks. TO
simple sugars include milk (lactose) from liquid milk
products, as well as malt sugar from kvass and beer.

Difficult to break down and long absorbed complex sugars
(starch) contained in pasta, cereals, bread, potatoes,
peas, beans, beans, dishes with flour.

It is very easy to remember which sugar-containing products in which
volumes can be used with the help of the “Traffic Light” system. Green
group – we eat without restrictions, yellow group – we limit ourselves
half the usual portion, red group – we exclude or eat
Extremely cautious, rare and tiny portion.

  • So, green products: tea, mineral water, soda
    sweetener, mushrooms and all vegetables, except potatoes,
    corn and ripe beans and beans.
  • Yellow: potatoes, corn, bread, pasta, ripe legumes,
    fruits, with the exception of dried fruits and grapes. This also includes
    sweeteners such as aspartame, saccharin, cyclamate,
    acesulfame.
  • TOрасные: сахар, джем, варенье, мед, конфеты, шоколад, печенье,
    cakes, cakes, waffles, gingerbread, sherbet, marshmallow, marshmallow, marmalade,
    juices, sweet soda, sweeteners xylitol, fructose,
    sorbitol.

Regulate and have to use fat

  • If you use the same scheme, then the yellow group fall
    lean meat and fish, cottage cheese up to 4% fat, cheese up to 30% fat,
    nonfat milk and lactic products.
  • In the red sector will be: lard, margarine, smoked meats,
    sausages, sour cream, fatty fish, nuts, seeds, cottage cheese and cheese with
    more than in the yellow group with fat.

If you imagine the perfect plate for one meal,
then it should take half of the vegetables from the green group, a quarter –
yellow protein main course, quarter – side dish of
potatoes, pasta or porridge, a piece of bread. The plate can add
a glass of non-fat milk or yogurt and a dessert made from half fruit. All
food must be kept within the recommended calorie.

Self Control Parameters

After establishing pregnant gestational diabetes in her
It is advisable not only to monitor the level of sugar, but also to lead
diary of their observations of the nature of power. This is significant
simplifies status tracking and streamlines lifestyle
patient.

  • Glycemia is measured with a glucometer (using test strips) on
    empty stomach and after 60 minutes from breakfast, lunch and dinner.
    It is considered normal when on an empty stomach in the morning, at 15 o’clock and
    at bedtime, glucose does not exceed 5.1 mmol per liter, and after an hour
    после еды она не выше, чем семь ммоль per liter. Also periodically
    urine is given to assess the presence of ketone bodies in it.
  • Body weight and blood pressure are measured regularly.
  • Started food diary.

If the diet fails to reduce sugar with a diet for
two weeks and his performance is twice or more than
targeted, women are given small doses of injectable insulin
drugs. Standard scheme includes short-acting insulin.
before eating and long overnight.

Gestational diabetes mellitus without complications
is the basis for hospitalization of a pregnant woman, her early
delivery or delivery by cesarean section.

Thus, it is worth remembering that gestational diabetes
its course and outcomes directly depend not only on features
carbohydrate metabolism, but also on the lifestyle and diet of the pregnant.
Remember that everything you eat in an interesting position may be
used against you.

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