Pregnancy in diabetes, or gestational diabetes, is really common. Up to about 12-14 percent of all pregnancies. There are certain women that are more at risk of developing gestational diabetes but in fact, everybody is at risk. This can be hard because you might think – I am young, healthy and without symptoms so what am I doing with diabetes?

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And it is an issue in pregnancy that needs to be addressed. Most people know that in a diabetic pregnancy the baby can get very big which can complicate the birth. Once born the big baby can also be unwell. Less people know that the placenta can be affected and result in the baby being growth restricted.

This episode talks about:

• When and how you are tested for gestational diabetes
• Blood sugar limits for testing for diabetes
• How testing positive for diabetes isn’t a failure!
• The risk factors that increase your chances of gestational diabetes
• Treatment options to help bring your blood sugar level down
• The importance of a good diabetes educator
• How diabetes may change over the course of your pregnancy
• Why getting induced is common if you have gestational diabetes
• What happens after you have your baby

Brigid [00:00:36] Well, welcome, everyone. This is episode 17, and today we’re going to talk about when you get told you have diabetes in pregnancy. It’s really common, isn’t it Paddy? 

Patrick [00:00:44] It sure is. And sometimes it’s a real surprise to people because they think I’m young. I’m healthy. Slim and eat well. So what am I doing with diabetes? 

Brigid [00:00:55] Yeah. And sometimes I think that, you know, they don’t have any symptoms. So why are you even suggesting I should get tested? Why is that even relevant? Yeah. So for listeners, we are in our hometown of Ballarat and it’s beautiful here at the moment, isn’t it? Spring and springtime. And we’re going channel my mum here and she always thinks there’s gonna be more babies in springtime. 

Patrick [00:01:18] Love that it is such a country thing that it’s springtime and the lambs are being born. So there should be more babies born. When your mother says that, I just smile and nod. 

Brigid [00:01:28] In fact, we’ve there’s no rhyme or reason, is there, for when our practice is busier. We’re not doing anything in January. There’s a very busy month, isn’t it? 

Patrick [00:01:39] Well, that’s gonna be the busiest of the year. Yeah. Yeah. 

Brigid [00:01:42] All right. So, Pat, is there a difference between diabetes and diabetes in pregnancy? 

Patrick [00:01:47] Well, yes. Most people are familiar with Type 1 diabetes, which is the diabetes that comes on in children and young people. And you need insulin injections and type 2 diabetes, which is usually diabetes that comes on in older people usually associated with obesity. And pregnancy diabetes is different. It has something in common with those conditions. But the causes of it are complex. They were relate to certain degree to genetics and ought also to the behaviour of the placenta. Okay. So it’s a different risk group. In fact, everybody is at risk. 

Brigid [00:02:28] Right? And so how common is it? 

Patrick [00:02:30] Well, it’s up to about 12 to 14 per cent of pregnancies. And certainly you’re at high risk if you’re very overweight or older, but you’re also at some risk if you’ve got a normal body weight and you are young.

Brigid [00:02:46] Yeah, right. Well. All right. Well, why is it a problem in pregnancy? Why do we even test for it? 

Patrick [00:02:51] Well, the studies have shown that it’s not great for the baby to grow in an environment of excess sugar. Everybody’s heard of the idea that diabetic pregnancy, the baby can get very big and fat, which is true. And that can be a problem for the baby being unhealthy, but also maybe not fitting out and then. But less people know about the idea that a diabetic pregnancy, the baby can be small and growth restricted and sick sick from being too small. And that’s to do with the placenta not working terribly well. When, when and if the blood sugars are highly abnormal,.

Brigid [00:03:29] What does it just becomes like calcified or something. 

Patrick [00:03:32] So there’s lots of complex ways in which the placenta can malfunction and they’re more common with diabetes. 

Brigid [00:03:38] Right. Okay. So when do we have the test? When’s the most important time to be tested? 

Patrick [00:03:45] The standard test is done at 28 weeks, and sometimes that might be done earlier if someone had, for example, had gestational diabetes in a previous pregnancy or was very overweight or had some other risk factors. But the standard test for a healthy woman is done at 28 weeks. And that’s that oral glucose tolerance test, which is the famous test of where we go in fasted and the blood is taken fasting. 

Patrick [00:04:12] So straight up blood taken on an empty tummy. And then you drink the the gross drink, which tastes like um neat, cordial. 

Brigid [00:04:22] It’s disgusting. 

Patrick [00:04:23] And then the bloods are taken one and two hours after the drink. And the test is how well your body metabolizes that sugar. 

Brigid [00:04:33] And the limits have changed a little bit, haven’t they? So in 2013, they changed to be a little bit lower. So more women are diagnosed with diabetes now? 

Patrick [00:04:43] Yes. So the Australian Diabetes Association, the experts in the disease in diabetes, have changed a couple of times over my career. They’ve made some changes to make the diagnostic criteria more strict. So just a growth of knowledge in the area. We used to be thought that a certain level of sugar was not associated with problems. They found out it was. So to pass the test, you had to do a little better. 

Brigid [00:05:07] Yeah. And so I’ve got the limits here. So fasting. You have to be at or below 5.1. 

Patrick [00:05:14] Yeah. And that’s that’s that’s that’s clearly abnormal to have a fasting higher than that. Yeah. You haven’t anything to eat for 7 hours. So it should be right. 

Brigid [00:05:26] Yeah. And women do get a bit pent up about that. So you know they say well I was 5.2 and they’ve said that I’ve got gestational diabetes and I don’t believe it and. What do you think? 

Patrick [00:05:36] Look, I think some. There’s probably the odd case where you could argue that it was a bit too strict, but we have to have the cut off somewhere, a woman diagnosed as a borderline case has nothing to lose from from that diagnosis. The diabetic diet is one we should probably all follow. Yeah. To a certain degree. So. So let’s say you you felt that you only failed the test because of the way that the test was conducted or that you were having a bad day. 

Brigid [00:06:02] Or so had had something to eat just before the time frame for the fasting started. 

Patrick [00:06:07] And yet the test has been designed in the way that that shouldn’t explain being over the limit. But even if it did. What if you really got to lose? We certainly have people who are way over the limit on the test, but they make some minor adjustments to their lifestyle in terms of diet and exercise, and they never get a single high sugar again for the rest of the pregnancy. Well, it’s not that they didn’t have it, it’s that those changes were necessary. 

Brigid [00:06:31] That actually had an impact. 

Brigid [00:06:32] Yeah, yeah, I know. I think you said the word that might explain it. And that is you failed the test.

Patrick [00:06:42] So I shouldn’t have said failed. 

Patrick [00:06:43]  So this is what we worry about, isn’t it, that people might or might feel an enormous amount of pressure. These are glucose tolerance test for diabetes it’s not a pass or fail test. It’s how you perform on the test. And failure suggests that you’ve done something wrong and you haven’t. It’s just sugar is too high and we are going to help you bring it down. 

Brigid [00:07:03] Yeah. Or that your body’s failed you in some way or whatever it might be. But that’s that’s kind of the language around it, isn’t it, that women do feel like they’ve not pass that test? 

Patrick [00:07:12] Yeah. And I think that to have a little bit of understanding that the pathology behind gestational diabetes is complicated and it can be genes that aren’t your fault and interactions between your system and your placenta that aren’t your fault, that can that can push the sugars up. And it’s nothing to do with you eating the wrong, sometimes, t’s nothing to do with you eating the wrong things or not doing enough exercise. 

Brigid [00:07:32] Yeah, because it could be just your cultural background, couldn’t it. Yeah. 

Patrick [00:07:36] So some people are just sitting ducks. It’s much more common to get pregnancy diabetes if you’re from a South East Asian background, for example. Yeah. 

Brigid [00:07:46] And then does it make any impact if you’ve had other things like you and we might have had gestational diabetes in the past or or any other hormonal issues. 

Patrick [00:07:56] Yeah. So women with polycystic ovaries, for example, more likely to be diagnosed with pregnancy diabetes and someone with a strong family history of Type 2 diabetes is at high risk as well. Yeah. 

Brigid [00:08:07] And I read somewhere that if you’ve given birth to a large baby, you’re predisposed to it? 

Patrick [00:08:11] There may be. And we’ll. Yes, you are. And the explanation might have been that you actually did have gestational diabetes back in that pregnancy as well. Yeah, right. And it just wasn’t for whatever reason, diagnosed. So, you know, if some if someone has a very big baby with no other apparent explanation, we always think, hang on it a minute. Was this diabetes and we missed it. 

Brigid [00:08:32] And what is a big baby? Let’s just go there. 

Patrick [00:08:35] Oh, well, I would consider a small woman with a small partner, who’d had a baby over four kilos in the past and no diagnosis of gestational diabetes. I would think hang on, maybe she did. And maybe we should have our extra sensors out for the same thing happening this time. 

Brigid [00:08:52] So there’s leeway if you had a larger couple. Both both partners, a bigger frame or whatever you would expect if they had a bigger baby than that, then that’s less suspicious. Yeah, yeah. Yeah. All right. And the other thing is that if you’ve gained weight too fast in the first half of the pregnancy. 

Patrick [00:09:09] Yeah, that does happen to people. 

Brigid [00:09:12] Too many magnums. 

Patrick [00:09:14] Didn’t you say you had a magnum a day?  

Patrick [00:09:16] Maybe I have a magnum a day in the first pregnancy. Yeah. So. So a lot of weight gain. Absolutely. Yeah. So in that regard it is important. Body weight and diet are important, but they’re not the whole story.

Brigid [00:09:30] All right. So I’ve come back and I’ve got a fasting that’s over 5.1. What is what is M M O L again? 

Patrick [00:09:36] Oh, that’s milimolle. That’s that’s a.. Just a measurement of the amount of sugar. 

Brigid [00:09:40] Okay. And that’s an Australian and that’s what we use in Australia. 

Patrick [00:09:43] But yeah. Everywhere will have their own system. But the Australian is. You’re over the limit on the test. If it’s more than 5.1 fasting or more than ten at one hour or more than eight point five at two hours. 

Brigid [00:09:56] All right. And we might put in the UK and the US standards as well in our show notes. 

Brigid [00:10:01] That’s great. Yeah. People can have a look at that. All right. So we’re over the limit. So what do we do now? 

Patrick [00:10:06] Yeah. So the first thing I like to say to people is don’t panic. This is this is, you know, we can fix this. We can bring the sugars back down one way or the other. It’s often easy to bring them back down. And when we bring them back down, the outcomes are good. So don’t panic. The first thing I like to do is get my patients with gestational diabetes into see a diabetes educator because they go and spend half an hour to an hour with a diabetes educator and learn a bit about the disease. Learn the basics of managing the diet, dietary requirements and you get a glucometer and the strips. And so the glucometer is a little gadget that measures the blood sugar and it makes a little prick in your finger drop, a little bit of blood and the strip sucks the blood up off your finger and goes into the machine. Tell us what the blood sugar is. 

Brigid [00:10:59] So this is something that you take home. Yeah. And do you know whether you have to buy it or is there a cost? 

Patrick [00:11:03] Well in Australia it is subsidised. So you go through a diabetes educator and they’re the one who gets you all that gear. Right. And so they show you how to use it. And the first thing I want to see is a week’s worth. Yeah. Okay. Because the test itself is a lot artificial, isn’t it? You don’t actually drink that much sugar in normal basis, no one sits down with a cordial bottle and just drinks out of the top.

Brigid [00:11:23] Well we hope not. Maybe one of our kids might. 

Patrick [00:11:26] Yes. So you go to diabetes educator and you get the gear and a book and in the book they write the targets. So you know what the morning target to be whatever. And then the post meal targets to be whatever. And you go off and you take your sugars every morning before breaky, and after breaky, after lunch and after dinner. And we see people after a week. That’s what I do. And sometimes they’re perfect. And that’s because the diabetes educator has also told that person about eating well and doing some more exercise. 

Patrick [00:11:57] And if they’re perfect, they’re perfect. 

Brigid [00:11:58] But they just have to keep eating well and exercising. 

Patrick [00:12:01] You can’t get usually they’re perfect because you’ve made some changes. Yeah. Yeah. So we carry on and we keep on measuring because as the pregnancy progresses, the sugar metabolism changes a little bit. And it can be harder to keep normal levels. 

Brigid [00:12:17] Is that why some women can control by diet and exercise, but then need a different treatment plan towards the end of their pregnancy? Absolutely. Yeah. 

Patrick [00:12:24] So you sugar’s fine and then suddenly it’s less fine and then suddenly it’s not. Yeah. And then so we keep on testing and at some point it might be clear that that more treatment than just diet and exercise is needed. And there’s two big treatments that are bought in after that. One is metformin, which has a tablet and it’s the tablet that people with type 2 diabetes traditionally take. And it it’s safe for use in pregnancy and works pretty well. Metformin upsets people’s tummy and bowels, constipation or diarrhoea. And so it’s not a hugely popular drug to be on. But after a couple of weeks, the upset of the bowels often settles down. And it’s to avoid that upset of the bowels and also to try and be more precise than a lot of us use insulin. Yeah, sounds a bit drastic to me straight on insulin, but actually it’s not that hard to do either. And in that setting, we go back to diabetes educator and sometimes to a doctor who’s an expert in managing diabetes. 

Brigid [00:13:25] What’s their specialty called? 

Patrick [00:13:27] Well, they’ll often be a physician and endocrinologist. And they’re, you know, they’re specialist doctors who take hard cases of diabetes for non pregnant people. And they’re also very good at managing it in pregnancy. So they’ll often help us with dosing and so forth. And then we just want to do is learn how to use the little insulin injector pen. 

Patrick [00:13:47] We put the cartridge in, dial up the dose we need. And it’s got a little needle. 

Brigid [00:13:51] A little fine gauge needle, isn’t it? 

Patrick [00:13:53] They’re small. You can’t really get it wrong. You just pinch up some fat on your tummy or your thigh and put the needle in up to the hilt and push the button. Having dialled up the dose on the pen. 

Brigid [00:14:05] Yes. And as I know that there will be people that are a bit phobic about needles, but it’s sort of a means to an end, isn’t it? Yes. 

Patrick [00:14:13] And it’s and even the most, you know, even people who are scared of it at the start get the hang of it pretty fast. Yeah. And of course, insulin works like a charm. Which brings the sugars right back in line very quickly. Yes. And the idea, of course, is that if you if you recreate normal blood sugar levels, the various processes of how the placenta works and how the baby grows should should be restored to normal. 

Brigid [00:14:34] And so let’s talk a little bit about that. I mean, we’ve talked about what the treatment is and what the levels are and stuff. But why do we care so much? 

Patrick [00:14:40] You know, it’s it’s an excellent question. And for a long time, we didn’t actually know that pregnancy, diabetes was a significant condition. So some studies were eventually done that that that determined that that outcomes were definitely better if we tested for it to saw it as a real thing and treated it. Okay. We’ve always known that pre-existing type 1 diabetes is it really complicates pregnancy. So this is somebody who’s already got diabetes. They’re already on insulin and then they get it. We’ve always known that those pregnancies were complicated, but was gestational diabetes a real thing? The evidence that it is a real thing is not that old but it’s in now. And we know that it’s a real thing and that some of the complications related to diabetes in pregnancy will be seen with just gestational. It’s not always mild. 

Patrick [00:15:34] We know that that outcomes for mothers and babies are better if we treat it, and we know that immediate outcomes for the babies are better, lke how they go immediately after birth. But there’s some fascinating research going on as well about whether the origins of adult disease can be dated back to the foetal environment. Right. So if you have a heart attack at 50 because you have heart arteries too hard and they get blocked is their tendency to getting hard and blocked. Can that be traced right back to what was going on when your foetus. 

Brigid [00:16:07] What, in relation to gestational diabetes? 

Patrick [00:16:12] Potentially.

Patrick [00:16:13] So, you know, this is still an area of research. But if we think that a lot of adult diseases are partially, partially have their origins in the quality of the foetal environment, then it makes sense to maximize that environment as best we can. 

Brigid [00:16:25] Yeah. And so their long term potential complications of having gestational diabetes. What about. Well, just what are some symptoms? I don’t know what what the symptoms of having gestational diabetes would be for the mother and the baby? 

Patrick [00:16:39] Well, the mother typically didn’t feel many symptoms. So it’s a bit it’s a bit like type 2. You know, type 2 usually gets diagnosed because your GP thinks you’re overweight and tests you for it, not because you come in with any particular complaint. 

Brigid [00:16:51] Peeing a lot? 

Patrick [00:16:53] Yeah. But you know, it’s often just diagnosed through vigilance. Yes. Yes. And pregnancy diabetes it’s not that common for it to cause you know that to thirsty painting a light that could be related to say a teenager who’s diagnosed with type 1 much more often, it just turns up on the test. Yeah. The reason why we have test everybody, no matter how healthy is it happens to healthy people, but also because it doesn’t have reliable symptoms. Yeah. And then for the babies. Well we know that they can get. They can be sick because they’re too small. 

Brigid [00:17:29] That’s because of the placenta. 

Patrick [00:17:30] Placental dysfunction. They can be sick because they’re too big. Okay. So baby comes out five kilos, looks big and healthy, but actually sick. 

Brigid [00:17:39] Because of why? 

Patrick [00:17:40] Well they have trouble maintaining their own blood sugars. When they when they’ve come out of such a sugary environment into the world where cold world where the sugar comes from, what they eat. So they look big and strong. But but often their blood sugar will be too low. And in response to the sugary environment, they will pump out more of their own insulin and so forth. So these are all problems for those first few days. And if babies get too big, then they get to then getting too big to fit out is a problem. 

Brigid [00:18:15] And so does that mean that most women with diabetes, gestational diabetes will be induced? 

Patrick [00:18:21] You know, getting induced is common. And there’s a few reasons behind that. One is that will often see complications related to diabetes happen at the very end. And if we can afford to get on with it before the very end comes the very end, the pregnancy comes, then we can skip those. 

Brigid [00:18:39] What do you mean? What are those things that happen at the end? 

Patrick [00:18:44] One of the things that commonly happens is that you can go from really nice control to really bad control right after the due date. 

Brigid [00:18:51] So, you know, blood sugar levels are spiking and all over the show. 

Patrick [00:18:54] And it can be very variable. Yeah. And if we think we can get away with an induction before all that happens, then that’s that can be better avoided than than treated. Secondly, if diabetes in pregnancy is going to affect placental function, that might not actually be revealed until the very end as well. So you can get past the serious problem of the placenta not working properly by having the baby before the placenta packs up. And sometimes we’re trying to knock some shave some growth off. Yeah, okay. So big baby, macrosomic baby. Our best chance of getting that baby out vaginally might be into intervening before it gets super big. 

Brigid [00:19:32] Yes. And that’s that’s tricky, isn’t it? Because people think, you know, you read it again, that people say, oh, well, they’re my obstetrician thought the baby was going to be for four kilos. It ended up being 2.8. Now, that’s probably an extreme they hopefully wouldn’t get it that wrong.

Patrick [00:19:47] But no, but that’s a that’s a good point. Right. So estimated figure weight is a tricky thing. We try and pick big babies just by the old fashioned laying on of hands. So we put our hands on the belly and we measure with tape measure. Yeah, surprisingly accurate for a bit of old fashioned analogue technology. And the laying on of hands is a, you know, surprisingly accurate in experienced hands. So I I wouldn’t say I am good at picking, you know, to the gram, what weight your baby will be, but your hands do get pretty good. If you see a pregnant woman in clinic and you know, she’s 34 weeks and you put your hands on and think “This is way too big or way too small” Yeah. Yeah. So then you get an ultrasound and ultrasound will give an estimated foetal weight where they will measure the head, the belly and the legs and a computer model within the ultrasound machine will calculate an estimated weight of the baby, but it’s an estimate. 

Brigid [00:20:40] Let’s say someone has seen someone and they’ve said the baby is big when the assess with the laying on hands, it sounds  sounds like it’s your natural practice to then go on for ultrasound. But if that isn’t the natural practice of that particular health provider, can a woman then say, can I go and have confirmation from an ultrasound or is there any with any use in her doing that? 

Patrick [00:20:59] I would like to think that scans are being offered to people these days who where where decisions are being made based on the fact that the baby is too big. Yeah. Ultrasound. You know, it’s not 100 percent accurate in measuring the baby’s size, but it’s a lot better than nothing. 

Brigid [00:21:13] Now, you mentioned that a baby that is too big might have trouble controlling their own sugars. Well, what happens then? Does the baby go to the special care nursery or anything like that? 

Patrick [00:21:24] So we’ll usually bring the pediatricians to the birth of a baby where the pregnancy is being affected by diabetes and there’s a a protocol within the hospital for managing that baby when they first come out. So babies that are over a certain size or there’s been diabetes or both are at risk of their sugars going way too low. And the pediatricians will be on to that. They’ll measure the sugar levels of the baby’s blood with a little technique to get some blood that we used to test babies for all sorts of things. And if the sugars are too low, they’ll treat that. Then they will use glucose jelly, which they can rub in the baby’s mouth on the gums and that that works quite nicely in a mild to moderate case. They’ll use an intravenous sugar drip in a severe case and they’ll often turn to early feeding as well. And we’re talking about before the breast milk comes in. So. Right. So give formula from the start until the breast milk comes as the baby’s sugars too low to wait for the breast milk. 

Brigid [00:22:21] And I also read that, you know, again, motivated patients with gestational diabetes might actually collect colostrum before. Yeah, yeah. 

Patrick [00:22:29] Yeah, absolutely. So that works. That works really very well. 

Brigid [00:22:34] Can I say they must be very motivated. I remember trying to get some colostrum and it’s like dropper’s full, like a drip. 

Patrick [00:22:40] Yeah, you need a little  5 mil or 1 mil syringe and just pick it up in little beads off the nipple. And it’s hard but yeah. So you collect it in a little syringe and squirt into a little like a little urine specimen container and then freeze it. Yeah. 

Brigid [00:22:58] So when can you start that? 

Patrick [00:23:00] Well  people start to lactate from about halfway through the pregnancy. You know it’s seen as a bit of a nuisance, but if you collect it it’s unbelievably handy to have if there’s a problem with delayed onset of lactation or if the baby comes too early. 

Brigid [00:23:15] Right. And can’t suck. Yes. Yes. So that’s back in the premmie episode. Yeah. 

Patrick [00:23:20] Yeah. So the people put the nose knows gastric tube down and then they can put the express breast milk down the tube. 

Brigid [00:23:28] Yeah. Oh, clever people. All right. So if I’ve got gestational diabetes, what what does that mean for my personal longterm health? 

Patrick [00:23:36] Yeah. It certainly raises your risk of getting type 2 diabetes in the future. And that’s just that they share some common genetics. So everybody who’s been diagnosed with gestational diabetes should have another all oral glucose tolerance test at six weeks after the baby comes. And that’s to make sure that they don’t have type 2 already. So especially somebody who’s overweight, what we might be finding at their 28 week diabetes test is just type 2 that they’ve had for ages and they’ve still got it even after the pregnancy hormones gone away. So some of those will be positive and that’s type 2 and that person should be managed accordingly. Weight reduction, lifestyle change and tablets. And most people will pass that. But in the future, they are more likely to get type 2 than somebody else. So they would keep in touch with their GP over the years and get tested from time to time. 

Brigid [00:24:29] And just instigate a diabetes diet for that whole time. You know, it’s probably as you said, we all should be eating it. Yes. 

Patrick [00:24:36] So so that person, well advised would be would be trying to stay in better nick than they otherwise would have because they’re at higher risk of diabetes. 

Brigid [00:24:47] One question I meant to ask. You know, if someone’s in a really long labour and they’ve got gestational diabetes, what is their blood sugar level doing? 

Patrick [00:24:54] With gestational diabetes it’s usually fine. You don’t go too low with some gestational diabetes. So if anything, it would be a little bit high during the labour. And that’s not the end of the world. If you’ve got type 1 diabetes taking insulin, then it’s always a balance between the food you put in that pushes blood sugar up and the insulin you inject that pushes your blood sugar back down. And in labour, in active labour. People don’t eat much. So they’re expanding energy. Yes. So you’re spending energy, you’re not eating much. And it’s easy for your blood sugar to go too low. So it’s like running a marathon, you don’t stop to eat. You might stop to drink. But in advance labour, it’s the same as the marathon. The cardiac output, the blood from your heart is going out to your muscles and in the labour it’s going into the uterus. Not much is going to the gut. And the gut knows that. So doesn’t want you to want to eat. So because not not a lot of blood supply goes into the stomach and the small bowel. So your system knows that you shouldn’t eat. So you don’t need usually as much insulin as you think. And that’s why in labour with a type 1 diabetic, we would use a sliding scale. That’s just a way of dosing the insulin based on what the blood sugar says. 

Brigid [00:26:12] It doesn’t matter even if you’ve got gestational diabetes and you’ve been using insulin to control it?

Patrick [00:26:18] Well, gestational with insulin. Yeah, you might use a sliding scale as well. Yeah. Yep. Gestation without insulin, no.

Brigid [00:26:24] Yeah. And we’ve probably gone into sort of obstetric consultant territory and you don’t listener need to sort of concern yourself about that. The obstetrician or your health care provider in charge will be the one sort of controlling your treatment.

Patrick [00:26:38] I think what we need to know about sliding scales is, is that it’s a way of adjusting the dose based on what the blood sugar is right now. So you might have a you might take a blood sugar level at every hour or two and take a dose of insulin to match the sugar. The immediate sugar. Yeah. And then after the baby’s out, or more accurately, after the placentas out, people with gestational diabetes goes away. 

Brigid [00:27:04] Immediately? 

Patrick [00:27:04] Immediately. Yeah. So that is phenomenal, isn’t it? Well it is, but it just goes to show how much of it is hormonal through the placenta. Yeah. Yeah. It really goes away immediately and so convincingly that we don’t even really bother checking the sugars from that time onwards. 

Brigid [00:27:22]  Apart from your six week check. Just to make sure you haven’t got type two. 

Patrick [00:27:26] Exactly. Yeah. So the. So the baby gets checked there that they’re not that good at telling us stuff without us checking. But even if it’s insulin dependent, it’ll go away straightaway. Yeah. Right. Yeah. People with type 1 I’ve still got type 1, type 1 level. 

Brigid [00:27:38] That’s their lot in life and they’ve got that at birth or not birth but no early onset. Yeah. 

Patrick [00:27:43] Well they might have, they might have been set up for it as a foetus. Who knows. 

Brigid [00:27:46] Yeah. Who knows. Oh it’ll be interesting to get that study. Well you know when it’s finally released. 

Patrick [00:27:51] Well there’s lots of studies that it’s an area of study where then they’re just looking at how many diseases have have their origins in foetal life. And presumably, as a corollary, what can we do about it? 

Brigid [00:28:02] Yeah. Well, fascinating. So I just wanted to recap. Firstly, about 12 to 14 percent of all pregnancies. So the amount of people who have gestational diabetes is quite high. 

Patrick [00:28:14] Got to test everybody. Everybody gets tested. 

Brigid [00:28:17] And it’s a oral glucose tolerance test at 28 weeks. And you have increased risk of gestational diabetes if you’ve got a history of type 2 diabetes in your family. 

Patrick [00:28:30] Overweight, overweight, polycystic ovaries, over 40 previous, previous pregnancy affected by gestational diabetes. 

Brigid [00:28:38] Yep. You know, you. Your health care provider will send you off to a diabetic educator and you’ll be sorted from there. 

Patrick [00:28:46] They’re the most valuable resource. It’s all about education. Most people know some with type 1 diabetes they are a whizz at managing their own sugar level. They become better at it than their doctors. By mile because they know their own system. And I like women with gestational diabetes to be highly educated about what it is. Yeah. And a good diabetes educator will get people up to speed in no time. Taking it seriously. Getting those sugars as good as we possibly can. 

Brigid [00:29:12] And the reason why we do all of this is because it can impact the growth of your baby either. They’ll be growth restricted or your baby will be too big. 

Patrick [00:29:20] Potentially too big. And then problems with labour and delivery and problems in the neonatal period that are all better prevented than treated. Yeah. 

Brigid [00:29:29] All right. And so my big takeaway, too, Pat, is just to tell people that it’s not a failure. This is not a failure. This is just, you know, it’s so common. It’s a common symptom of well, not symptom a common issue in pregnancy. 

Patrick [00:29:42] To do with complicated interactions between the placenta, the foetus and the mother and not a matter of necessarily being overweight or having a poor diet or not exercising enough. It can happen even if you doing all those things, right? 

Brigid [00:29:55] Yes, exactly. All right. Well, that’s it for today. I hope you enjoyed that. And we’ll see you next time. 

Brigid [00:30:01] And just jump on our Instagram @grow_my_baby and join our family there and give us some feedback and have a chat with us online. All right. Good on you people. Thanks for listening, everybody.