Because I had gestational diabetes I might get diabetes when Im older
This is true. Gestational diabetes is a temporary form of insulin resistance that usually reveals itself about halfway through the pregnancy. This is when the hormones of pregnancy normally create extra insulin resistance. Most women are able to overcome this extra resistance to insulin. However, for women with gestational diabetes, either their pancreas is not able to make the additional insulin that is needed or their body's cells become less efficient at taking up glucose from the blood.
Women who have had gestational diabetes are at greater risk for getting diabetes again. They have a 2 in 3 chance of developing gestational diabetes during future pregnancies. Also, their risk of developing type 2 diabetes 5 to 15 years after they had gestational diabetes rises to between 40 and 60 percent, compared with about a 15 percent risk in the general population. Obesity increases the risk of getting type 2 diabetes after having gestational diabetes to a 3 in 4 chance. Women who have had gestational diabetes can reduce their risk of developing diabetes closer to a 1 in 4 chance by keeping a healthy body weight (see Chapter 1).
higher than normal blood glucose level, but not diabetes, your risk of developing diabetes in the next 5 years is high. About 60% of women with gestational diabetes eventually develop type 2 diabetes. The good news is that you can delay or prevent type 2 diabetes in the future with modest weight loss and moderate activity. Losing the weight you gained with your preg-
nancy may be enough to lower your risk. You also need to have your blood glucose level checked once a year to detect any changes. Ask to have your glucose levels tested earlier in the course of any future pregnancies. Remind all providers that you had gestational diabetes. Some drugs, such as steroids, can raise your blood glucose levels just as pregnancy did.
Don't forget that you can become pregnant again soon after you give birth. Even if you have not had a period, you can still ovulate. And breastfeeding does not necessarily prevent you from becoming pregnant. So, before you resume having intercourse, be sure you are using effective birth control.
Although virtually every aspect of your life may seem turned on its head after the birth of a new baby, the four basic management tools remain the same: insulin or oral diabetes medication (oral diabetes medications cannot be used while you are breastfeeding), blood glucose monitoring, meal planning, and exercise. Exercise may be the last thing you are thinking about after the baby is born. But as soon as you feel well enough and you have your doctor's okay, taking your baby for a daily walk can help you feel better and more relaxed.
Highs and Lows. Hormonal changes, emotional shifts, irregular sleep patterns, and fatigue may hide or change your symptoms of high or low blood glucose. You may find it hard to tell the difference between "after-baby" blues, such as unexplained crying or moodiness, and low or high blood glucose. Fatigue, feeling spacey, weakness, or forgetfulness can be caused by both high and low blood glucose and by lack of sleep. If you're not sure, play it safe and check your blood glucose.
With a new baby depending on you, it's critical to guard against hypoglycemia. Test often; if you feel hypoglycemia coming on, treat it right away, whether or not you can test. Keep items such as glucose tablets, hard candy, or regular soda handy in several rooms. Make sure that those around you know how to spot your signs of low blood glucose; teach them what you want them to do if you don't seem like yourself. Keep a glucagon kit on hand.
If you have had hypoglycemia unawareness in the past, be vigilant not to let your blood glucose get too low when you are alone with your baby. Get help with middle-of-the-night feedings, or make it a habit to eat a snack then. Take care to test before you get into the car to drive. Don't nap or sleep on an empty stomach. Remember that your best protection is still frequent blood glucose monitoring and regular snacks and meals.
Having a new baby can affect your diabetes care habits, especially if you have other children to care for. You may find that your baby's unpredictable schedule and your own erratic sleep patterns make it difficult for you to eat or snack when you need to. Using multiple injections may make your life easier and give you more flexibility. Although it is tempting to put your infant's needs before your own, taking care of yourself is important for both you and your baby.
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