An Insider's Guide to Gestational Diabetes in Calgary
I have had two sugar babies. "Sugar babies" is a term used online by expectant parents who are pregnant with or have given birth to babies when they have been diagnosed with gestational diabetes.
What is Gestational Diabetes?
GD (Gestational Diabetes) or GDM (Gestational Diabetes Mellitus) is a form of diabetes that occurs specifically during pregnancy. Diabetes is a condition where your pancreas does not produce sufficient amounts of insulin to regulate your blood sugar.
Hormone fluctuations from placental function increase your body's insulin resistance, which is normal in pregnancy. Some people's bodies, however, have a more difficult time regulating this state of higher resistance which results in higher blood glucose. This is usually referred to as "insulin resistance" because your body requires more insulin (or more effective use of the current amount of insulin it is producing) to stay within a healthy blood glucose range.
Having unregulated or consistently high blood glucose increases some risks for an expectant parent and their baby. Management of blood glucose levels is key to a healthy parent and healthy baby. The sooner your blood glucose levels are well managed in your pregnancy, the better.
In this post we will explore how GD is diagnosed, options for management, options for your birth, and resources to learn more.
Image description: a glucometer sits on a flat surface showing the reading of 5.9mmol/L. Beside it sits a lancet pen.
How do I find out if I have gestational diabetes?
Routine screening for GD is recommended between 24-28 weeks gestation. The timing of the test is strategic based on your increasing insulin resistance. This insulin resistance begins to peak in the second trimester so the screen is scheduled to capture this. LEARN MORE>>
While this screening is routinely recommended, you always have the right to discuss with your maternity care provider what is appropriate for you, for this pregnancy. The Society of Obstetricians and Gynaecologists of Canada (SOGC) consider people who meet the following criteria to be at low risk of GD and appropriate candidates to decline routine screening:
maternal age less than 25
Caucasian or member of other ethnic group with low prevalence of diabetes
Pregnant body mass index (BMI) ≤ 27
No previous history of GDM or glucose intolerance, no family history of diabetes in first-degree relative, and no history of GDM-associated adverse pregnancy outcomes LEARN MORE>>
Blood glucose is measured in two different units of measure. In this post, we will use the mmol/L measurement. Blood glucose targets are more aggressive during pregnancy.
Image description: two small tables distinguish the blood glucose levels for pregnancy and a non-pregnant state.
If you consent to the routine screen at 24(ish) weeks, you will be given a requisition form by your maternity care provider to take to a Calgary Lab Services (CLS) location of your choice.
Pro-tip: While you can drop in to any CLS location during their business hours, you will save time by scheduling an appointment for your screening. This can be done online.
There are two tests available, a one-hour screening test and a two-hour diagnostic test*. The lab technicians at CLS will not discuss your test results with you. Your results will be sent to your primary maternity care provider who will discuss them with you and make any necessary recommendations and/or referrals.
*What is the difference between a screening test and a diagnostic test? “The primary purpose of screening tests is to detect early disease or risk factors for disease in large numbers of apparently healthy individuals.
The purpose of a diagnostic test is to establish the presence (or absence) of disease as a basis for treatment decisions in symptomatic or screen positive individuals (confirmatory test)” — Source: Health Knowledge
You do not need to fast prior to the one-hour screening test. When you arrive at the lab, you will be given glucola to drink (this is an orange sugary concoction).
For the one-hour screening test, the glucola contains 50g of glucose. An hour after drinking the glucola, a lab technician will draw your blood to test your blood glucose levels. To pass the screen, you will need to have a blood glucose reading of less than 7.8 mmol/L.
If your blood glucose level is higher than 7.8 mmol/L, or if you are at a higher risk for GD to begin with, your maternity care provider may recommend the two-hour diagnostic test.
Image description: a hand holds a plastic bottle of glucose drink, orange flavour, 75 grams of glucose. Photo credit: Sherisa Ritraj
You will need to fast prior to the two-hour diagnostic test. Confirm fasting directions with your maternity care provider and/or Calgary Lab Services. When you arrive at the lab, a lab technician will do an initial blood draw to test your fasting glucose. You will then be given glucola, this time with 75g of glucose. Two hours later, your blood will be drawn again.
The goal of this test is to determine how well your body processes glucose in a short window of time (in other words, how well your insulin is doing its job). The target for the two-hour test is 6.7 mmol/L or less. If your blood glucose levels are higher than 6.7 mmol/L at the two hour mark, you will be diagnosed with GD.
Pro-tip: Bring a book, download a movie to your phone, or bring a project to keep your hands busy. Get comfy. You'll be asked not to leave the lab or eat until the test is complete.
There is another test that looks at your average blood glucose levels over a three month period of time called the A1C, however, this is rarely recommended for screening or diagnosing GD. While looking at A1C results may be helpful information, it does not tell you how your body is responding to the ongoing fluctuations of hormones and increasing glucose resistance of your pregnancy.
So I have Gestational diabetes. What happens next?
1. Feel the Feels
You might be scared, disappointed, angry, defeated, or perhaps not surprised. Whatever you are feeling, it is valid. You are not alone.
If you feel like peer support would be helpful for you, I highly recommend the Facebook group Gestational Diabetes Canada.
If you are not on Facebook, talk to your doula, your maternity care provider, or ask around. There are likely parents in your social circle that faced GD in their pregnancy.
You may experience a roller coaster of emotions throughout this time and that's okay. All the feels are allowed.
2. Glucose Testing and Management
In Alberta, once you are diagnosed with gestational diabetes, your primary maternity care provider will refer you to a Diabetes in Pregnancy (DIP) clinic. The DIP clinic will then call you directly to make your first appointment. In Calgary, there are four DIP clinics, one at each hospital: Peter Lougheed Centre, South Health Campus, Foothills Medical Centre, and Rockyview General Hospital.
At your first appointment, you will be encouraged to have your weight recorded, and will be provided a glucometer and a selection of test strips and lancets (going forward the purchase of the lancets and strips will be your responsibility). You will work with several different practitioners at the clinic, including nurses, dietitians, and endocrinologists (doctors specializing in all things hormone related). They will recommend and discuss with you various strategies for managing your blood glucose levels. These strategies may include diet changes, increased activity, blood glucose tracking, and (if necessary) medication.
If you already have a glucometer at home, you may start testing your blood glucose whenever you'd like. Glucometers are sold at most pharmacies and range between $30-$50. The test strips are more expensive, averaging $75-$90 for a box of 100.
Pro-tip: If you have a drug plan, check to see if they will cover these costs (usually you must have a prescription to claim them). Or you can save money by purchasing the strips at Amazon.ca.
It is usually recommended that you test your blood glucose levels several times each day. Typically first thing in the morning to check your fasting blood glucose level (checking within 10 minutes of waking before eating breakfast), as well as one or two hours after each meal.
Using a glucometer is simple (a quick finger prick and your blood glucose is instantly read by the monitor), although not always easy. It can be intimidating to imagine using a needle on your fingers so frequently but worrying about needle pricks is often worse than the actual doing. At the end of the day, knowing your blood glucose levels is the first step in appropriate management.
It is recommended that your fasting glucose be lower than 5.3 mmol/L. This is often the trickiest part of managing GD for most people. At night, your liver may produce excess glucose resulting in a higher fasting blood glucose reading. Many people find that a small snack pairing a carbohydrate and protein at bedtime helps to lower their fasting blood glucose level.
Pro-tip: Having a 20 minute walk after you eat a meal can help to process the glucose in your bloodstream and will help you maintain lower post-meal blood glucose levels.
You're doing all the things right but your readings are still high. now what?
You're eating well, you're exercising, you're testing four times a day...and your blood glucose readings are still high. Usually, at this point, the DIP clinic will recommend medications to help lower your blood glucose levels.
While there are several options, usually the most effective (especially in managing those creeping fasting numbers) is insulin. Your body is already producing it, but you might require a bit more.
Insulin is injected into fleshy tissue like your thigh or pinched tummy roll. Again, the thought of the needle prick is often worse than the reality. It can be helpful to remember that the goal is a healthy pregnancy, parent, and baby and that means keeping your blood glucose readings within target. These interventions are all working with you towards that goal.
The DIP clinic will help you navigate the equipment, dosage, and timing of your insulin use - they are a strong resource so don't hesitate to make use of them. They will also maintain communication with your primary maternity care provider about how things are going so that you are all on the same page.
Here are some quick facts about insulin:
insulin is produced by the pancreas and is a naturally occurring hormone in our bodies.
prescribed insulin is kept refrigerated.
there are different kinds of prescribed insulin: a fast acting and long lasting. Fast acting insulin is taken with meals, and long lasting is usually taken at bedtime to help manage fasting blood glucose levels.
prescribed insulin is biosynthetic and derived from actual human insulin particles.
Image description: a large jar is filled to the brim containing used test strips, lancets, needle heads, and empty vials of insulin. Next to it is a standard pack of gum for size comparison. The jar is a reflection of how many pokes were sustained over two managed pregnancies with GD.
3. Resources, Reading, and Conversation Starters
You will learn a lot by trial and error in this process. It can help to have additional information and context about GD when having conversations with your care providers. Here are some resources I've found particularly helpful:
4. Birthing with gestational diabetes
Whether you are under the care of a low risk maternity clinic, a midwife, or a high risk team of obstetricians, they are each going to have their own confidence/comfort level in caring for someone with GD. Depending on how management of your GD is going, your care provider may recommend induction, scheduling a cesarean birth, or waiting until labour begins spontaneously.
Don't be afraid to ask questions, to understand how and why something is being recommended to you, and don't be afraid to ask for more time or to exercise your rights to informed consent AND informed refusal. Routine recommendations may not always suit you, your pregnancy, and your unique circumstance. You are the best person to make that decision.
If you're unsure about what to ask, here are some suggestions that might be helpful for your next appointment:
Tell me about the risks if my GD is well managed versus not well managed.
Tell me more about using ultrasound to determine baby's weight/size as we approach my due date.
What factors will influence a recommendation for induction? and why?
Walk me through how we manage my blood glucose while I'm in labour.
Tell me about the expectations for baby's blood glucose and testing once baby is born.
What about testing recommendations for me after baby is born?
The Summary
A gestational diabetes diagnosis is a game changer, but it's not the end of the world. It's hard to not feel resentful when your pregnant body wants cheeseburgers and pancakes and your DIP clinic is encouraging whole wheat grains, protein, healthy fats, and vegetables. I get it. I've been there. Sometimes, it can take time and a lot of effort to find your groove and get to a healthy managed blood glucose state. Be generous with yourself, as you would be with a dear friend. Offer yourself lots of grace and kindness. You've got this.
