I was listening to this program recently and was blown away by a couple things. First, by the amazing amount of information – one of the better Forum episodes, in my opinion – and then by the crazy statistics the guests were delivering. Like that the Journal of American Medical Association (JAMA) recently did a study of trends of diabetes in the US from 1988-2012 and found that almost 50% of the American population is living with diabetes or pre-diabetes. Whoa, really? That’s a huge percentage people. “‘Diabetes prevalence significantly increased over time in every age group, in both sexes, in every racial and ethnic group, by all education levels, and in all poverty income groups,”‘ according to the researchers of this study. In other words, everyone is affected but, of course, we are not all affected equally. Among African Americans, 22% had diabetes, 23% of Hispanic people, and 20% of Asian people compared with 11% of white people.
Let’s bring this back to pregnancy, shall we? Life is a continuum and the diseases that affected us before pregnancy usually affect us during and afterward, and diabetes is no exception. So what’s going on with Gestational Diabetes, or the type of diabetes state diagnosed during pregnancy? First, a short description of how our body processes the food that we eat. Our bodies metabolize, break down the food that we eat into sugar, specifically glucose, for fuel. The goal is to get the glucose inside of our cells to be further used. Insulin, made by the pancreas, is what transports the glucose into the cells. In Type I diabetes there isn’t any insulin, so affected people have the glucose knocking on the door of the cells but no key (insulin) to let it in. In Type II diabetes, insulin is produced but the cells are resistant, like having some defective locks in our analogy, and more insulin needs to be produced which really tires out the pancreas. In Gestational Diabetes, during the second half of pregnancy, the amazing placenta puts out a hormone called Human Placental Lactogen that will increase our cell’s resistance to insulin, kind of like Type II diabetes. (Interestingly, during early pregnancy the cells are more receptive to insulin resulting in less glucose in the blood. This may cause symptoms of hypoglycemia like nausea and vomiting, and fatigue. Sound familiar?) A healthy pancreas will be able to increase the supply of insulin to cope with the resistance. If not there will be increased levels of glucose in the blood free to cross the placenta to the baby. This extra sugar may make the baby bigger than s/he would have normally grown and labor and birth may be difficult, and in unchecked cases, may increase the baby’s risk of physical defects, decrease blood flow to the baby resulting in growth restriction and complications of Pre-Eclampsia and hypertension, and increased risk of stillbirth. Later in life, babies who experienced higher levels of glucose in the womb are more likely to have higher BMIs and are more at risk for glucose intolerance themselves. Women who have been diagnosed with Gestational Diabetes are more likely to develop Type II Diabetes later in life. Some experts believe that Gestational Diabetes is actually undiagnosed Type II Diabetes. The risk of diabetes has even been shown to increase in men if their wives had Gestational Diabetes!
Although it seems by nature’s design that the healthy pregnant body experiences an increase in blood glucose levels due to decreased insulin cellular receptivity, the increase is very minimal. Researchers studied a group of pregnant, normal weight, normal glucose tolerant people and found that that their fasting blood glucose levels were around 71 mg/dL, 1 hour postprandial (after the meal) were around 109 mg/dL, and 2 hour postprandial were around 99 mg/dL. Comparatively the cut off values used today are less than or equal to 95, 140, and 120 for the fasting, 1 hour PP, and 2 hour PP respectively. Are our cut off values too high and we are potentially under diagnosing and therefore under treating Gestational Diabetes and glucose intolerance?
What are the lifestyle factors that are associated with someone developing Gestational Diabetes? Diet and exercise are high on the list, as well as family and personal history of diabetes and glucose intolerance, age and higher BMI. Interestingly, pregnant people who are exposed to organic pollutants early in pregnancy are at increased risk, and there are probably other environmental factors that change our metabolism. Some researchers have found that abnormalities in fat cells, a sign of insulin resistance, can increase one’s risk of developing Gestational Diabetes.
What can you do about you own personal risk? Take charge of your health. Taking charge of your nutrition, exercise, stress and sleep will make the biggest difference. Some cases of Gestational and Type II diabetes can be slowed or reversed with diet and exercise changes alone, no medication! This means eating fresh, local fruits and vegetables, healthy protein sources, healthy fats, and reducing your intake of simple carbohydrates like flour, sugars and simple grains (non-whole grains), and reducing or eliminating refined, prepared foods from your diet. Try to get some exercise every day, even if you can only go for a walk. A fifteen brisk minute walk after meals 2-3x per day can make a difference in how your body processes extra glucose in your blood. Other options are dancing, hiking, swimming, or biking. Monitoring your blood glucose levels at home with a glucometer can be an excellent way to see how your body is responding to the foods your normally eat, and can help you change your diet if needed. This may not be enough to keep your blood glucose levels low enough and you still might need medication, but you are learning and helping your body with every adjustment you make. Just take charge of your health because you are about to be in charge of someone else’s health, your baby’s.
Here’s an awesome video of a local community doing things to take charge of their collective health.