Gestational Diabetes: The Naturopathic View

Gestational Diabetes: The Naturopathic View

Pregnancy can be physically challenging. The extra demands on your body while it makes a bonny babe are considerable. Mostly your body miraculously and wonderfully meets all the challenges, but for a small proportion of women (2-10%), this doesn’t naturally happen. Gestational diabetes can be the result. 

For a lot of women it’s a surprise to be told they’ve developed diabetes in pregnancy. She may have been trotting along feeling perfectly healthy, passing all the milestones brilliantly, only to find that inwardly, her body has begun to struggle with one of the most important processes it performs. Turning food into fuel.

Overfed but starving
In a healthy state the body takes the food we eat, digests it into it’s smallest components, absorbs it from the digestive tract into the bloodstream and finally transports it to it’s final destination, our cells. Here it is used to fuel the cells so they can do all of their various jobs. In short, this delivery of fuel keeps our cells working and us alive!

The body’s preferred fuel is glucose, and we  have the amazing pancreas to produce insulin. Insulin’s job is to transport the glucose from the blood stream across the cell membrane and into the cells where it can be utilised. The cells ‘door’ needs to be ‘opened’ to let the glucose in. Like a VIP at an exclusive club, insulin knows the magic word to get in. In diabetes (type 2 and gestational) two main scenarios are happening. One is that the pancreas is simply not making enough insulin, and the other is when the cells become insensitive or resistant to the insulin. In effect the magic word doesn’t work any more. Both scenarios lead to higher than normal glucose levels in the bloodstream and the unwelcome side effects we associate with diabetes. The fuel is of little use outside the cells, so in diabetes, we have too much fuel but at a cellular level we are starving.

When we are pregnant, there is an increased demand for many things, including insulin. This increased need puts a strain on the pancreas and some people’s pancreases aren’t up to it. About 50% of women who test positive for gestational diabetes were probably undiagnosed diabetic already. For others, pregnancy may have caused them to loose the taste for veggies and fish and instead they have been living on hot chocolate and cake.  In this case, eventually the body cells get sick of insulin knocking on the door and insulin resistance begins. Other risk factors are a history of diabetes in your family, being overweight or over 25years of age. As you can see there are many factors and some of them are entirely out of your control.

How do I know I have gestational diabetes?
Between 24 and 28 weeks of pregnancy you may be recommended by your midwife or specialist to take a polycose test. This test is designed to see how your body is coping with sugar and requires you to take 50gms of sugar in liquid form. Your blood is tested an hour later to see how well it has metabolised the sugar.  If your midwife sees glucose in your urine (which should be a standard test every visit) before 28 weeks, you may be sent to have a polycose test earlier in your pregnancy. If your polycose test shows higher than normal blood sugar (above 7.8mol/ml) you'll be recommended to take another test called a glucose tolerance test (GTT). This test is similar but you take 75gm of sugar after skipping breakfast and have your blood tested at 1 hour and then 2 hours after ingestion. From these results a diabetes diagnosis can be made or excluded and the need (or not) for medication decided. It is worth noting that the polycose testing has a high false positive rate of 15-20%. So it is important not to jump to conclusions based solely on this.

Considerations for holistic mamas
There is some discussion and disagreement about the testing and interventions surrounding gestational diabetes. It seems that pregnant women have higher than normal blood glucose levels from time to time without any negative effect. Certain pregnancy hormones suppress insulin, possibly because your baby needs a steady supply of glucose to fuel its growth and development. This glucose needs to be in the blood stream to reach baby. Because of this, some people dislike the use of standard testing and the subsequent intervention (possibly insulin medication). They wonder, if higher blood glucose levels are normal, why intervene? There is also concern about the mega dose of sugar required for the polycose test and the negative effect this huge spike in blood sugar could have on baby (and of course the subsequent, even higher level of sugar in the GTT). My advice comes down to preconception care. You should ask to have your HBA1c tested before you conceive to pick up on poor blood glucose metabolism. This is the standard test for diabetes risk and if your result is above 39 we need to get to work on reducing that number. If that test is above 41 you're at a higher risk of gestational diabetes but there is still ways to reduce that number. This is why I love working with women to prepare their bodies for pregnancy. It’s the best investment in your child’s future health you can make. If you are already pregnant with the routine polycose test coming up you do have the option of declining it. But you want to take your particular situation in to account.

Why test?
I recommend doing the ploycose test if:
There is glucose in your urine
You are overweight
You are a sugar fiend
There is a family history of diabetes
Your HBA1c test was above 39
You've had an abnormally high number of infections
You have not done any physical activity during your pregnancy
You have had a large previous baby (above 400gm)
You have had a previous still birth or unexplained neonatal death
You have been having excessive thirst or blurred vision

If you have some of the above precipitating factors it’s better to know what’s happening with your glucose levels rather than just hope it’s fine.

The risks of gestational diabetes
Uncontrolled blood glucose in pregnancy can lead to a larger than average baby, which in turn can make a natural birth difficult and lead to interventions and complications.
Because the baby is usually larger, women are often advised to be induced for labour at 38 weeks. If baby is exposed to continually to high blood glucose levels in the womb, it may have difficulty maintaining those levels and their blood sugar may drop dangerously, immediately after birth (once the umbilical cord is cut). For these reasons I think it’s imperative to know about your blood glucose levels.

If you're opposed to the sugar that comes from the polycose or the GTT test, you can buy a glucose meter and monitor your levels yourself. They're available from most pharmacies and come with instructions. Monitor and document the reading after each meal for several days a week and ideally share this with your LMC.

Natural medicine
Along with dietary and lifestyle protocols, I often prescribe herbal medicines (Gymnema sylvestre and Humulus lupulus) for their positive effect on blood sugar balance. Other nutrients such as chromium also helps with the cells sensitivity to insulin. These and a few others can be great adjuncts to dietary changes. For the best management work with a professional and monitor your blood glucose levels regularly.

By no means is gestational diabetes an insurmountable problem. Whether you need insulin or not, it's important to point out that most women with gestational diabetes have healthy pregnancies and healthy babies. Diet and exercise, along with good monitoring is often all you need!