Gestational diabetes type 2

What is the difference between type 1, type 2 and gestational diabetes?

Type 1 diabetes

Type 1 diabetes is an autoimmune disease. This means that the body’s own immune system has attacked the insulin producing cells of the pancreas. The pancreas can no longer produce insulin when this occurs. Although often diagnosed in childhood or adolescence, it can occur at any age.

How is it managed?

  • Administering insulin by injections or a pump will help to manage blood glucose levels. The amount of insulin required will constantly need to be reviewed.
  • Eating well, moving regularly and monitoring blood glucose levels are also important to stay well and manage type 1 diabetes. It’s a big job!

How can it be prevented?

  • Currently type 1 diabetes cannot be prevented or cured.

Type 2 diabetes

Type 2 diabetes occurs when the pancreas does not produce enough insulin or the insulin being produced does not work effectively (this is called insulin resistance). Although often diagnosed in adulthood, more and more children and teens are being diagnosed.

How is it managed?

  • Eating well, focusing on carbohydrate serving sizes, monitoring blood glucose levels and staying active is important. Some people will also require medications or insulin to manage blood glucose levels.
  • Using insulin DOES NOT mean a person with type 2 becomes a person with type 1 diabetes.

How can it be prevented?

  • In many people, type 2 diabetes can be prevented or its onset delayed with regular exercise, healthy eating, not smoking and maintaining a healthy weight.

Gestational diabetes mellitus (GDM)

GDM occurs during pregnancy when the pregnancy hormones block the action of insulin. This leads to insulin resistance and high blood glucose levels.

How is it managed?

  • Eating well for pregnancy, focusing on carbohydrate serving sizes, blood glucose monitoring and moving regularly are all important factors. Some women will also require insulin to maintain blood glucose levels within their target ranges.

How can it be prevented?

  • Many women CANNOT prevent GDM.
  • However, women can reduce their risk by maintaining a healthy weight before getting pregnant and during pregnancy, healthy eating and doing regular physical activity.

Gestational Diabetes

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes. Every year, 2% to 10% of pregnancies in the United States are affected by gestational diabetes. Managing gestational diabetes will help make sure you have a healthy pregnancy and a healthy baby.

Causes

Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy.

During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin.

All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant. They start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

Preventing Type 2 Diabetes

About 50% of women with gestational diabetes go on to develop type 2 diabetes, but there are steps you can take to prevent it. Talk to your doctor about how to lower your risk and how often to have your blood sugar checked to make sure you’re on track.

Symptoms & Risk Factors

Gestational diabetes typically doesn’t have any symptoms. Your medical history and whether you have any risk factors may suggest to your doctor that you could have gestational diabetes, but you’ll need to be tested to know for sure.

Complications

Having gestational diabetes can increase your risk of high blood pressure during pregnancy. It can also increase your risk of having a large baby that needs to be delivered by cesarean section (C-section).

If you have gestational diabetes, your baby is at higher risk of:

  • Being very large (9 pounds or more), which can make delivery more difficult
  • Being born early, which can cause breathing and other problems
  • Having low blood sugar
  • Developing type 2 diabetes later in life

Gestational diabetes usually goes away after your baby is born. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes. You can lower your risk by reaching a healthy body weight after delivery. Visit your doctor to have your blood sugar tested 6 to 12 weeks after your baby is born and then every 1 to 3 years to make sure your levels are on target.

Getting Tested

It’s important to be tested for gestational diabetes so you can begin treatment to protect your health and your baby’s health.

Gestational diabetes usually develops around the 24th week of pregnancy, so you’ll probably be tested between 24 and 28 weeks.

If you’re at higher risk for gestational diabetes, your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.

Prevention

Before you get pregnant, you may be able to prevent gestational diabetes by losing weight if you’re overweight and getting regular physical activity.

Don’t try to lose weight if you’re already pregnant. You’ll need to gain some weight—but not too quickly—for your baby to be healthy. Talk to your doctor about how much weight you should gain for a healthy pregnancy.

Treatment

You can do a lot to manage your gestational diabetes. Go to all your prenatal appointments and follow your treatment plan, including:

  • Checking your blood sugar to make sure your levels stay in a healthy range.
  • Eating healthy food in the right amounts at the right times. Follow a healthy eating plan created by your doctor or dietitian.
  • Being active. Regular physical activity that’s moderately intense (such as brisk walking) lowers your blood sugar and makes you more sensitive to insulin so your body won’t need as much. Make sure to check with your doctor about what kind of physical activity you can do and if there are any kinds you should avoid.
  • Monitoring your baby. Your doctor will check your baby’s growth and development.

If healthy eating and being active aren’t enough to keep your blood sugar under control, your doctor may prescribe insulin, metformin, or other medication.

Gestational diabetes arises in certain women who cannot overcome the insulin resistance that develops during pregnancy. In most cases, the condition goes away after the baby is delivered. However, women who have gestational diabetes have increased risks of developing Type 2 diabetes later in life.

It’s important to note that gestational diabetes is not actually the cause of that long-term increased risk of Type 2 diabetes. In fact, it’s the other way around: the increased risk of Type 2 diabetes was there all along, even before pregnancy, and is the cause of the gestational diabetes.

“Gestational diabetes appears to be an early symptom of an abnormal ability to secrete insulin,” explains Dr. Lorraine Lipscombe, director of the Centre for Integrated Diabetes Care at Women’s College Hospital (WCH). “It’s an early sign of a disorder that can eventually lead to Type 2 diabetes.”

Insulin, a hormone secreted by the pancreas, regulates blood sugar levels. Abnormal insulin secretion can lead to high blood sugar, which is the main characteristic of diabetes.

Treatment for gestational diabetes protects the baby from the effects of high blood sugar and from the increased insulin production required to control it. Because insulin is a growth factor, women with gestational diabetes may have large babies, which increases the risk of delivery complications. The increased need for insulin can also stress the baby’s pancreas before birth.

“There is evidence emerging that if they are exposed to high blood sugars in pregnancy, the baby’s pancreas has to work harder and that can lead to a potential increased risk of diabetes and insulin secretory defects in the baby,” Dr. Lipscombe explains. “That’s the other concern: that over the years it predisposes the baby to a higher risk of Type 2 diabetes, so it’s a vicious cycle.”

Early warning

Gestational diabetes is treated in pregnancy to try to avoid or minimize the short- and long-term risks to the baby. For mothers, it can provide an early warning of their own health risks.

“Women get gestational diabetes because they have risk factors for Type 2 diabetes, but it hasn’t developed yet,” Dr. Lipscombe says. “As they get older, especially if they gain weight or if they have an unhealthy diet, or they have other factors that play into the increased challenge to the pancreas, then eventually the pancreas has to work harder, and eventually it fails to the point where they get Type 2 diabetes.”

While it may increase the baby’s future diabetes risk, research indicates that gestational diabetes does not add to a woman’s pre-existing risk of Type 2 diabetes.

“A number of studies have compared women who do and do not get pregnant, who have similar risk profiles,” Dr. Lipscombe says. “One group will get gestational diabetes in pregnancy and the other group won’t get it because they never got pregnant. And it appears that the pregnancy does not increase the risk further. So the gestational diabetes does not make them progress to Type 2 diabetes more rapidly.”

Although the lifetime risk of Type 2 diabetes for women with gestational diabetes may be as high as 50 per cent, it is not a certainty. Research suggests that lifestyle can play an important role in managing those risks for women who have had gestational diabetes.

Research using data from the Nurses’ Health Study II looked at the long-term health of study participants with a history of gestational diabetes.

“For the women who remained more active and kept their weight healthy, their risk of diabetes was much lower despite the gestational diabetes,” Dr. Lipscombe says. “So we know that by keeping to a healthy weight and staying physically active you can reduce your risk of Type 2 diabetes even if you had gestational diabetes. It’s not a fait accompli – you can do something about it.”

Encouraging healthy changes

That’s one of the reasons Dr. Lipscombe and her colleagues at the Women’s College Hospital Research Institute are studying a preventive program. Now in its pilot phase, it is designed to support new mothers who have had gestational diabetes to make healthy lifestyle changes. The home-based program is adapted from WCH’s highly successful Women’s Cardiovascular Health Initiative program. It includes telephone counselling and a personal health coach to help women build healthier habits to reduce their long-term risk of Type 2 diabetes.

“It’s not easy to engage new mothers to change their behaviour when they’ve just had a baby,” Dr. Lipscombe says. “We’ve trained the coaches to be sensitive to the fact that these women are in a very demanding period of their life, but it is a time when bad habits do form because of those challenges.”

There is no data from the trial yet, but it has completed recruitment. Dr. Lipscombe reports that they have received positive feedback from participants: 98 per cent would recommend the program to other mothers with gestational diabetes, and 96 per cent described their own experience in the study as good, very good or excellent.

“We’ve had over 70 women who have come back for their final assessment and many have really made positive changes and were starting to see positive results,” she says. “It’s our hope that they will sustain that long-term.”

This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: March 29, 2017

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Preventing Type 2 Diabetes after Gestational Diabetes

Gestational diabetes is a type of diabetes that develops during pregnancy that affects 2-10% of the pregnancies in the United States each year. Gestational diabetes typically goes away after the baby is born.1 However, women who have had gestational diabetes have a 3-7 times increased risk of developing type 2 diabetes within 5-10 years,2 and their child from that pregnancy has increased risk for both obesity and type 2 diabetes.1

The good news is that you can decrease the risk of developing type 2 diabetes after having had gestational diabetes. A study published in the New England Journal of Medicine in 2001 showed that people with pre-diabetes who lost 5-7% of their body weight and exercised a minimum of 150 minutes per week decreased their risk of developing type 2 diabetes by 58%.3 Even 10 years after making changes to their food choices and exercise habits, people who participated in a lifestyle change program were one-third less likely to develop type 2 diabetes.4

Key food choice strategies to decrease risk of developing type 2 diabetes

There isn’t one set diet that helps promote weight loss or prevents type 2 diabetes. However, a study published in 2012 that followed over 4,000 women with a history of gestational diabetes from the Nurses’ Health Study II found that women who chose a diet that contained more whole grains, fresh fruits, vegetables and legumes with moderate amounts of poultry, seafood and nuts while limiting red and processed meats like lunch meats, sausage and hot dogs reduced their risk of developing type 2 diabetes by half.5 Information from this large study also showed a correlation between drinking one or more sweetened beverages such as sweet tea, lemonade, soda, and fruit drinks per day with increased body weight as well as increased risk of developing type 2 diabetes.6 Our tips:

  • Choose 100% whole grain bread, cereal and crackers instead of more processed white and enriched products. Look for the word ‘whole’ in the first ingredient to be sure you’re choosing a food made from whole, less processed grains.
  • Enjoy fresh fruit as a naturally sweet snack instead of candy, ice cream or cookies.
  • Choose unsweetened frozen fruit or canned fruit packed in its own juice or water for desserts.
  • Include larger portions of fresh, frozen or canned vegetables than potato, rice, noodles or other types of starchy foods.
  • Choose skinless poultry and seafood more often than red meat. Bake, broil or grill instead of frying or deep-frying.
  • Enjoy meatless meals a few times per week by replacing animal meats like chicken or hamburger with lentils, black beans, pinto beans or other types of legumes that contain more beneficial fiber and less harmful saturated fat.
  • Avoid lunch meats and hot dogs and instead choose nut butter or less processed sliced turkey.
  • Make plain water your primary beverage.

Key exercise strategies

Exercise can help promote weight loss, and it also helps your body utilize insulin effectively to maintain healthy blood sugar levels. Aim for 30 minutes of physical activity most days of the week for the best benefits.7 Even shorter amounts of exercise give you benefits, so avoid falling into the trap of thinking that if you don’t have 30 minutes to exercise, it’s not worth it. Some exercise is always better than no exercise! Endurance types of exercise like walking, dancing, swimming, and riding a bike as well as strength exercises like weight training or circuit training help reduce insulin resistance that plays a large role in type 2 diabetes.3 Our tips:

  • Start slowly and gradually build up exercise over time doing any type of activity that you enjoy and keeps you moving such as walking, an exercise class, or playing outside with your children.
  • Make exercise part of your daily routine, such as taking a 10-minute walk during lunch or after dinner.
  • Break exercise into smaller segments that you spread throughout the day, such as a 5 minute brisk walk on your way to work, 5 minute walk at lunch, and 20 minutes exercise while watching TV.
  • Incorporate physical activity into your routine by parking further away and taking the stairs whenever possible.

In addition to healthy eating habits and regular exercise, the National Institutes of Health also recommends that women with gestational diabetes:8

  1. See your physician to have your blood sugar levels tested 6-12 weeks after the baby is born. Women who have had gestational diabetes should have their blood sugar levels tested every 3 years since type 2 diabetes usually develops gradually without symptoms.
  2. Breastfeeding your child not only can help you lose weight, it also helps decrease your blood sugar levels.
  3. Talk to your doctor if you plan to become pregnant again in the future since you are at higher risk for developing gestational diabetes.
  4. Tell your child’s doctor if you had gestational diabetes.
  5. Keep up healthy habits for a lifetime to prevent or delay type 2 diabetes.

By adopting these healthy strategies into your life you’ll positively influence the health of your children and family members. Since children born to women with gestational diabetes also have increased risk of being overweight or developing type 2 diabetes, establishing healthy eating and exercise habits is important for everyone in your family.

  1. Centers for Disease Control and Prevention. Gestational Diabetes. https://www.cdc.gov/diabetes/basics/gestational.html Last updated 7-25-17; accessed 10-20-18.
  2. Andrew Curry. Exploring Why Gestational Diabetes Leads to Type 2. Diabetes Forecast. January 2015.
  3. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance. Tuomilehto J et al. May 3, 2001. N Engl J Med 2001; 344:1343-1350
  4. Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677-1686. doi:10.1016/S0140-6736(09)61457-4.
  5. Tobias DK, Hu FB, Chavarro J, Rosner B, Mozaffarian D, Zhang C. Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus. Arch Intern Med. 2012;172(20):1566-72.
  6. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004;292:927–34
  7. National Institute of Diabetes and Digestive and Kidney Diseases. Preventing Type 2 Diabetes. Published November 2016, accessed 10-30-18.
  8. National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Month 2018. https://www.niddk.nih.gov/health-information/communication-programs/ndep/partner-community-organization-information/national-diabetes-month Updated 7-25-17; accessed 10-21-18.

The Link Between Gestational Diabetes and Type 2

If you developed gestational diabetes mellitus (pregnancy-related diabetes) during your pregnancy, then you already know what you need to do to prevent type 2 diabetes: Watch what you eat, stay on top of your blood sugar levels, and get appropriate exercise.

“Outcomes for gestational diabetes have improved dramatically because women are very motivated during pregnancy. We just wish they would stay that way after the birth,” says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of the section of endocrinology at Tulane University Health Sciences Center in New Orleans.

Gestational Diabetes: What Is It?

Gestational diabetes — elevated blood sugar during pregnancy — occurs in pregnant women who have not had diabetes prior to the pregnancy. Doctors do not know what causes gestational diabetes, but they have some theories. Insulin, made by the pancreas, helps regulate the blood sugar levels in the body. When a woman is pregnant, the placenta, which nourishes the baby, also makes hormones that block the mother’s insulin. That makes it tough for the insulin to convert the blood sugar into energy. If the sugar can’t be converted into energy, that sugar gets stored in the blood. And that is the start of gestational diabetes.

These high blood sugar levels can cause complications with the pregnancy and put the baby at risk. When a woman is diagnosed, she and her doctor will work hard, focusing on diet, exercise, and weight management, to maintain normal blood sugar levels.

Gestational Diabetes: Who’s at Risk?

“Weight certainly plays a role, and it’s also genetically determined,” explains Dr. Fonseca. If you are overweight, you have a close relative who had gestational diabetes, or you had gestational diabetes with a previous pregnancy, you are at risk for developing gestational diabetes.

While gestational diabetes occurs in about 7 percent of all pregnancies, women of Hispanic, African-American, Native American, or Alaska Native heritage are more likely to get it than their peers.

Type 2 Diabetes: Ways to Prevention

After the baby is born, 5 percent to 10 percent of mothers who had gestational diabetes will have type 2 diabetes — and those who escape it then have a 20 percent to 50 percent chance of developing type 2 diabetes within the next 10 years.

Although gestational diabetes often goes away with the birth of your baby, you still have to be aware of your increased risk of type 2 diabetes and take steps to prevent it. Here are some steps you can take to control your risk:

Get screened. You should get tested for diabetes six weeks to three months after delivery and then keep getting checked every one or two years. By getting tested regularly, you will know when your blood sugar levels rise above normal (prediabetes) and can take action before type 2 diabetes develops.

Maintain a healthy weight. Being obese or overweight is one of the leading risk factors for developing type 2 diabetes. Even losing 5 to 10 percent of your body weight can cut your risk of developing type 2 diabetes dramatically. Your first goal should be to return to your pre-pregnancy weight by the time the baby is three months old.

Breast-feed your baby. This will help you lose weight; it’s also been shown to reduce the risk of diabetes and obesity in your child.

Eat a healthy diet. A low-fat, calorie-controlled diet rich in fruits and vegetables is ideal for reducing your risk of type 2 diabetes. In fact, studies show that your type 2 diabetes risk goes down with every serving of fruits or vegetables you eat.

Move for 30 minutes a day. Whether you take a long walk, play basketball with the kids, or get your merengue groove at a Latin dance class, get at least 30 minutes of physical activity a day to reduce your diabetes risk.

If you had gestational diabetes, your children are at increased risk for type 2 diabetes as well — so the changes you make to reduce your own risk can put them on track for a healthier lifestyle.

Women who have gestational diabetes — a type of diabetes that occurs during pregnancy and usually ends after the baby’s delivery — can lower their risk of later developing type 2 diabetes by starting up an exercise routine, a new study has found.

Having gestational diabetes may provide an opportunity for patients to recognize their increased risk of type 2 diabetes and take steps to prevent it, the researchers said.

In the study, the researchers looked at more than 4,500 women who had gestational diabetes in the past, and followed them from 1991 to 2007, to examine whether increasing physical activity and reducing sedentary behaviors (such as watching TV) lowered their risk of developing type 2 diabetes.

By the end of the study period, 635 women had developed type 2 diabetes. The researchers found that women who increased their activity level so they were moderately exercising for 150 minutes weekly (or 75 minutes of vigorous exercise) had a 47 percent lower risk of developing type 2 diabetes, compared with women who didn’t change their activity levels.

Conversely, the more time women spent watching TV, the higher their risk of type 2 diabetes was, according to the study, published today (May 19) in the journal JAMA Internal Medicine.

“These findings suggest a hopeful message to women with a history of gestational diabetes, although they are at exceptionally high risk of type 2 diabetes: Promoting an active lifestyle may lower the risk,” the researchers wrote in their study.

Gestational diabetes is somewhat common: The condition occurs in about 2 to 10 percent of pregnancies. It is also a sign of higher risk for developing type 2 diabetes later in life — women who have had gestational diabetes have a 35 to 60 percent chance of developing diabetes in the next 10 to 20 years, according to the Centers for Disease Control and Prevention.

In both type 2 and gestational diabetes, body cells become unable to respond to the hormone insulin, and the body is unable to properly metabolize sugar, the body’s main source of energy. Many patients with gestational diabetes can control their blood-sugar levels by eating a healthy diet and exercising regularly, but some women must also take insulin.

The new findings are in line with lifestyle changes recommended to prevent type 2 diabetes. People with high blood sugar who are at high risk for developing type 2 diabetes can reduce their risk of developing the condition by 58 percent if they lose 5 to 7 percent of their weight and get at least 150 minutes of moderate physical activity per week, according to the CDC.

Email Bahar Gholipour. Follow Live Science @livescience, Facebook & Google+. Original article on Live Science.

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