Gestational diabetes: features of diabetes mellitus during pregnancy

Today, in the era of high development of information technology and, thereby, active popularization of knowledge about various diseases of the population, incl. During pregnancy, improving family planning methods, it is relevant to increase the knowledge of women planning pregnancy about the risk of developing gestational diabetes mellitus in order to timely seek medical help in highly qualified medical institutions, where this problem is dealt with by doctors with extensive clinical experience in managing such patients.

Causes of Gestational Diabetes

The exact mechanism of the disease is still not completely clear.
Doctors are inclined to believe that the hormones responsible for the proper development of the fetus block the production of insulin, which leads to disruption of carbohydrate metabolism. During pregnancy, more glucose is required for both the woman and the baby. The body compensates for this need by suppressing insulin production. There are other possible causes of gestational diabetes, such as autoimmune diseases that destroy the pancreas. In principle, any pancreatic pathology can increase the risk of diabetes during pregnancy.

Symptoms

Photo: ruslangaliullin / freepik.com
The clinical picture of gestational diabetes mellitus is quite poor; a woman may not have any complaints at all. It is worth paying attention to the following signs:

• Unmotivated weakness
• Thirst, dry mouth,
• Frequent urination
• Blurred vision.

The dangers of diabetes during pregnancy

This pathological condition threatens the health of both mother and child.
Even before birth, the fetus begins to actively produce insulin to compensate for the increased glucose in the mother’s blood. Such children are prone to low blood sugar from birth, and they have a higher risk of obesity and type II diabetes in adulthood. Gestational diabetes increases the risk of high blood pressure, as well as preeclampsia, a severe form of preeclampsia. It manifests itself as headaches, nausea, vomiting, blurred vision, lethargy, drowsiness or insomnia. This is one of the most severe disorders during pregnancy, affecting the central nervous system.

Another alarming factor is that diabetes during pregnancy contributes to rapid weight gain in the baby during the prenatal period (macrosomia). This causes difficulties during childbirth and poses a threat to the mother. A child over 4 kg is considered large. These babies have a higher risk of birth injuries and are more likely to require a caesarean section. Due to the large size of the fetus, early delivery may be required. At the same time, the risk of premature birth is high.

Also, high sugar in pregnant women increases the risk of cardiovascular and nervous pathologies of the fetus, increases the risk of respiratory distress syndrome in the baby (a condition that makes breathing difficult) and generally increases the frequency of complications during pregnancy and childbirth.

What is its reason?

Diabetes mellitus in pregnant women develops due to the hormonal explosion associated with bearing a child. The hormonal cocktail entering the blood (cortisol, human chorionic gonadotropin, estrogens and progesterone) inhibits the action of insulin, which is required to ensure the flow of glucose from the blood into the cells. This happens because the body tries to save glucose for the growing fetus and provokes “insulin resistance,” when the mother’s cells stop responding to the usual amount of insulin. In response to increasing amounts of glucose in the blood, the pancreas is supposed to produce more insulin, but sometimes it fails. Gestational diabetes occurs.

Up to 39% of all pregnancies are complicated by GDM.

Risk factors for gestational diabetes

• Age under 18 and over 30 years old.
• Unbalanced diet with a lot of fast carbohydrates.
• Bad habits (smoking, alcohol abuse).
• Overweight and obesity. Excess weight obviously implies a violation of metabolic processes.
• Lack of physical activity.
• Previous gestational diabetes or prediabetes. The tendency to diseases of this series does not disappear over time.
• Polycystic ovary syndrome.
• A close relative has diabetes. The risk of gestational diabetes increases twofold or more if close relatives have any form of diabetes.
• Previous birth of a child over 4 kg or a large fetus during the current pregnancy.
• Race. Caucasians have the lowest risk of developing gestational diabetes, and black women are most likely to suffer from this problem.

Unfortunately, GDM can develop in a completely healthy woman without risk factors, so you need to visit a doctor and not skip recommended screenings.

Are there any contraindications to the test?

Yes, I have. Absolute and relative.

Absolute contraindications include:

• Allergy and/or glucose intolerance,
• Diabetes mellitus in the acute phase (then a test is not needed),
• Diseases of the gastrointestinal tract in which normal glucose absorption is disrupted (exacerbation of pancreatitis, gastric surgery).

Relative (temporary) contraindications:

• Early toxicosis (gestosis) of pregnant women,
• Exacerbation of chronic diseases

Important! It is very important to determine the presence of GDM in a timely manner. Screening is recommended for all pregnant women. The glucose tolerance test does not harm the liver and is not something to be afraid of.

When diagnosing GDM, additional tests are sometimes used, including:

• General urine analysis (glucosuria - detection of glucose in the urine, which normally should not be there, as well as ketone bodies - products of impaired glucose metabolism),
• Ultrasound of the fetus (presence of fetopathy - fetal development disorders).

Diagnosis of gestational diabetes

There is good news.
When registering, all pregnant women are required to take a blood test for glucose levels, so if you regularly undergo all prescribed examinations, you will detect the problem at the very early stage. The normal value is 3.3-5.1 mmol/l when testing blood from a vein on an empty stomach. Patients whose glucose levels exceed 5.1 mmol/l are at risk. In this case, the doctor will order a glucose loading test or glucose tolerance test to confirm or refute the diagnosis. It is carried out at 24-28 weeks of pregnancy. Such a study includes two stages: first, a woman takes a regular blood test for glucose on an empty stomach, after which she drinks a special solution containing 75 grams of glucose, and after two hours she takes the test again. If a disease is suspected, the same analysis is repeated again after a few hours.

The diagnosis of gestational diabetes is made if the fasting blood glucose level is less than 7 mmol/l, but above 5.1 mmol/l, and the venous blood glucose level two hours after consuming 75 g of glucose is above 8.5 mmol/l.

basic information

Gestational diabetes mellitus, which develops during pregnancy, is characterized by hyperglycemia (increased blood glucose levels). In some cases, this disorder of carbohydrate metabolism may precede pregnancy and be first identified (diagnosed) only during the development of this pregnancy.

During pregnancy, physiological (natural) metabolic changes occur in the mother's body, aimed at the normal development of the fetus - in particular, the constant supply of nutrients through the placenta.

The main source of energy for the development of the fetus and the functioning of the cells of its body is glucose, which freely (through facilitated diffusion) penetrates the placenta; the fetus cannot synthesize it on its own. The role of the conductor of glucose into the cell is played by the hormone “insulin”, which is produced in the β-cells of the pancreas. Insulin also promotes the “storage” of glucose in the fetal liver.

Amino acids - the main building material for protein synthesis in the fetus, necessary for cell growth and division - are supplied in an energy-dependent way, i.e. through active transfer across the placenta.

In the mother’s body, to maintain energy balance, a protective mechanism is formed (“rapid starvation phenomenon”), which implies an immediate restructuring of metabolism - preferential breakdown (lipolysis) of adipose tissue, instead of the breakdown of carbohydrates with the slightest restriction in the supply of glucose to the fetus - ketone bodies (products) increase in the blood fat metabolism are toxic to the fetus), which also easily penetrate the placenta.

From the first days of physiological pregnancy, all women experience a decrease in fasting blood glucose levels due to accelerated excretion in the urine, decreased glucose synthesis in the liver, and glucose consumption by the fetoplacental complex.

Normally, during pregnancy, fasting blood glucose does not exceed 3.3-5.1 mmol/l. The blood glucose level 1 hour after eating in pregnant women is higher than in non-pregnant women, but does not exceed 6.6 mmol/l, which is associated with a decrease in motor activity of the gastrointestinal tract and an increase in the absorption time of carbohydrates supplied with food.

In general, in healthy pregnant women, fluctuations in blood glucose occur within very narrow limits: on an empty stomach on average 4.1 ± 0.6 mmol/l, after meals - 6.1 ± 0.7 mmol/l.

In the second half of pregnancy (starting from the 16-20th week), the fetal need for nutrients remains highly relevant against the backdrop of even faster growth rates. The placenta plays a leading role in changes in a woman’s metabolism during this period of pregnancy. As the placenta matures, active synthesis of hormones of the fetoplacental complex occurs, which maintain pregnancy (primarily placental lactogen, progesterone).

As the duration of pregnancy increases, for its normal development in the mother's body, the production of hormones such as estrogens, progesterone, prolactin, cortisol increases - they reduce the sensitivity of cells to insulin. All these factors, against the background of decreased physical activity of the pregnant woman, weight gain, decreased thermogenesis, decreased insulin excretion by the kidneys, lead to the development of physiological insulin resistance (poor tissue sensitivity to its own (endogenous) insulin) - a biological adaptive mechanism for creating energy reserves in the form of adipose tissue in in the mother's body in order to provide nutrition to the fetus in case of starvation.

In a healthy woman, a compensatory increase in insulin secretion by the pancreas occurs approximately three times (the mass of beta cells increases by 10-15%) to overcome such physiological insulin resistance and maintain blood glucose levels normal for pregnancy. Thus, there will be an increased level of insulin in the blood of any pregnant woman, which is the absolute norm during pregnancy!

However, if the pregnant woman has a hereditary predisposition to diabetes mellitus, obesity (BMI more than 30 kg/m2), etc. The existing secretion of insulin does not allow overcoming the physiological insulin resistance that develops in the second half of pregnancy - glucose cannot penetrate the cells, which leads to an increase in blood sugar and the development of gestational diabetes mellitus. Through the bloodstream, glucose is immediately and unhinderedly transferred through the placenta to the fetus, facilitating its production of its own insulin. Fetal insulin, having a “growth-like” effect, leads to stimulation of the growth of its internal organs against the background of a slowdown in their functional development, and the entire flow of glucose coming from the mother to the fetus through its insulin is deposited in the subcutaneous depot in the form of fat.

As a result, chronic hyperglycemia of the mother harms the development of the fetus and leads to the formation of so-called diabetic fetopathy - fetal diseases that occur from the 12th week of intrauterine life until the onset of labor: high fetal weight; violation of body proportions - large belly, wide shoulder girdle and small limbs; advance of intrauterine development - with ultrasound, an increase in the main dimensions of the fetus in comparison with gestational age; swelling of the tissues and subcutaneous fat of the fetus; chronic fetal hypoxia (impaired blood flow in the placenta as a result of prolonged uncompensated hyperglycemia in a pregnant woman); delayed formation of lung tissue; trauma during childbirth.

Treatment of diabetes in pregnant women

The first step in treating GDM is a balanced diet and moderate exercise.
The main goal of the diet is to reduce sugar to normal values, so the expectant mother will have to give up sweets and fast carbohydrates. Pregnant women are recommended:

• Eat little, but often.
• Exclude foods with a high glycemic index (sugar, honey, potatoes, white bread, baked goods, bananas, grapes).
• Avoid fast food and fatty sweet pastries.
• Drink enough fluids if there are no contraindications from the kidneys.
• Diversify your diet with fresh vegetables, lean meats, and cereals.

Like all pregnant women, it is important for patients with GDM to receive the full range of vitamins and minerals that are necessary to maintain their own health and the proper development of the fetus.
Walking, swimming, water gymnastics, physical therapy for pregnant women - any light activity will be beneficial.

If diet and exercise do not help lower blood sugar levels, insulin therapy is prescribed.

Important: with high sugar, a woman should check her glucose level daily. Measurements are taken on an empty stomach and an hour after each meal using a home glucometer.

UZ "Mogilev City Emergency Hospital"

Gestational diabetes mellitus (GDM) is a disease in which elevated blood glucose is detected during pregnancy and resolves after childbirth.

Risk factors for developing GDM:

– overweight or obesity before pregnancy, rapid weight gain during this pregnancy;

– existing carbohydrate metabolism disorders: GDM in previous pregnancies, impaired glucose tolerance before pregnancy, the appearance of glucose in the urine during a current or previous pregnancy;

– family history of type 2 diabetes mellitus;

– a large fetus during a current pregnancy or a history of the birth of a child weighing more than 4000 g;

– polyhydramnios during current pregnancy or in history;

– complicated obstetric history (preeclampsia, stillbirth, premature birth);

– multiple pregnancy, pregnancy after IVF;

– taking glucocorticoids during pregnancy;

– age over 30 years.

For pregnant women, blood glucose levels are set at different levels than for other people.

In pregnant women, it is necessary to determine glucose in venous plasma (“blood from a vein”). The norm of glucose for pregnant women in venous plasma on an empty stomach (after fasting for at least 8 hours) is less than 5.1 mmol/l. If fasting venous plasma glucose is ≥ 5.1 but < 7.0, a diagnosis of gestational diabetes mellitus is made.

In whole capillary blood (“finger blood”), the glucose norm for pregnant women is less than 4.6.

If venous plasma glucose on an empty stomach is ≥7, or ≥6.1 in whole capillary blood, or during the day ≥11 mmol/l in any blood, or glycated hemoglobin ≥6.5%, then a diagnosis of “manifest” diabetes mellitus is established ( i.e. diabetes mellitus 1, 2 or specific type, which was first identified during pregnancy).

To establish a diagnosis of GDM, the norm must be exceeded in at least 2 tests. In doubtful cases, an oral glucose tolerance test with 75 g of glucose is performed.

Basics of GDM treatment:

1. Balanced diet.
2. Self-monitoring of blood glucose with a glucometer, checking for the presence of ketone bodies in the urine.
3. Physical exercise.
4. Insulin therapy.

Oral medications to normalize glycemic levels during pregnancy are prohibited.

Rational nutrition for gestational diabetes.

Often, a pregnant woman, upon learning the diagnosis of gestational diabetes, sharply limits her carbohydrate intake and reduces the amount of food and meals. You can't do that. During pregnancy, the mother's body and fetus should receive a sufficient amount of carbohydrates (175 g or 50% of the calculated daily calorie intake). If there are not enough carbohydrates, the body begins to break down protein and fat to obtain energy, ketosis develops, and ketone bodies appear in the urine. A pregnant woman with gestational diabetes constantly balances the risk of ketone bodies in the urine due to insufficient carbohydrate intake and high blood glucose levels. Therefore, it is necessary to consume carbohydrates, but these should be “slow” carbohydrates that slowly increase blood glucose.

The calorie content of the daily diet depends on the presence of excess body weight or obesity before pregnancy. During pregnancy, you cannot sharply limit your daily calorie intake (the daily calorie intake should not be more than 30% of what you consumed before pregnancy and should not lead to the development of “starvation ketosis”). If you are overweight or obese before pregnancy, the calorie content should be up to 25 kcal/kg/day. With normal body weight before pregnancy, calorie content should be 25-30 kcal/kg/day.

In overweight women, weight gain during pregnancy should be no more than 4-8 kg. The greater the excess body weight, the less weight gain should be during pregnancy.

Recommendations for gaining weight

Meals for gestational diabetes should be frequent (three main and three intermediate meals). Long gaps between meals should not be allowed. Before going to bed or at night, an additional intake of 12-15 g of carbohydrates is necessary to prevent “hunger ketosis”.

It is necessary to exclude easily digestible carbohydrates from the diet juices (including sugar-free), lemonades, sugar, honey, jam, sweets, chocolate, fructose, baked goods, grapes, bananas, dried fruits.

It is necessary to consume slow-digesting carbohydrates with a high level of dietary fiber in sufficient quantities: porridges made from whole grain cereals (but not flakes) are preferable: (oatmeal, buckwheat, pearl barley), vegetables (except boiled beets): cabbage of all varieties, zucchini, eggplant.

Individually, under the control of blood glucose, you can also eat potatoes (baked or boiled, but not mashed), boiled beets (have a high glycemic index and can increase blood glucose), durum wheat pasta (almost overcook when cooking).

All fruits and berries increase blood glucose. However, they cannot be excluded during pregnancy. Avoid or limit fruits with a high glycemic index (pineapple, watermelon, bananas, grapes, persimmons).

The use of sweeteners such as saccharin and cyclamate is prohibited.

Blood glucose control in gestational diabetes.

Every day you need to check your blood glucose several times a day with a plasma-calibrated glucometer: on an empty stomach, 1 hour after breakfast, lunch, dinner and before bed.

Rules for collecting blood when measuring with a glucometer:

• wash your hands with warm water and soap (no need to use an antiseptic);
• hands must be dry;
• it is necessary to pierce not the central part of the pad, but the side surface of the fingers (sensitivity is lower there);
• Do not forcefully squeeze out a drop of blood (if the blood does not flow out well, you need to rub your finger before puncturing).

There are special prickers for pricking fingers, which usually come with glucometers. In piercers, you can adjust the depth of the skin puncture. A person may use their lancet (lancing needle) several times. You should not let anyone use your lancing device or lancet to avoid contracting hepatitis and HIV.

When prescribing insulin therapy, daily self-monitoring of glycemia is carried out at least 7 times a day (before and 1 hour after meals, at night), if you feel unwell, and, if necessary, at night.

Target blood glucose levels for gestational diabetes: fasting, before meals, at bedtime and at night <5.1 mmol/L, 1 hour after meals - <7.0 mmol/L.

Once every 2 weeks it is necessary to check the urine for ketone bodies (“acetone”). If you are prone to ketonuria, checks should be carried out more often. You can purchase Urotest strips at the pharmacy for self-monitoring of ketone bodies in urine.

When ketonuria occurs, it is necessary to increase the amount of carbohydrates in the diet under the control of blood glucose.

A pregnant woman with gestational diabetes should keep a self-monitoring diary and a food diary, which includes food, blood glucose, the presence of ketone bodies in the urine, and when prescribing insulin therapy, the dose of insulin.

Physical exercise.

Pregnant women with GDM are advised to have moderate dosed physical activity (150 minutes of active walking per week, swimming, aerobic gymnastics, water aerobics and yoga for pregnant women, Nordic walking) taking into account the individual characteristics of the woman. It is necessary to exclude increased physical stress on the abdominal muscles.

Insulin therapy for gestational diabetes mellitus.

If, despite a balanced diet, target blood glucose levels are not achieved within two weeks, insulin is prescribed. Insulin for gestational diabetes is prescribed only during pregnancy and is discontinued after childbirth.

The insulin therapy regimen is prescribed depending on glycemic indicators. If blood glucose is elevated after meals, short-acting insulin is prescribed before main meals. If blood glucose increases in the morning on an empty stomach, long-acting insulin is prescribed before bedtime. If the effectiveness is insufficient, short-acting insulin + long-acting insulin is prescribed.

More information about insulin therapy will be written below.

Tactics after childbirth

Insulin therapy in patients with GDM is canceled immediately after childbirth with mandatory control of glycemia on an empty stomach and after meals for at least three days against the background of diet therapy.

A tolerance test with 75 g of glucose is performed 6 weeks after birth. If there are no disturbances in carbohydrate metabolism according to the test results, the test is repeated after 6 months, then 12 months after birth and then after 3 years.

Gestational diabetes mellitus is a transient condition, however, patients with previous GDM are at risk for developing type 2 diabetes mellitus, therefore, even after childbirth, they should adhere to recommendations for lifestyle modification (diet therapy, weight normalization, adequate physical activity).

Subsequent pregnancies should be planned.

INSULIN THERAPY FOR GESTATIONAL DIABETES

In gestational diabetes, insulin is prescribed when it is impossible to achieve compensation with diet. After childbirth, insulin is discontinued.

Often pregnant women are afraid of insulin therapy, fearing that they will be “put on insulin” or that insulin will “harm the baby.” This fear is completely unfounded. Insulin tolerance does not develop, and high blood glucose levels have an adverse effect on the fetus.

In healthy people, insulin is constantly produced (regardless of food intake) at a rate of 0.5-1 U/hour - this is called basal insulin secretion.

When eating food, there is an additional release of insulin in response to food - a food (prandial) peak.

Insulin preparations are divided into short-acting and long-acting insulin.

Depending on the time at which glucose levels exceed the target level, different insulin therapy regimens are prescribed.

The doctor may prescribe only long-acting insulin 1-2 times a day, or short-acting insulin before meals, or basal-bolus insulin therapy (short-acting insulin before meals + long-acting insulin 1-2 times a day).

Short-acting insulin is administered before meals, its task is to reduce the rise in blood glucose after meals (meal peak). After administering short-acting insulin, you need to eat. In order to determine whether the dose of short-acting insulin is sufficient, check blood glucose 1 hour after a meal (meal peak), 2 hours after a meal (peak action of insulin) and 4-5 hours after the injection (end of action of insulin). An intermediate meal (snack) is taken at the peak of the action of short-acting insulin.

Long-acting insulin is administered regardless of food intake, at the same time, 1-2 times a day; after the injection of long-acting insulin, you do not need to eat. The purpose of long-acting insulin drugs is to maintain the basal (background) concentration of insulin in the body while a person is not eating.

The need for insulin can change depending on many factors: physical activity, acute diseases, exacerbation of chronic diseases, stress, etc.

Insulin is administered subcutaneously. Insulin can be administered using insulin syringes or pens. As a rule, pregnant women are provided with syringe pens for administering insulin.

However, you must be able to administer insulin using an insulin syringe.

Volumes of insulin syringes: 0.3 ml, 0.5 ml and 1 ml. The syringe is marked with divisions and numbers. The numbers indicate the number of units (from 10 to 100 units). In the picture there is a syringe with a volume of 1 ml, 1 ml contains 100 units, one small division corresponds to 2 units of insulin.

The syringe must match the insulin concentration. Now almost all insulins have a concentration of 100 U/ml and they correspond to syringes 0.1 ml - 10 IU (1 ml syringe marked 100 IU; 0.5 ml - 50 IU; 0.3 ml - 30 IU). But earlier insulin was produced with a concentration of 40 units/ml and there were corresponding syringes for it (40 units - 1 ml). If you draw insulin with a concentration of 100 U/ml into such a syringe, the dose will be exceeded by 2.5 times. In our country, such syringes are currently not produced.

The length of the needle in an insulin syringe is from 6 to 13 mm. The needle thickness is indicated by the letter “G” (G31 – G26). The higher the number, the thinner the needle (i.e. a G31 needle will be thinner than a G26).

The choice of the optimal length and thickness of the needle depends on the individual parameters of the body and is selected experimentally.

Syringe pens

A syringe pen is a device into which insulin is inserted in special bottles called cartridges. The required dose of insulin is set and administered as an injection (shot), just like with a syringe. The needles in pens are removable and must be changed after each insulin injection. After injecting insulin, the needle must be removed. Do not store the pen with the needle screwed on. Insulin may leak from the needle and air may enter the cartridge.

Needles come in lengths from 4 to 12 mm and thicknesses G32 - G29. Just like an insulin syringe, the higher the number, the thinner the needle.

Recommended sites for insulin injection

Insulin can be injected into the area of ​​the anterior outer surface of the thighs, buttocks, outer surface of the shoulders, and abdomen. In the abdominal area, insulin is not injected around the navel area (2 cm in diameter), in the midline of the abdomen, from the ribs down, 2 cm must be injected.

Depending on where the insulin is injected, the action time of the genetically engineered insulin differs. The fastest action of insulin occurs when injected into the stomach, so short-acting insulin is injected into the stomach. Long-acting insulin is injected into the thighs and buttocks.

It is advisable to inject insulin into the shoulders only if someone else is doing the injection.

Insulin will be absorbed faster under conditions of increased blood circulation (after a bath, hot shower, massage of the injection site, physical activity). Insulin slows down the action of cooling, vasospasm, dehydration.

Insulin cannot be injected into the same place; insulin injection sites must be alternated (left-right thigh or shoulder, left-right half of the abdomen), the distance between insulin injections must be at least 2 cm. Insulin is not injected into the area of ​​scars, stretch marks ( stretch marks).

Insulin injection technique

If you are administering extended-release NPH insulin (“cloudy” long-acting insulin), then before use it must be mixed by rolling it between your palms at least 10 times (do not shake the bottle).

If insulin is injected with a syringe, then you need to draw air into the syringe according to the number of units of insulin (if you inject 10 units of insulin, you need to draw 10 units of air). Then inject the collected air from the syringe into the insulin vial and draw the required amount of insulin. Remove air bubbles from the syringe (needle up, tap the syringe), release excess air and 0.5-1 units of insulin from the syringe.

If insulin is administered with a syringe pen, then you need to dial and release 0.5-1 units of insulin, while holding the pen with the needle up.

Injections are performed on a clean area of ​​skin with clean hands. If you follow the rules of personal hygiene and take a shower every day, there is no need to disinfect your skin before each injection.

It is necessary to form a skin fold (muscles should not be grasped into the fold, only the skin should be grasped). Insulin injections should be administered into subcutaneous fat and not intradermally or intramuscularly. The fold should be taken with two fingers, and not with the whole hand (so as not to catch the muscles).

The needle is inserted, depending on the thickness of the subcutaneous fat, inserted at a right angle or at an angle of 450 into the base of the fold, with the needle cut upward.

After inserting the needle, you must gently press the plunger of the syringe or syringe pen (grasp the syringe pen with 4 fingers, press with your thumb), inject insulin and hold the syringe under the skin for at least 10 seconds (count to 20). The higher the dose, the longer you need to hold the needle. After this, take out the needle (don’t let go of the fold!), wait a little (count to 3) and release the fold.

Insulin storage

The insulin supply should be stored in the refrigerator at a temperature of 2 to 80C. Insulin should not be frozen! If insulin has been frozen, it cannot be used. On an airplane, insulin cannot be checked in as luggage. he might freeze there.

The bottle from which insulin is administered can be stored at room temperature (up to 250C) for up to 4 weeks. Avoid exposing insulin to direct sunlight.

If insulin is removed from the refrigerator, it should be at room temperature for at least 1 hour.

When traveling or on the beach, insulin reserves should be stored in special thermal cases for storing insulin. Also, thermal covers should be used at negative ambient temperatures. When the ambient temperature is below freezing, insulin should be transported by placing it close to the body and not in a bag.

Do not use insulin if color changes, flakes or sediment appear.

During insulin therapy, it is necessary to consume a stable amount of carbohydrates in food, because The insulin dose is adjusted to a specific amount of carbohydrates.

To determine how a certain product will increase blood glucose, the concept of “bread unit” (XE) is introduced. 1 XE = 10 grams of carbohydrates. You should consume at least 18 XE per day, which is distributed over 5-6 meals.

There are approximate systems for counting grain units:

A more precise composition of products is given in the section “Tables with the composition of products” (the tables provide approximate data; according to different sources, data on the nutritional value of the same products may differ).

HYPOGLYCEMIA

Hypoglycemia is a decrease in blood glucose levels below normal.

The borderline level for hypoglycemia is a glucose level ≤ 3.9 mmol/l.

Hypoglycemia may cause various symptoms: sweating, mood changes, irritability, hunger, trembling, palpitations, numbness of the lips, fingers and tongue, headache, dizziness, weakness, drowsiness, blurred vision. With severe hypoglycemia, a person loses consciousness.

Hypoglycemia during insulin therapy can be caused by the following reasons:

• not eating enough (not enough carbohydrates in food) or skipping meals after administering short-acting insulin;
• discrepancy between the action profile of short-acting insulin and food absorption;
• excess insulin (incorrect dose calculation, erroneous administration);
• night peak of extended insulin;
• exercise stress;
• alcohol;
• injection of insulin into muscles.

Hypoglycemia must be stopped with fast carbohydrates. Cookies, chocolate, cakes (contain fat, which slows down the effect of carbohydrates), caramel and lollipops (can cause choking) are not

It is important to properly treat hypoglycemia so as not to “overdo” carbohydrates and increase blood glucose too much.

Relief of hypoglycemia is carried out according to “Rule 15”: eat or drink 15 grams of fast carbohydrates, check your glucose after 15 minutes. If glucose ≤ 3.9 mmol/L, eat or drink 15 grams of carbohydrates again and check your glucose after 15 minutes. And repeat this until hypoglycemia stops.

To relieve hypoglycemia, you can use:

½ cup of juice, non-diet sweet drink (200 ml juice bags are convenient); 1 tablespoon of sugar or honey; 4-6 pieces of refined sugar.

If you lose consciousness, people around you can help relieve hypoglycemia by rubbing honey or thick syrup into your gums. They should not pour liquid, push sweets, etc. into your mouth, because... this can lead to asphyxia.

Preventing Gestational Diabetes

Unfortunately, there are no 100% effective measures that would protect against this disease.
But the more useful habits a woman develops before pregnancy, the easier pregnancy and childbirth will be:

• From the first days of pregnancy, eat healthy foods: choose foods high in fiber and low in fat. Focus on vegetables and whole grains. Strive for variety and watch portion sizes.
• Stay active. Try to devote 30 minutes to sports every day. Take daily walks, ride a bike, or go swimming.
• Plan your pregnancy at a healthy weight and don't gain more than recommended. Excessively rapid weight gain can increase the risk of gestational diabetes.

Although there is no universal protection against GDM, you can reduce your risk of developing it through a healthy lifestyle. The most important thing is to detect the problem in time and prevent it from developing.

After childbirth

Gestational diabetes is a disease characteristic of pregnancy. After childbirth, GDM goes away as hormonal levels return to normal.

However, we must not forget that GDM is a risk factor for the development of type 2 diabetes mellitus and recurrent disease during the next pregnancy.

Immediately after birth, if insulin therapy was prescribed, it is canceled. During the first days, glucose levels are monitored by collecting venous blood. If there are no abnormalities, a glucose tolerance test is performed 6–12 weeks after birth to rule out type 2 diabetes.

If GDM was diagnosed during pregnancy, it is necessary to follow a diet and engage in dosed physical activity. Otherwise, there are no restrictions; after GDM you can breastfeed as usual.

Insulin preparations approved for use during pregnancy

Rules for storing insulin and administering injections

• Sealed vials and cartridges with insulin should be stored in the refrigerator at a temperature of +4–8°C; opened ones can be kept at room temperature no higher than +25°C for one month;
• Before using a new bottle, you must check the expiration date information;
• You cannot use an insulin syringe pen if its body has cracks, the cartridge is not tightly screwed to the piston, or the pen body is wet from leaking insulin;
• The needle should be changed after each injection, as crystallization of insulin and “clogging” of the needle may occur, which will lead to inaccurate administration of the drug dose;
• Before the injection, it is necessary to “reset” 1 unit of insulin;
• If the insulin does not "reset", it may be low or the plunger is not touching the rubber cap inside the cartridge;
• Optimal absorption of insulin is ensured when it is administered into the subcutaneous fatty tissue. To do this, use two fingers – the thumb and index – to form a skin fold;
• For best absorption of the drug, it is recommended to hold the fold;
• Continue to press the plunger of the syringe pen for 10–15 seconds after the end of the injection so that all the required amount of insulin has time to flow out of the needle;
• If you practice good personal hygiene and use disposable needles for hypodermic insulin injections, there is no need to wipe your skin with alcohol before injection. Alcohol causes the destruction of insulin and has a tanning or irritating effect on the skin.

Hypoglycemia is a condition characterized by low blood sugar levels. Hypoglycemia is considered to be blood sugar below 3.9 mmol/l during pregnancy only during insulin therapy. It is very rare in gestational diabetes mellitus.

Causes of hypoglycemia in gestational diabetes mellitus:

• Too much insulin was administered;
• Lack of carbohydrates in the diet;
• Skipping meals;
• Too intense physical activity.

Signs of hypoglycemia:

• Headache, dizziness;
• Hunger;
• Visual impairment;
• Restlessness, feeling of anxiety;
• Frequent heartbeat;
• Sweating;
• Shiver;
• Deterioration of mood;
• Poor sleep;
• Confusion.

What others might notice if you experience hypoglycemia:

• Pallor;
• Drowsiness;
• Speech disorders;
• Anxiety, aggressiveness, inappropriate behavior;
• Impaired concentration.

Algorithm of action for signs of hypoglycemia

• Stop any physical activity;
• Determine your sugar level - is it really low?
• Immediately eat or drink something containing quickly digestible carbohydrates: 100 ml of juice, or 4 pieces of sugar (can be dissolved in water;
• After this, you need to eat or drink something containing slowly digestible carbohydrates in quantity (a glass of kefir,
• piece of bread, apple).

The most reliable method of preventing hypoglycemia is regular self-monitoring of glycemia.