A1C & eAG
What is eAG? Estimated average glucose is a simple way to understand A1C. It provides your approximate average blood-glucose level for the last three months.
What is eAG?
Estimated average glucose eAG is a comfortable way to relate your A1C result to that of glucose meter reading.
A1C result is available in percentage. Thus, challenging to understand and relate it to the self-monitoring blood glucose level. Therefore healthcare professionals coin a new term called estimated average glucose eAG. It could give their patients A1C results in easy-to-understand terms.
Estimated average glucose (eAG) helps translate your A1C % result into mg/dl or mmol/l. This way, it relates to the daily glucose meter reading.
Is Hba1c an average of blood glucose levels?
The hba1c test is not an average of blood glucose levels. Still, it is logical to assume a high glucose level leads to more glycation and increased HbA1c.
Generally,
- Fasting plasma glucose level underestimates A1C. That is, the estimated A1C based on fasting BS is lower than the actual A1C.
- Post-breakfast glucose levels overestimate A1C. That is, estimated A1C based on post-breakfast BS is higher than actual A1C.
- Post-lunch glucose level relates to A1C comparable to mean plasma glucose.
What does an eAG mean? A1C of 7% does not confirm that your blood sugar has been steadily maintained at X mg/dl (or mmol/l) for the past 2 to 3 months. If you tested your BS for every minute, hour, day, and night for the past 2 to 3 months, then its average might be equal to eAG.
Know the limitations of A1C & eAG
No doubt, eAG & A1C provide useful information to gain an idea of how good or bad is your diabetes control.
Only less than 4.7% of glucose is linked to RBCs in the hemoglobin of a non-diabetic population. Short-term hourly blood sugar elevations do not have a significant change in the A1C number. Only, long-term high BS leads to a slow rate of glucose linked with hemoglobin and elevated A1C.
For diabetics, eAG and A1C are just a piece of the puzzle for your entire blood sugar level management.
Excellent eAG & A1C, do not necessarily mean you are in reasonable diabetes control. Even a superb eAG and a1c may be due to a combination of undesirable high and low blood sugars. Thus, aside from getting your A1C test, you need to track blood sugar. The combination of BS and A1C (eAG) data provides the best info to assess your diabetes control.
In most occasions, healthy eAG means to reflect most of your blood sugar readings are normal.
Two popular estimated Average Glucose (eAG) studies
In April 2009, the College of American Pathologists survey collected info from 3,000 labs. 16.7% of them reported eAG; 28.8% used ADAG formula, 22.6% used DCCT formula, and balance used other methods.
There are many studies and methods to convert A1C to blood-glucose level. Two significant studies are the Diabetes Control & Complications Trial (DCCT), and A1C Derived Average Glucose (ADAG). These two studies provide different formulas for eAG.
Dr. Richard K. Bernstein, the author of the popular book "Diabetes Solution." He is the first who succeed in the use of a low-carb diet for his type 1 diabetes control (with an A1C of 4.2 to 4.6). He recommends DCCT's formula to convert A1C to eAG.
We provide two A1C charts (eAG); one is based on the DCCT A1C chart and another is based on the ADAG A1C chart. We request you to put your mind and find which one best suits you. However, we trust Dr. Richard K. Bernstein. Additionally, our website visitors have preferred DCCT over the ADAG formula.
Why do my average glucose reading (from glucometer) and eAG (from A1C) differ?
Blood glucose levels from preceding 30 days influence about 50% of the total HbA1c.
Most glucose monitors provide an average of all the past several weeks or months of reading. In many instances, this meter average might not be the same as the eAG, learn why.
Your blood glucose meter provides the blood glucose level at that moment. Even if you are testing ten or more times, then the average is likely to be higher or lower than your eAG. However, eAG is an average glucose level 24/7 for two to three months.
A1C
Before going into the hbA1C details, you should know about blood, RBC, and hemoglobin.
A blood drop contains more than a million red blood cells (RBC or erythrocytes). Each RBC contains over 600 million hemoglobin.
What is RBC (red blood cell)?
RBC or erythrocyte is a biconcave disk with a flat center with indentation. RBC looks similar to a donut without a hole. This RBC's shape provides a greater surface area to carry fresh oxygen throughout the body. The life span of RBC is about 120 days.
What is hemoglobin?
Hemoglobin is a protein in red blood cells. It carries oxygen to every cell in your body. Hemoglobin provides a red color to the red blood cell; it contains an iron atom at its center. RBC is red when iron atoms bind to oxygen; otherwise (when iron does not bind to oxygen) blue-red.
What is the Glycation of Hemoglobin HbA1C?
Other names of A1C are hba1c, glycated hemoglobin, hemoglobin A1C, and glycated hemoglobin A1C. Some people call it A1C diabetes and A1C measurement. Sometimes people wrongly call it glycosylated hemoglobin, hga1c, ha1c, hemoglobin 1ac, and hemoglobin h1c.
When glucose in the blood chemically reacts with hemoglobin, it forms glycated hemoglobin. That is, glucose is attached to hemoglobin.
Imagine rolling new hard gum or donut over a tray containing sugar. The sugar sticks to the hard gum or donut. Likewise, glucose in the blood sticks to the hemoglobin, this reaction is called glycation.
The glucose concentration in the blood decides the extent of hemoglobin glycation. This glycation process is irreversible, and it stays for its entire life.
A1C reflects the hemoglobin glycation that is proportional to average glycemia. However, you should not expect every individual to glycate to the same degree for a given level of glycemia.
What is an A1C diabetes test?
A1C test results show the percentage of glycated hemoglobin. An A1C of 5% indicates; out of 100 hemoglobin, 5 of them are glycated (glucose attached to it).
The HbA1C test measures the percentage of hemoglobin attached to the glucose in the blood. The glucose level decides the rate of glycation in the blood.
The lifespan of red blood cells is approximately 90 days. So, the percentage of hemoglobin A1C correlates to the average blood glucose for the last 90 days.
The glycated hemoglobin test shows the level of glucose in the blood for the past two to four months. Measuring A1C helps to assess the effectiveness of diabetes treatment.
Why is it called HbA1C? Because it measures the percentage of glycated hemoglobin variant "A" subtype "1c" in blood. "Hb" is for hemoglobin, "A" is a variant, and "1C" is a subtype.
What is the difference between glycosylation and glycation?
Blood glucose binds with a protein or lipid molecule by an enzymatic process called Glycosylation. Glycosylation is an essentially biological process that does many vital functions. These functions are proper protein folding, increased protein stability, substrate binding, and solubility. Glycosylation is a normal part of cell function; it does not have a link with the aging process.
However, glycation is a non-enzymatic process of sticking process that protein. This glucose denatured the protein; this contributes to many diseases of aging. It develops chronic vascular complications, non-diabetic nephropathy, vascular disease, Alzheimer’s disease, and aging.
Danger of glycation
Typically, glucose provides energy to the cells. However, insulin cannot effectively push glucose into the cells in insulin-resistant individuals. Thus, glucose stays in the blood, and later denatures the proteins in the body.
Hyperglycemia increases the rate of glycation, thus increasing the risk of diabetes complications. It leads to diabetes complications such as blindness, and renal & vascular disease. The glycated molecule may develop Thus, advanced glycation end products (AGEs). AGE accumulation in the eyes, kidneys, arteries, nerve endings, joints, and skin leads to many health issues.
Why are people with diabetes prone to flu and other infections?
Viruses use glycosylation or glycolate to shield the underlying viral protein from immune recognition. Viruses (such as HIV, Epstein-Barr virus, etc.) rely on glycosylation either for infection, relaxation, and immune evasion. Viruses exploit host glycosylation to ensure their propagation and survival.
The A1C test, how do I take it?
The A1C test is a simple blood test, fasting is not required! You can eat as usual, without restriction.
The hba1c test can be performed with a regular finger stick using a lancing device or by blood sample drawn from a vein. For the A1C test, you can take a blood sample at any time of the day. Home A1C testing is available; if you do not follow the instructions, the test may result in inaccuracy.
What are the different methods to measure HbA1C?
There are four fundamental ways to measure HbA1c. They are Immunoassay, Ion-exchange high-performance liquid chromatography (HPLC), Boronate affinity HPLC, and Enzymatic Assays.
Laboratories should be aware of their limitations that interfere with the most common Hb variants. They can select new methods that are less likely to have an intervention. If a result does not fit into the clinical picture, then further investigation is needed by the clinician.
Ask your doctor if the lab running the test uses a method certified by the NGSP. Sadly, not every laboratory or home test kit meets those standards — list of NGSP Certified Laboratories.
Why is HbA1c measurement important?
HbA1c gives valuable information to people with diabetes. HbA1c does not fluctuate a lot, why? Once red blood cells are glycated, they stay there for their entire life (3 months). So, HbA1c gives an overall picture of blood glucose control for the past three months. The hba1c number is the best-proven marker of risk towards diabetes complications.
The downside of the A1C test
A significant disadvantage of the A1C test is
• A person’s blood sugar is consistently healthy and
• Another person’s blood sugar fluctuates high and low,
Could have the same A1C test result. So, for effective diabetes management undergo both A1C and self-monitoring blood glucose (SMBG) tests.
Why do you need to take both SMBG and A1C tests?
Blood glucose fluctuates; from seconds to seconds; minute to minute; hour to hour; and day to day. The A1C has changed slowly for the past 8 to 10 weeks. So, it is useful as a 'quality control' test.
So, why should I measure my blood glucose level?
A blood glucose test provides freely available sugar concentrations in the blood at that moment. Thus, it helps detect low or high blood sugar. It allows us to make appropriate treatment changes; e.g., insulin, food intake, and activity levels.
Monitoring blood sugar allows for making a quick adjustment. Thus, it helps to achieve tight diabetes control and healthy A1C. Additionally, it lowers or eliminates many diabetic complications.
Diabetic blood glucose level fluctuates more than in healthy individuals. Blood sugar level elevates after food, especially sweets, refined carbohydrates, and carbohydrate-rich foods. BS drops after exercise and is unpredictable after stress. For people with diabetes, this makes it challenging to maintain sugar levels. Thus, the glucose level measurement is the best for immediate real-time correction.
In summary, both BS and A1C tests are necessary for immediate and long-term BS info. It helps in decision-making for proper diabetes management.
If you self-monitor your glucose today and treat it accordingly, it contributes to achieving optimal A1C later. A1C & glucose tests are interrelated, and regular BS measurement is necessary to attain healthy A1C.
A1C % is meaningless unless it is converted into an equivalent BS level using an A1C chart & calculator. If your A1C is on the higher side, do not panic; learn how to lower your A1C level.
Research shows improving both BS and A1C is essential to avoid micro & macrovascular diabetes complications.
Alternative medicines
Alternative medicine is a set of diverse traditional medicinal healthcare systems and practices that are not generally considered part of conventional or modern medicine.
Alternative Medicine (Traditional/Natural medicine)
Alternative medicine is a health care approach that is applied instead of Conventional or Western drugs. Alternative medicinal treatment may include ingesting or applying organic substances, mostly herbs, and some minerals. It also includes a unique diet plan that primarily vegetables and fruits. Generally, a physician who practices conventional or modern medicines would not suggest. Alternative medicine not only offers remedies for various health issues but also teaches us how to lead a healthier lifestyle.
Alternative medicine is an umbrella term for hundreds of natural therapies from all over the world. Most of them are the medical systems of older cultures that include Egyptian, Chinese, Asian Indian, Greek, and Native American.
The Alternative medicine user’s statistics
In May 2004, a survey was published by the National Center for Complementary and Alternative Medicine (NCCAM) in collaboration with the National Center for Health Statistics, which is a division of the Centers for Disease Control and Prevention. The result shows that in the United States alone, about 36% of adults used some form of CAM therapy during the past 12 months.
A British telephone survey by the BBC in 1998 shows about 20% of adults had used alternative medicine in the past 12 months.
The use of alternative medicine among people in developed countries appears to be increasing. A study in 1998 showed that the use of alternative medicine had risen from 33.8% in 1990 to 42.1% in 1997.
The most commonly practiced complementary treatments are herbal, yoga, acupuncture or acupressure, meditation, and massage. Other treatments are therapeutic touch, aromatherapy, Chinese medicine, dance therapy, music therapy, osteopathy, chiropractic, and naturopathy.
A 2002 survey of US adults 18 years and older conducted by the National Center for Health Statistics (CDC), and the National Center for Complementary and Alternative Medicine indicated that 49.8% had used some form of CAM.
A 2005 survey among Denmark's population aged 16 and older revealed that 45.2% of respondents had used some form of alternative medicine at some point in their lives. Additionally, 22.5% indicated that they had used alternative medicine in the last year.
Patients are opposed to the dangerous side effects of conventional drugs. Even antibiotic medications can potentially trigger a life-threatening severe allergic reaction in a small number of individuals. Additionally, many medications can lead to minor yet bothersome side effects such as coughing or stomach discomfort. In each of these instances, patients are turning to alternative medicine therapies to clear the negative side effects associated with conventional treatments.
Alternative medicine user’s class
A study from 1998 reveals that most instances of alternative medicine were utilized alongside conventional medical treatments. Approximately 4.4 % of those studied used alternative medicine as a replacement for conventional medicine. Research shows that those having used alternative medicine tended to have higher education or report more inferior health status.
People of all backgrounds start using alternative treatments. However, women, along with individuals who possess a higher level of education and income, are particularly noteworthy among them.
A 2008 survey conducted among medical students in Denmark revealed that 68% of respondents had utilized alternative therapies. The most commonly used alternative medicine was herbal medicines and Dietary supplements (50 %), Acupuncture (18 %), and Reflexology (18 %).
The alternative approach preferred most
When asked the people who use CAM, why they are using CAM?
- They thought CAM combined with conventional medicine would help faster relief.
- They thought CAM would be interesting to try.
- They thought conventional medicine would not help.
- The conventional medical professional suggested it.
- Conventional medicine is too expensive.
Natural herb products are the most commonly used alternative medicines among adults. Other popular alternative therapies are breathing exercises, meditation, massage reflexology therapy, acupressure, and yoga.
Different traditional therapies and their oneness
Although traditional treatments are diverse approaches, they share specific attributes; they consider humans as a whole and more than just physical bodies. Body, mind, and spirit constitute a unified reality, illness can influence and be influenced by both physical and mental states.
Almost every alternative medicine considers symptoms during health conditions to be due to the body’s efforts to cure its imbalance a disease).
What is vital energy?
The human body animates by integrated energy called the vital force, life force, prana, qi, or chi. The life force sustains the physical body linked to a higher being or infinite energy source. When life forces quantity and if it flows freely throughout the body, then you can enjoy optimal health. Obstructed or diminished vital energy can cause a deficiency in energy for organs, tissues, and cells, ultimately leading to illness or disease over time.
They view vital energy as the force that integrates the body, mind, and spirit, which connects everything. The Chinese mention this as a life force as qi or chi, the Ancient Greeks call it pneuma, and the Hindus call it prana. In every culture, they believe the life force is both self-nurturing and self-sustaining.
Health conditions that prompt alternative treatment use
People use complementary alternative medicine treatment for many diseases and conditions, most familiar to them are musculoskeletal problems such as back, neck, or joint pain.
Now people start looking for alternative treatments for many conditions such as:
- Allergy, Arthritis/Osteoarthritis, Asthma, Attention Deficit, Autism,
- Birth Defects, Cancer, Chronic Fatigue, Cognitive Dysfunction, Colds, and Influenza,
- Depression, Detoxification, Diabetes, Digestive Disorders,
- Eating Disorders, Epilepsy, Erectile Dysfunction,
- Heart Disease, Hepatitis C, Hypertension,
- Immune System, Infertility, Inflammatory Bowel, Insomnia, Interstitial Cystitis,
- Liver Disease, Neuro-degeneration, Ocular (Eye) Disorders, Osteoporosis,
- Parkinson's Disease, Peripheral Neuropathy, Prostate Cancer, Prostate Disease, Psoriasis,
- Restless Leg Syndrome, Seasonal Affective, Stress, and the list is endless.
Natural Alternative Medicine Treatments are available here
Let us see detailed information on Alternative medicines; such as Ayurvedic medicine, Yoga Therapy, Traditional Chinese Medicine, Acupressure, Reflexology massage, and seven chakras.
Sleep & Sleep Disorder
Sleep is a natural state of rest for both the mind and the body, usually, close the eyes, and consciousness is partially or entirely lost. Furthermore, during sleep, there is a decrease in bodily movement, and relatively more responsive to internal stimuli than external stimuli.
How important is your sleep?
Sleeping may be considered a big waste of time. Nevertheless, sleep appears to be necessary; there is still an ever-lasting debate about why we sleep. How much sleep do you need?
No one knows and understands clearly, why we sleep, but sleep has an impotent restorative function.
Benefits of Sleep in Restorative Process
This theory of sleep suggests that sleep helps the body recover from all the work it does. Experiments have shown that the more physical activity an animal does, the more NREM an animal will have. Besides, NREM-deprived persons may experience physical tiredness. If people are, deprived of REM sleep, and then they can get anxious and irritable. REM sleep has also been considered crucial for memory and learning.
Importance of deep Sleep and its benefits
Good night's sleep is essential for the normal, healthy functioning of the human body as well as mental health, including the immune system. Sleep helps to improve the immune system which is one’s ability to fight against diseases.
- The body rests and restores its energy levels during sleep
- Sleep is an active state that supports and improves both physical and mental well-being.
- Sleep often helps to cope with stress, and recover from illness.
The necessity of sleep is well understood from animal studies, which have shown that rest is a must for survival. The average life span of rats is two to three years. However, rats deprived of sleep live for only about three weeks.
Understanding Sleep
During sleep, the brain undergoes a natural cycle of brain wave activities that includes intervals of dreaming. Once sleep was thought of as a passive state, however, now it is understood as a dynamic process, and the brains are active during sleep. Sleep is a complicated physiological phenomenon that scientists are still not able to understand fully.
Brains state of activity during sleep and wakefulness results from different activating and inhibiting forces that were caused within the brain. Neurotransmitters are chemicals involved in nerve signaling, which controls whether one is asleep or awake by acting like the neurons (nerve cells) located in different parts of the brain. Neurons located in the brainstem induce sleep by inhibiting other parts of the brain that keep one awake.
Sleep needs to be looked after by the
- Relaxation of the muscles,
- Absence of voluntary activity for any rational objects or purpose
- Pulse is slower,
- Respiratory movements are fewer in number but deeper,
- Less blood in the cerebral vessels
Sleep Disorder Facts
Sleep health essentially needs a person’s physical and mental health and well-being, according to the National Sleep Foundation (NSF). However, millions of people do not get enough sleep or lack of sleep. A survey conducted by the NSF on 1999-2004, shows more than 40 million Americans have over 70 different sleep disorders, and 60 % of adults reportedly have sleep problems a few nights a week. Most of these problems go undiagnosed and untreated.
Additionally, there are more than 40 % of adults experience severe daytime sleepiness that interferes with daily activities at least a few days every month. And 20 % report problems of sleepiness a few days every week. Furthermore, 69 % of children experience sleep problems a few nights or more during a week.
Sleep & Sleep disorder information is available here
Come On, let us see detailed information on:
- Sleep (Stages of sleep, Sleep deprivation, Sleep hygiene),
- Sleep disorders (Sleeping Insomnia, Sleep apnea, Restless legs syndrome & Narcolepsy) and
- Home remedies for a sleep disorder,
- Sleep medicines
- Alternative therapies (herb, yoga, acupressure & reflexology).
Prevent Diabetes after Gestational Diabetes
Mostly blood-glucose level returns to normal after delivery. However, your chance to develop diabetes later in life, so take preventive measures.
Prevent Diabetes After Delivery
The rate of women developing diabetes later after gestational diabetes vary between 3% and over 90%
Since women with gestational diabetes are at high risk of developing diabetes 5 to 10 years postpartum, follow-up of women with gestational diabetes after the delivery is crucial. Type 2 diabetes can be prevented or at least delayed by lifestyle modifications.
Usually, after childbirth, the blood-glucose levels return to normal in about 6 weeks.
Because the placenta, which is responsible for increased hormonal production (that caused insulin resistance), is delivered.
Check your blood glucose level after childbirth to make sure it has returned to normal. Doctors may recommend an oral glucose tolerance test at 6 to 12 weeks after delivery for measuring blood glucose level. If healthy, OGTT repeated at six months & after that, every year after birth.
Diabetes risk of a gestational diabetes
NICE stated up to 50% of women diagnosed with gestational diabetes develop type 2 diabetes within 5 years of birth.
Statistics from Diabetes UK state shows there is a 7-fold increased risk in women with gestational diabetes develops type 2 diabetes in later life.
Women who had gestational diabetes during one pregnancy have a 40%-50% chance of developing gestational diabetes in their next pregnancy. So if you have gestational diabetes in a previous pregnancy and now planning to get pregnant again, consult your doctor to make necessary lifestyle changes before your next pregnancy.
How do you prevent diabetes?
Preventing diabetes after gestational diabetes during pregnancy can be of two parts; they are:
- What do you need to do while pregnant?
- What can you do after delivery?
What do you need to do while pregnant to prevent diabetes?
If you diagnosed with gestational diabetes, then you have to do the following while pregnancy to prevent the chances for type 2 diabetes.
- Age during pregnancy - Delivering a child after 30 years increased the risk of developing diabetes within ten years by 2.3 fold as compared to a younger mother. So if possible women should plan to have a baby before 30 years of age.
- Insulin treatment during pregnancy - Being treated with insulin during pregnancy increased the risk of developing diabetes within ten years by 2.3 fold as compared to a woman not treated with insulin. So, try hard to manage your blood glucose level at your target range using diet and physical activity and without medication.
- Delivering a baby weighing more than 3.5 Kg increased the risk of developing diabetes by 2.4 fold as compared to a woman delivering a child less than 3.5 kg. If you maintain your blood glucose level at your target range, then naturally, your baby will be healthy and below 3.5 kg.
- For every 1 kg increase in pre-pregnancy weight, there is a 40% increase in odds of developing Type 2 diabetes. So, those who are planning for a child and having increased risk towards gestational diabetes should maintain a healthy weight before pregnancy. It not only helps to have a healthy baby also prevent diabetes risk.
- An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes. So, analyze the reason behind the fasting glucose level rise and try lowering it without hypoglycemia risk.
What can you do after delivery to prevent diabetes?
The US Diabetes Prevention Program (DPP) confirmed that lifestyle change reduced T2D risk by 50% for women post-gestational diabetes. The Journal of Clinical Endocrinology & Metabolism. 2008 Dec; 93(12):4774-9.
If you are gestational diabetes, then you have to do the following to prevent or delay type 2 diabetes.
- Maintain healthy body weight - Obesity was the most influential risk factor. The study demonstrated for every 4.5 kg weight gained after delivery, and there was a doubling in risk for T2D development. Reference: The Journal of Clinical Endocrinology & Metabolism 2008 Dec; 93(12):4774-9. Conversably, Weight loss can lower the risk of diabetes development after gestational diabetes.
- Be physically active - For every 100 minutes of moderate-intensity physical activity has reduced 9% risk for T2D development. Conversely, high sedentary behaviors were associated with increased T2D risk. JAMA Internal Medicine 2014 Jul; 174(7):1047-55.
- Dietary fiber – Dietary fiber intake of 10 g/day decrease GDM risk by 26%. Reference: Diabetes Care. 2006 Oct; 29(10):2223-30. Dietary can produce a similar effect on diabetes prevention after GCM. Fiber intake also decreases the risk of type 2 diabetes.
- Mediterranean diet - Women consuming Mediterranean diet had 40% lower T2D. Mediterranean diet is a diet habit of Greece, Southern Italy, and Spain emphasize plant-based foods, such as fruits & vegetables, whole grains, legumes, and nuts primarily. Replace butter with olive oil and canola oil. Archives of Internal Medicine (JAMA Internal Medicine) 2012 Nov 12; 172(20):1566-72.
- Breastfeeding: Studies found breastfeeding for more than three months decreased the risk of T2D by more than 40%. Reference: Diabetes. 2012 Dec; 61(12):3167-71. And breastfeeding for more than ten months improved glucose tolerance, increased insulin sensitivity, and insulin secretion/sensitivity. European Journal of Endocrinology. 2013 Apr; 168(4):515-23.
Women who had gestational diabetes should undergo a test for diabetes or pre-diabetes once every year.
Pregnancy with Diabetes
Valuable to people with diabetes who want a baby
A woman with type 1 diabetes or type 2 diabetes can have a healthy pregnancy because of advances in diabetes research and knowledge gained.
Still, high blood glucose can be harmful to both for mother and her unborn baby. Even before becoming pregnant, you should maintain it close to the normal range. Keeping blood-glucose as required before and during pregnancy, helps protect both mother and baby.
Insulin needs may change when pregnant; the doctor may advise you to take more insulin and check blood-glucose more often. If you take diabetes pills, you will take insulin instead.
Women with diabetic pregnancy should need to have some extra.
- effort and commitment
- care on blood-sugar control
- knowledge on all areas of diabetes management
- Plan financial needs to meet laboratory tests and hospitalization if necessary.
Diabetes tips for before and during pregnancy
- Work with your health care team to get your blood glucose as close to the normal range as possible even before pregnancy.
- See a doctor who has experience in taking care of pregnant women with diabetes.
- Have your eyes and kidneys checked, because pregnancy can make it worse?
- Do not smoke, drink alcohol, or use harmful drugs.
- Follow the meal plan you get from your dietitian or diabetes educator to make sure you and your unborn baby have a healthy diet.
If you are already pregnant, see your doctor right away. It is not too late to bring your blood-glucose close to be normal so that you will stay healthy during the rest of your pregnancy.
Some risks of diabetes pregnancy
- Miscarriages - poorly controlled blood-sugar level or having severe complications are at some risk for miscarriage. Otherwise, the risk is no higher than that of the general population.
- Large Babies – chances may increase by high maternal blood-glucose level, makes the delivery more complicated, and needs to perform cesarean. Reduce this effect by maintaining blood-sugar near normal.
- Polyhydramnios - too many amounts of amniotic fluid throughout pregnancy, it is a less common effect. It causes an overly distended belly, rarely may cause harmful consequences.
- Toxemia - increase in blood pressure with the presence of protein in the urine, and swelling of hands/feet. It is a common complication of diabetic pregnancy, but with proper blood-sugar control, it is not common than in a non-diabetic pregnancy.
- Edema - Swelling is commonly happening during pregnancy. Limiting salt intake can help to reduce this excessive accumulation of fluids.
Gestational Diabetes Baby
Gestational diabetes baby's health care
Fetal care during pregnancy
If diagnosed with gestational diabetes before 20 weeks of pregnancy, a fetal anatomical survey should perform at 18 to 20 weeks.
All gestational diabetes should undergo a fetal growth scan at 28 to 30 weeks and 34 to 36 weeks of gestation. Also, include fetal biometry and amniotic fluid estimation.
Fetal heart should be monitored by auscultation on every antennal visit. Also, you should assess daily fetal activity; lie down on your side after a meal and absorb how long your fetus takes to kick you ten times. If your fetus does not kick at least ten times within 2 hours, then you should immediately consult your doctor.
Immediate neonatal care for the baby
Provide essential care and early breastfeeding for all newborns to prevent hypoglycemia.
After 1 hour of delivery, all newborns should monitor for hypoglycemia (capillary blood glucose less than 44 mg/dl). And monitor continuously for every 4 hours until four stable glucose numbers.
A newborn should evaluate for other complications such as respiratory distress, convulsions, and hyperbilirubinemia.
Gestational diabetes complications
Adverse outcomes of improperly treated gestational diabetes are macrosomia, stillbirth, and congenital abnormality.
The ‘Fetal Origin of Disease’ hypothesis proposes that susceptibility to adult diseases may influence by gestational programming. Journal of the Association of Physicians of India. 2008 Feb; 56():109-13, Whereby stimuli or stresses encountered by the fetus at critical or sensitive periods of development can permanently induce structural, physiological, and metabolic changes, which predispose the individual to disease in adult life [International Journal of Gynecology & Obstetrics 2009 Mar; 104 Supplement 1(): S35-8.].
Is every diabetic will have to get a Caesarian-Section?
Usually not, for most doctors suggests a vaginal delivery. However, if any complication arises during pregnancy, or if you have extensive eye disease with fragile vessels, your doctor may recommend a C-section. Approximately 50 to 60% of diabetes women have caesarian-section.
Will my baby be born with diabetes?
No. Your infant will not have diabetes at birth and will not expect to develop it. However, your baby is having your genes and thus, the slightly increased risk of developing diabetes. The risk for the infant is higher; if the father has diabetes compared with mother.
How can gestational diabetes affect your baby?
Hyperglycemia during pregnancy can affect the baby in numerous ways. It may include macrosomia, low sugar, difficulty breathing, etc.
Macrosomia - Untreated or poorly controlled gestational diabetes can harm your baby. When you have gestational diabetes, your pancreas works over to produce more insulin, but the insulin is not able to lower your blood glucose levels. Although insulin does not enter the placenta, glucose and other nutrients enter the placenta and reach your child. Baby is getting more energy than what is needed, this excess energy stored as fat and bigger baby with excess growth (macrosomia). It can make delivery challenging and more likely to become wedged in the birth canal or may need a C-section to deliver safely.
Hypoglycemia - Since the baby is getting more blood glucose than what is required. This excess blood glucose causes the baby's pancreas to make extra insulin to get rid of the blood glucose. Right after the baby is born, the blood glucose level may drop very low (hypoglycemia) because they have so much insulin in their bodies. Hypoglycemia in babies is easily treated by giving the baby a glucose solution or feeding the baby should raise the blood glucose level.
Difficulty breathing (respiratory distress syndrome) - Some babies have trouble breathing on their right after birth. It will go away after the lungs become stronger.
Development problems - Children of a gestational diabetes mother are at a higher risk for developmental issues such as language development and motor skill development.
Type 2 diabetes - Babies born to a gestational diabetes mother are at a higher risk for obesity, and when they become adults have high chance to get type 2 diabetes.
Does a diabetes mother can breastfeed her baby?
You must breastfeed your baby if it is possible; it helps both you and your baby. It is easy for you to manage your diet if you breastfeed. Your child’s risk for type 2 diabetes may be lower if you are breastfeeding your baby, and if your child maintains a healthy weight. Bottle-feeding is also acceptable if breastfeeding does not work out for you.
Food Pyramid
The food pyramid has been considered to provide effective diabetes control and blood-glucose management.
Because for people with diabetes, carbohydrate plays a significant role in blood glucose level, so it should not consume freely. "Food pyramid information is intended for non-diabetic who wants to avoid diabetes.” Still, diabetic can continue reading the food pyramid for general information, and in the following pages - diabetics diet and carb count can guide you correct diet planning.
Food Pyramid | Food Triangle
Healthy food triangle or pyramid depicts what to eat freely and what should be limited.
The top of the pyramid is of a limited lessor area; similarly, junk food, sweets and, sweet drinks should consume least and occasionally. Next significant area contains milk, cheese, eggs, meat, poultry, sausage, and fish; thus, consume minimally. Next, the more considerable area has vegetables, fruits, and cereals; thus, consume moderately. Finally, the most significant area is the base of the triangle has water; therefore, you can drink as much water as you like.
- Avoid eating and if you want to eat least that too occasionally – Junk foods, sweets, and sweet drinks.
- Eat minimally – Milk, cheese, eggs, meat, poultry, and fish.
- Eat moderately – Vegetables, grains, nuts, and fruits.
- Drink freely – Water.
Water
Around 70 percent of the body and the planet's surface are filled by the water.
Drinking water liberally to hydrate the body. Keeping hydrated is crucial for health and well-being.
Water hydrate joints, form saliva & mucus, maintain skin health, cushioning delegate organs, regulate body temperature, supports digestion, flush toxins, maintain blood pressure, kidney health, and weight loss.
Is drinking warm water beneficial!
Drinking warm water can provide your body with the water it needs to replenish fluids. It can also improve digestion, relieve congestion, and even make you feel more relaxed.
Most people who drink hot water as a holistic health remedy do so first thing in the morning helps to detox, relieve constipation, flush kidney, etc. It helps relieve nasal congestion, aids digestion, calms the nervous system, aid weight loss, and improve circulation.
Vegetables, grains, nuts, and fruits
Vegetables, whole grains, nuts & fruits rich in nutrition and they help extend life expectancy.
Vegetables provide vitamins, minerals, and fiber. They are low in carbohydrate. Useful vegetables include lettuce, broccoli, vegetable juice, spinach, peppers, carrots, (green) beans, tomatoes, celery, chilies, greens, and cabbage.
Whole grains provide carbohydrates, vitamins, minerals, and fibers. Don’t go for refined grain products (such as white bread, pasta, etc.) that is rich in carb and nutrition stripped. Useful grains include oats, brown rice, rye, barley, buckwheat, bulgur, quinoa, and millet.
Nuts contain proteins, nutrients, good fats, and antioxidants. Useful nuts are almond, walnut, cashew, pistachio, hazelnut, peanut, and pecan.
A study published in the Journal of the American College of Nutrition found regular nut consumption was associated with a decreased risk for cardiovascular disease, type 2 diabetes, and metabolic syndrome. Reference: Journal of the American College of Nutrition 2011 Dec; 30(6):502-10.
Fruits provide carbohydrate, vitamins, minerals, and fiber. Useful fruits include apples, fruit juice, strawberries, dried fruit, grapefruit, bananas, raisins, oranges, watermelon, peaches, mango, guava, papaya, berries, and canned fruits.
Milk, cheese, eggs, meat, poultry, and fish
Milk provides carbohydrate, protein, calcium, vitamins, and minerals. Eat fat-free or low-fat milk, yogurt with low calorie’s sweetener.
Meat and meat substitutes provide protein, vitamins, and minerals. The meat and meat substitutes are meat, poultry, eggs, cheese, fish, and tofu. Eat small amounts each day. Useful among them are chicken, beef, fish, canned tuna or other fish, eggs, peanut butter, tofu, cottage cheese, cheese, pork, lamb, turkey.
Junk foods, sweets, and sweet drinks
Several research studies found processed and fast foods have increased obesity, heart disease, diabetes, and other chronic diseases.
Sugar consumption makes you sick and shortens your life expectancy.
American Heart Association journal Circulation published a study by Harvard public health researchers. The study found people those who drink two or more sugar-sweetened beverages a day have a higher risk of dying early. These beverages are sodas, sports drinks, and fruit drinks sweetened with sugar, high-fructose corn syrup, or fruit concentrates have a higher risk of dying soon.
Gestational Diabetes Treatment
Gestational diabetes treatment
To keep your baby healthy and avoid complications during pregnancy and delivery, it is essential to control your blood glucose level.
Studies have shown that 70-85% of women diagnosed with gestational diabetes achieve successful glycemic control with lifestyle modification only [Diabetes Care 2017; 40(Suppl. 1):114–119.].
Your treatment strategies may include:
- Monitoring your blood sugar - You may need to check your blood sugar four to five times a day. First thing in the morning and after (three) meals to maintain blood sugar within a healthy range.
- Healthy diet - Eating the right kinds of food in a correct portion is the best ways to control your blood sugar.
- Exercise - Regular physical activity plays a crucial role in every woman's wellness before, during, and after pregnancy. Aerobic and resistant training combination is considered to be useful for women with gestational diabetes.
- Medication - If diet and exercise are not enough, then you may need insulin injections to lower your blood sugar. Between 10 and 20 percent of women with gestational diabetes need insulin to reach their blood sugar goals.
- Close monitoring of your baby - An important to carefully observe your baby's growth and development with repeated ultrasounds or other tests.
Medical nutrition therapy for Gestational diabetes
Nutrition intervention for women with gestational diabetes has been recognized as the cornerstone of treatment.
Medical nutrition therapy (MNT) is the primary therapy for 30 to 90% of women diagnosed with gestational diabetes.
Medical nutrition therapy (MNT) plays an essential role in the management of gestational diabetes. It has a significant impact on mother and newborns. Ref: Diabetes Care 21(Suppl. 2): B91–B98, 1998 & Current Diabetes Reports 4:377–386, 2004.
Goals for Medical Nutrition Therapy in gestational diabetes
- Optimal nutrition for proper development of the fetus.
- To maintain the mother’s health.
- Maternal normal glucose level.
The nutritional requirements of gestational diabetes are similar for all pregnancies, but special attention is to carbohydrates. MNT is a carbohydrate-controlled meal plan that promotes adequate nutrition with appropriate weight gain, normal glycemia, and the absence of ketosis.
To define carbohydrate-controlled, you need to determine the total amount of carbohydrate, use of foods with sugar, carbohydrate distribution, glycemic index, fiber, and artificial sweeteners.
Stop tasting sweets (occasionally you can enjoy sweet with a limit). Eat three small meals and 1 to 3 snacks per day. Maintain your meal’s time. Include fibers in your meals in the form of fruits, vegetables, and whole-grains.
Exercise for Gestational diabetes
Exercise is a visible adjunct therapy to MNT for women with GDM. One study of the acute effect of exercise on glucose levels showed a 23 mg/dl (1.3 mmol/l) drop in glucose values at 30 min. Ref: The Journal of Maternal-Fetal & Neonatal Medicine 10:52–58, 2001.
Women should monitor fetal activity, and blood glucose levels before and after exercise limited to 15 to 30 min. Women who have been physically active before pregnancy can continue an active lifestyle.
Exercise has a powerful potential to assist with blood glucose control. Due to the uncertainty of risks and benefits of exercise during pregnancy, women tend to avoid exercise. But, it is both safe and beneficial in the treatment of gestational diabetes.
Gestational diabetes recommended to do both aerobic and resistance exercise at a moderate intensity for a minimum of 3 times a week for 30 to 60 min each time.
Regular walking and swimming help maintain the health of mother & baby as well as help reach your blood glucose targets.
Insulin therapy for Gestational diabetes
Gestational diabetes who's Medical Nutrition Therapy failed to achieve a 2-hour postprandial glucose level of less than 120 mg/dL, need insulin therapy.
Some with gestational diabetes need insulin to reach their blood glucose targets. Insulin is not harmful to your baby, but high blood sugar level is dangerous.
Gestational Diabetes Diagnosis Test
Gestational diabetes diagnoses are by blood-glucose testing using random blood-glucose test, screening glucose tolerance test, and fasting blood glucose test.
Gestational Diabetes Test
Early diagnosis of gestational diabetes allows taking proper treatment to prevent/minimize the ill effects of high blood sugar on the mother & child in the short term & long term.
Pregnancy insulin resistance may be due to a combination of increased maternal adiposity and the insulin-desensitizing effects of hormones made by the placenta.
Recent studies show diagnosis and proper gestational diabetes treatment have beneficial effects on maternal and neonatal outcomes, including reduced rates of shoulder dystocia, fractures, nerve palsies, and neonatal hypoglycemia.
Gestational diabetes is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.
Gestational diabetes treatment consists of glucose monitoring, dietary changes, exercise, and pharmacotherapy (if necessary) to maintain the blood glucose level. Insulin therapy is a conventional treatment, although glyburide and metformin may also widely used.
When and how do you go for a gestational diabetes diagnosis?
Timely diagnosis of gestational diabetes can help prevent short-term and long-term ill effects of gestational diabetes.
The American & Canadian guidelines recommend 2 step screening. It includes testing with 50g one hour plasma glucose test. If it is more than 140 mg/dL is considered as positive. The screen-positive women are subjected to 100gm OGTT if 2 or the more abnormal result of plasma glucose confirms gestational diabetes.
The WHO recommends screening for gestational diabetes from 24 to 28 weeks of gestation. The screening test using the 75gm of sweet drink and 2 hour plasma glucose test. If it is more than 140 mg/dL and fasting, more than 126mg/dL is screen positive.
It is advisable to screen all pregnant women at 12 to 16 weeks of gestation. If the results are normal, the next screening is done at 24 to 28 weeks of gestation and finally at 32 to 34 weeks.
In 2010, the International Association of Diabetes and Pregnancy Groups (IADPSG) proposed criteria based on the incidence of adverse perinatal outcomes, as assessed in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. According to these criteria, the diagnosis of gestational diabetes based on at least one value of plasma glucose concentration is equal to or exceeds the thresholds of 92, 180 and 153 mg/dl (for fasting, one-hour and 2-hour post-glucose load glucose values respectively), after performing a 75 g OGTT. Diabetes Care. 2010 Mar; 33(3):676-82.
HAPO study results that demonstrated a continuous association of maternal glycemia with adverse pregnancy outcomes. IADPSG criteria developed based on the HAPO study. The IADPSG consensus panel consisted of leading experts in the field of gestational diabetes from a variety of countries.
The IADPSG suggests screening in all women at the first prenatal visit and a 75 g OGTT between the 24th and 28th week of gestation. One or more abnormal value confirm the diagnosis of gestational diabetes; more than or equal to 92, 180, or 153 mg/dl for fasting, 1-hour and 2-hour plasma glucose, respectively.