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Need to Cancel / Change an Appointment visit: Cancel or change your appointment? :: Dartford and Gravesham NHS Trust (dgt.nhs.uk)

Appointment text reminder service: Appointment text reminder service :: Dartford and Gravesham NHS Trust (dgt.nhs.uk) somewhere on here so people are directed to this page? Any suggestions of how this is possible are very welcome. 

 

 

Gestational diabetes

Diabetes is a common life-long health condition. There are 2.8 million people diagnosed with diabetes in the UK and an estimated 850,000 people who have the condition but don’t know it.

Diabetes is a condition where the amount of glucose in your blood is too high because the body cannot use it properly. This is because the pancreas does not produce any insulin, or not enough, to help glucose enter your body’s cells – or the insulin that is produced does not work properly (known as insulin resistance). Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it is used as fuel for energy so we can work, play and generally live our lives. It is vital for life.

Glucose comes from digesting carbohydrate and is also produced by the liver. Carbohydrate comes from many different kinds of foods and drink, including starchy foods such as bread, potatoes, rice, pasta and chapatis; fruit; some dairy products; sugar and other sweet foods.

If you have diabetes, your body cannot make proper use of this glucose so it builds up in the blood and isn’t able to be used as fuel.

During your Pregnancy, Darent Valley Hospital can offer and provide great care for you and your baby and depending on which type of Diabetes you have will determine the Care Pathway we choose for you and tailor it towards your individual needs.

If you have diabetes and you are considering starting a family, we offer a pre conceptual service in the Diabetes Centre and would love to see you in order to get good glycaemic control before you discover you are pregnant. All you need to do is discuss with your GP your plans for a future family and ask him/her to refer you to the pre-conceptual clinic at Darent Valley Hospital. It is important to have good glycaemic control prior to becoming pregnant to ensure a healthy baby and pregnancy.

Type 1 diabetes develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin.

Insulin is the key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel. In Type 1 diabetes the body is unable to produce any insulin so there is no key to unlock the door and the glucose builds up in the blood.

Nobody knows for sure why these insulin-producing cells have been destroyed but the most likely cause is the body having an abnormal reaction to the cells. This may be triggered by a virus or other infection. Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially in childhood.

Type 1 diabetes accounts for between 5 and 15 per cent of all people with diabetes and is treated by daily insulin injections, a healthy diet and regular physical activity.

At Darent Valley we offer a service to our pregnant ladies where you are routinely monitored and seen by the Diabetes and Pregnancy team. Your care will be tailored to your needs and we endeavour to ensure you have a positive experience.

Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance).

Insulin acts as a key unlocking the cells, so if there is not enough insulin, or it is not working properly, the cells are only partially unlocked (or not at all) and glucose builds up in the blood.

Type 2 diabetes usually appears in people over the age of 40, though in South Asian and black people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities.

Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin is often required.

If you are diagnosed with Type 2 Diabetes you receive the same high quality care as a Type 1 would receive. In addition to the team you may also see a diabetic Specialist Nurse, who will offer the same high quality service. 

Gestational diabetes mellitus (GDM) is a type of diabetes that arises during pregnancy (usually during the second or third trimester).

In some women, GDM occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy. In other women, GDM may be found during the first trimester of pregnancy. In these women, the condition most likely existed before the pregnancy. 

At the booking appointment you will be assessed for risk factors that can make you more likely to have gestational diabetes. These include:

  • Obesity 
  • A family history of diabetes (parent, brother or sister) 
  • An unexplained stillbirth or neonatal death in a previous pregnancy, and/or 
  • A very large infant in a previous pregnancy (4.5kg or over) 
  • You have had gestational diabetes before 
  • Your family origin is South Asian, Black Caribbean or Middle Eastern. 
  • Persistent sugar in your urine at Ante Natal visits. 
  • Excessive “water” around your baby. This is usually confirmed by a scan appointment. 
  • Diagnosed ‘large for dates’ diagnosed following USS.

If you have any of these characteristics you should be offered a test for gestational diabetes.

In most cases, gestational diabetes comes to light during the second trimester of pregnancy. Since the baby’s major organs are fairly well developed at this stage, the risk to the baby is lower than for women with Type 1 or Type 2 diabetes. However, babies of women who had blood glucose problems that were undiagnosed before pregnancy, have a higher risk of malformations. The degree of risk depends on how long blood glucose levels have been high and on how high the levels have been. 

Often, blood glucose levels can be controlled by diet. You will be referred to a dietitian and specialist nurse/midwife who will advise you about healthy eating. If your blood glucose cannot be controlled by diet, you may need tablets or insulin to treat your diabetes (this applies to about 10 - 20 per cent).

Blood glucose target levels are the same as for women with Type 1 or Type 2 diabetes and you will receive the same specialised care as they do. 

Usually it does. Before you are discharged to the care of your GP you will be advised to have your bloods repeated 6 weeks following the delivery of your baby. This should be a fasting blood test six weeks after your baby is born and then it should be repeated every year by your GP. If you took medication (tablets or insulin) during your pregnancy, you will be able to stop them once your baby is born.

Women with GDM have a 30 per cent risk of developing Type 2 diabetes during their lifetime (compared to a ten per cent risk in the general population).

About five to ten per cent of women with GDM develop Type 1 diabetes sometime in their life. These women have a slowly developing form of Type 1 that is ‘unmasked’ during pregnancy. With this in mind will we advise you to continue with the “Healthy Eating Plan” that was adopted in pregnancy in order for you to have a healthy and happy future.

You are more likely to develop GDM again if you have had it in previous pregnancies; but, if you are overweight and lose weight, you may cut your risk of having GDM again. If you plan another pregnancy you should be offered the opportunity to self-monitor your glucose levels, with an OGTT at 16-18 weeks which will be repeated at 28 weeks if normal.

Harvesting of colostrum and breast feeding

At Darent Valley Hospital we offer a service for all mothers with diabetes who would like to breast feed their newborn babies, and commence from 36 weeks the expressing of colostrum and storage in order to feed baby at birth with pre expressed breast milk. The importance of harvesting colostrum in the ante natal period for high risk mothers has been highlighted in order to reduce the incidence of neonatal hypoglycaemia (Low blood sugars), avoiding the supplementation of breast fed babies with formula. This has numerous additional health benefits, inclusive of reduced risk of type 2 diabetes in mother and child. If you would like to discuss the possibility of harvesting of colostrum further please contact the infant feeding advisor or specialist diabetic midwife. 

Diabetes is serious and should be treated properly. People with diabetes should have access to good, regular healthcare. However, at the same time, the decisions that are made by those with diabetes are central to the management of their condition.

Although diabetes cannot yet be cured it can be managed very successfully. This is likely to involve lifestyle changes that will have enormous health benefits and allow a person to continue their normal day-to-day life. You may also be required to take diabetes medication or insulin, or a combination of the two.

If medication is needed to achieve good diabetes control your healthcare team will discuss the best choice of treatment. 

Diabetes medication will not cure your diabetes and most people will have to take them for the rest of their lives, but medication will help you to feel better by relieving the symptoms of diabetes and reducing your risk of complications.

If you take medication, it is important to know how it works, and to be aware of the potential problems/side effects you may have. Remember that you can always discuss any questions you may have about your treatment with your diabetes healthcare team.

It is important to remember that the medication is not instead of diet and physical activity: you will still need to continue with this. Increasing or changing diabetes medication is not a sign that your diabetes is becoming more severe, but that your healthcare team are working with you to improve your diabetes management.

Page last edited: 13 February 2020