Express Big Health 丨How to control sugar correctly? Experts teach you to use the "five-wheeled carriage" well

Modern Express News (intern Wang Haonan reporter Mei Shuhua / Wen Gu Wei / photo) pregnant women, the body and mind may be in an unstable state, many pregnant mothers only eat can not move, excess nutrition, high blood sugar problems also follow, and even lead to gestational diabetes. This disease is not the patent of fat mothers. Does gestational diabetes affect your baby? How can I prevent management? Recently, the "Famous Doctors Heavenly Group" of Modern Express invited Wu Lan, director and chief physician of the obstetric ward of Nanjing Maternal and Child Health Hospital, to teach pregnant mothers how to use the "five carriages" and correctly "control sugar".

△ Wulan (right) interpreted gestational diabetes in detail in the live broadcast of the famous doctor Tiantuan

Q: What is gestational diabetes?

Ulan: Gestational diabetes refers to a pregnancy-specific complication in which a woman who does not have diabetes before pregnancy and discovers high blood sugar when she is pregnant. It is due to the gradual development and formation of the placenta in the middle and third trimester of pregnancy, the production of certain hormones that cause insulin to not work properly, so that the body's need for insulin increases, when some pregnant women can not compensate to increase the amount of insulin secretion, gestational diabetes mellitus (referred to as GDM) will occur. If the patient with GDM is not treated, there will be some maternal and child complications, which seriously endanger the health of the mother and child, so it is necessary to follow the requirements of a professional doctor for treatment in order to obtain a healthy pregnancy.

Q: Are fat mothers more likely to have gestational diabetes?

Ulan: Gestational diabetes is not a patent of fat mothers, and people who are susceptible to gestational diabetes are divided into seven categories: obesity, family history of diabetes (especially first-degree relatives), history of glucose tolerance, history of birth of a giant child, positive urine glucose, patients with polycystic ovary syndrome, and patients with a history of GDM or other abnormal obstetric diseases.

Q: Will Gestational diabetes affect your baby? What are the hazards?

Ulan: Gestational diabetes will have a certain impact and harm on pregnant women, fetuses and offspring in the long run. Effects on pregnant women include hypertension or preeclampsia during pregnancy, hyperhydramnios, and urinary tract infections. Effects on the fetus include macrosomia, neonatal hypoglycemia, neonatal respiratory distress syndrome, neonatal hypocalcemia, hypomagnesium, and neonatal jaundice. The disease can also have long-term effects on future generations, easily leading to childhood and adult obesity, a high risk of developing type 2 diabetes, and an earlier age of onset of diabetes (about 30 years).

Q: Can Gestational diabetes be prevented?

Ulan: Pregnant women with GDM risk factors must pay attention to a reasonable diet from the early pregnancy and maintain an ideal weight, which can reduce the risk of gestational diabetes. In the early pregnancy, it should be noted that the total energy required by the mother will not increase than when she is not pregnant, and do not over-supplement and eat too much, especially pregnant women who already have diabetes or are at risk of GDM.

Q: When is gestational diabetes tested?

Ulan: At the first prenatal visit, fasting blood glucose is detected. For example, when the fasting blood glucose ≥ 7.0mmol/L, it indicates that you already have diabetes before pregnancy, but you have not been diagnosed before pregnancy. For example, pregnant women with fasting blood glucose < 7.0 mmol/L, at 24 to 28 weeks of pregnancy, fasting blood glucose or 75 g oral glucose tolerance test (75 g OGTT) are performed. Through this test, the diagnosis of gestational diabetes mellitus is carried out. If the fasting blood glucose > 5.1 mmol/L in the early pregnancy, there may be glucose tolerance abnormalities before pregnancy, and diet and exercise management should be strengthened, and attention should be paid to monitoring blood sugar and controlling weight gain during pregnancy, so as to avoid abnormal increase in blood glucose before oral glucose tolerance test in the middle pregnancy, which will bring harm to the mother and fetus.

Q: What are the goal of controlling blood glucose and blood pressure during pregnancy?

Ulan: blood glucose on an empty stomach or before meals and before going to bed is 3.3-5.3mmol/L, blood glucose ≤ 7.8mmol/L for 1 hour after a meal, 6.7mmol/L≤ for 2 hours after a meal, glycosylated hemoglobin should be controlled below 6.0% as much as possible, and blood pressure should be controlled below 130/80mmHg.

Q: How is gestational diabetes managed?

Ulan: The management of gestational diabetes requires a "five-wheeled carriage". First, understand their own medical conditions and listen to the doctor's words; second, manage the diet, according to the special diet of scientific diet; third, exercise therapy, choose the exercise that suits themselves; fourth, insulin therapy, insulin is currently the safest and most important for gestational diabetes, but also the best drug to save gestational diabetes caused by adverse pregnancy; fifth, we must standardize blood glucose measurement.

Q: How should pregnant women with gestational diabetes eat?

Ulan: First, reasonable control of total calories, staple food (rice, noodles) amount of 200-300g / day, coarse and fine collocation; weight growth does not exceed 1.5 kg / month, pregnancy increase of 10-12 kg is appropriate; second, food varieties are diversified, coarse, fine, meat, vegetarian collocation, not picky eating, not partial eating; third, a small number of meals, regular quantitative meals, 4-6 meals a day, no increase in meals; fourth, to light and less salt as the principle, take steaming, boiling, burning, stewing and other methods to reduce frying; fifth, Eat more than 500 grams of vegetables a day to increase your fiber intake; sixth, try to choose fruits with low sugar content, preferably between meals.

In addition, in terms of diet, there are also many misunderstandings of pregnant mothers. For example, some pregnant mothers are worried that if they eat too much carbohydrate and their blood sugar rises quickly, they will eat less or not eat, which is not right, and insufficient carbohydrate intake can cause starvation ketosis and affect the normal development of the fetus. The correct approach is to appropriately limit carbohydrates but the daily intake is not less than 150 grams; some pregnant mothers think that dietary fiber is beneficial to the body, just eat coarse grains and do not eat fine grains, which not only violates the principle of balanced diet, but also eats too many coarse grains will affect the nutrient absorption of protein, vitamins and some trace elements due to increasing the burden on the gastrointestinal tract, which can cause malnutrition for a long time; some pregnant mothers love to eat fruits, in fact, there are prerequisites for eating fruits, blood sugar should reach the standard, eat between meals, try to eat fresh fruits with low sugar content, No more than 200 grams per day, deduct half of two staple foods. The fruits that are preferentially selected are strawberries, pineapples, grapefruit, kiwifruit, etc., and fruits that should not be eaten are bananas, sugar cane, longan, grapes, etc.

Q: How should pregnant women with gestational diabetes exercise?

Ulan: First, choose a soothing, rhythmic sport, not a tense and intense sport. Walking is currently the most commonly used and safe method of aerobic exercise, and different walking speeds are selected according to your own condition. At the same time, some resistance exercise can also be added in an appropriate amount every week, such as our hospital's self-compiled elastic band exercise exercise, which can strengthen the muscle strength exercise of the upper and lower limbs; second, the heart rate should be maintained within 130 times / minute; third, 1 hour after the meal exercise, the duration is 20-30 minutes; fourth, to avoid the occurrence of hypoglycemia, carry candy or biscuits; fifth, if there are high risk factors, such as type 1 diabetes complicated pregnancy, heart disease, retinopathy, aura premature birth or miscarriage, placenta previa, gestational hypertension and other diseases , exercise should be avoided.

Q: What if diet and exercise management cannot control blood sugar?

Ulan: Some diabetic pregnant women rely on diet and exercise alone to achieve blood sugar control goals, if after diet adjustment and exercise therapy about 1 week, the patient's blood glucose monitoring level is still high, then insulin therapy is needed.

Q: Is insulin addictive?

Ulan: No. Insulin is a protein secreted by the human pancreas itself, normal people have in the body, there is no addiction, even if long-term injection is also the need of the disease, there is no problem of addiction.

Q: Does using insulin indicate that the condition is serious?

Ulan: No. Severity should be based on glycemic control levels, not the type of medication. Insulin is one of the tools of good blood sugar control, the use of insulin does not mean that the disease is serious, whether you can use it at the right time, is the most important for good health. For example, special conditions such as pregnancy infection are not suitable for continued use of oral hypoglycemic drugs and require insulin therapy.

Q: With insulin, can I let go of my stomach and eat and drink?

Ulan: No, you can't. Although insulin is the drug with the strongest hypoglycemic ability, it does not mean that the use of insulin can open the stomach to eat and drink, in order to control blood sugar, scientific life management is indispensable. The daily diet should try to control the total calorie intake to maintain the ideal weight; balance the diet, so that the intake of various nutrients is balanced; regular, quantitative, fixed meals, and adhere to a small number of meals; can not blindly eat and drink.

Q: Gestational diabetes is actively treated during pregnancy, how long will it take after childbirth for blood glucose to return to normal?

Ulan: Unless diabetes persists, blood glucose can generally return to normal levels within 6 weeks after childbirth, pay attention to reasonable diet and appropriate exercise, and follow up regularly.

Q: How should pregnant women with gestational diabetes be followed up postpartum?

Ulan: Pregnant women with gestational diabetes mellitus undergo a glucose tolerance test 6-12 weeks postpartum and recommend testing for both lipids and insulin. If glucose tolerance is normal, a blood glucose test is done every 3 years; if the glucose tolerance is impaired, a blood glucose test is done once a year for prevention; if diabetes is developed, treatment is required. Because about 50% of pregnant women may develop gestational diabetes again in the process of second pregnancy, and about 10% of pregnant women may develop diabetes in middle age and old age. Therefore, pregnant women with gestational diabetes should attach great importance to themselves and follow up regularly.