Managing Blood Sugar Levels After Gestational Diabetes: Key Insights

Gestational diabetes mellitus (GDM)

Hello Doctor: I had gestational diabetes during my second pregnancy.
I have no family history of diabetes and am not overweight.
I managed my condition through dietary control and daily self-monitoring of blood glucose.
Now that I have given birth and am in the postpartum recovery period, I continue to monitor my blood sugar levels.
Currently, my fasting blood glucose in the morning is approximately between 80-95 mg/dL, pre-meal around 80-110 mg/dL, and post-meal two hours later around 105-135 mg/dL.
I have a few questions: 1.
Are these blood glucose levels considered normal? 2.
I recorded post-meal levels for three weeks, and one meal unexpectedly showed a reading of 146 mg/dL.
Is it acceptable to exceed 140 mg/dL once? 3.
Should post-meal blood glucose levels ideally be maintained below 120 mg/dL?

angie, 30~39 year old female. Ask Date: 2017/01/10

Dr. Xiao Yongxun reply Internal Medicine

(1) According to the American Diabetes Association's diagnostic criteria for diabetes: a.
Fasting plasma glucose level ≥126 mg/dL after fasting for at least 8 hours.
b.
Plasma glucose level ≥200 mg/dL during a 2-hour oral glucose tolerance test.
c.
HbA1c (glycated hemoglobin) ≥6.5% (this must be confirmed with a method that is certified by the National Glycohemoglobin Standardization Program (NGSP) and meets the Diabetes Control and Complications Trial (DCCT) standards).
The above criteria a, b, and c must be confirmed on two separate occasions.
d.
Clinical symptoms of diabetes (such as polyuria, polydipsia, polyphagia, and unexplained weight loss) along with a random plasma glucose level ≥200 mg/dL (this can be confirmed on one occasion).
As for postprandial glucose levels, it is generally desired to maintain them around 140 mg/dL.
Therefore, both your fasting and postprandial glucose levels are normal and acceptable.

(2) An occasional elevated postprandial glucose level may be related to overeating or consuming high-calorie foods, or it may be due to a lack of physical activity.
However, if your levels have returned to normal, it should not be a concern.
(3) Postprandial glucose levels are generally recommended to be controlled below 140 mg/dL; if they are between 140 and 180 mg/dL, the possibility of impaired glucose tolerance should be considered.
Of course, if levels exceed 180 or 200 mg/dL, the possibility of diabetes should be evaluated.
(4) Risk factors for developing diabetes include a family history of diabetes, gestational diabetes, obesity, hypertension, hyperlipidemia, physical inactivity, excessive dietary intake, alcohol abuse, use of certain medications, poor lifestyle choices, and high levels of stress.
You are actually one of the high-risk groups; please be mindful to eat until you are about 80% full at each meal, avoid high-calorie, high-fat, and high-sugar refined foods, and ensure adequate sleep and regular exercise.
(5) If possible, please discuss and plan with your primary care physician.

Reply Date: 2017/01/10

More Info

Managing blood sugar levels after experiencing gestational diabetes is crucial for both maternal and infant health. Your proactive approach to monitoring your blood sugar levels during and after pregnancy is commendable. Let’s address your questions based on the information provided and current medical guidelines.

1. Are these blood sugar values normal?
Your reported blood sugar levels are generally within the normal range. According to the American Diabetes Association (ADA), normal fasting blood glucose levels should be less than 100 mg/dL, and postprandial (after meal) blood glucose levels should ideally be less than 140 mg/dL two hours after eating. Your fasting levels of 80-95 mg/dL and pre-meal levels of 80-110 mg/dL are well within the normal range. Your postprandial levels of 105-135 mg/dL are also acceptable, especially considering your recent history of gestational diabetes.

2. Is it acceptable to exceed 140 mg/dL once?
Experiencing a single spike in blood sugar, such as the 146 mg/dL you mentioned, is not uncommon, especially in the postpartum period when your body is adjusting. While it is ideal to keep postprandial blood sugar levels below 140 mg/dL, occasional excursions above this threshold can happen. It’s important to consider the context of that particular meal—what you ate, your activity level afterward, and any stress factors that might have influenced your blood sugar. If this spike is an isolated incident and not a regular occurrence, it may not be a cause for concern. However, if you notice frequent spikes, it would be wise to consult your healthcare provider.

3. Should postprandial blood sugar be controlled below 120 mg/dL?
The recommendation for postprandial blood sugar levels can vary based on individual circumstances. While the ADA suggests that postprandial blood glucose levels should ideally be below 140 mg/dL, some healthcare providers may recommend stricter targets, such as below 120 mg/dL, especially for those with a history of gestational diabetes. This stricter target can help reduce the risk of developing type 2 diabetes later on. It’s essential to discuss your specific targets with your healthcare provider, who can tailor recommendations based on your overall health, lifestyle, and any other risk factors.

Additional Considerations:
- Diet and Exercise: Continue to focus on a balanced diet rich in whole foods, including vegetables, lean proteins, and whole grains, while limiting processed sugars and carbohydrates. Regular physical activity can also help manage blood sugar levels effectively.

- Monitoring: Keep up with your blood sugar monitoring, as it provides valuable insights into how your body is responding to different foods and activities. If you notice patterns or consistent elevations, it’s important to discuss these with your healthcare provider.

- Follow-Up Care: Since you have a history of gestational diabetes, regular follow-up with your healthcare provider is essential. They may recommend periodic screening for type 2 diabetes, especially within the first year postpartum.

- Support: Consider joining a support group or seeking resources for new mothers managing blood sugar levels. Sharing experiences and strategies can be beneficial.

In summary, your current blood sugar levels appear to be within a normal range, with occasional spikes being acceptable. Maintaining a healthy lifestyle and regular monitoring will be key in managing your blood sugar levels effectively. Always consult your healthcare provider for personalized advice and follow-up care.

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