Parveen Nake, Author at GOQii

August 23, 2022 By Parveen Nake 3 Comments

What Gestational Diabetes Can Do To You & Your Unborn Child

We all know about Diabetes Mellitus to some extent as Diabetes Mellitus is a chronic metabolic disorder that prevents the body from utilising glucose completely or partially. It is characterised by raised glucose concentration in the blood and alterations in carbohydrate, protein and fat metabolism. But have you ever heard of Gestational Diabetes or Pregnancy Diabetes?

Gestational Diabetes is a high blood sugar (glucose) condition that develops during pregnancy and usually disappears after giving birth. It can happen at any stage of pregnancy, but is more common in the second or third trimester. Insulin requirements goes up one to three times in pregnancy. During normal pregnancy the level of plasma insulin is raised by the action of placental hormones thus placing a burden on the insulin secreting cells of the pancreatic islets. The pancreas may be unable to meet these demands in women genetically predisposed to develop both types of diabetes. Long term studies show that some 80% of women with gestational diabetes ultimately develop permanent clinical diabetes requiring treatment.

What Causes Gestational Diabetes?

The causes of Gestational Diabetes is not known clearly yet. Some, but not all women with gestational diabetes are found to be overweight before getting pregnant or have a family history of diabetes. It is more common in Native American, Alaskan Native, Asian and Black women, but white women may develop it due to poor lifestyle.

Are There Tests to Determine it?

Oral glucose tolerance test (OGTT) is a confirmatory test. The OGTT measures blood glucose after you fast for at least 8hours. Firstly, the blood sample is drawn in fasting state. Then, 75g of glucose dissolved in 250-300 ml of water is given, Lemon juice may be added for flavour and to prevent nausea. Then the blood specimens are collected every 30mins for 2-3 hours after the administration of glucose.

High blood glucose levels at any two or more blood test times – Fasting, 1 hour, 2 hours or 3 hours – mean you have Gestational diabetes.

Complications During Pregnancy

If blood sugar is not controlled, it can lead to problems for both maternal and foetal health. Uncontrolled diabetes during the first trimester of pregnancy increases the risk of abortions and congenital malfunctions in the foetus. Some of the major consequences are:

High Blood Pressure (Preeclampsia): Preeclampsia is a potentially dangerous pregnancy complication characterised by high blood pressure. Due to the high blood pressure levels of the mother, the protein in urine spikes up and swelling in fingers and toes and lower body persists. High blood pressure can be harmful to both – the mother and the unborn baby. It might lead to the baby being born early and also could cause seizures or a stroke (a blood clot or a bleed in the brain that can lead to brain damage) in the woman during labour or delivery.
An Extra Large Baby: Uncontrolled Diabetes in the mother causes the baby’s blood sugar to be high. The baby tends to “overfeed” and grows extra-large. Besides, causing discomfort to the mother, it can lead to problems during delivery causing prolonged labour pain which might need a C-section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery.
Low Blood Sugar (Hypoglycaemia): People with diabetes who take insulin or other medications can develop blood sugar that is too low or hypoglycaemia. Low blood sugar can be very serious and even fatal if not treated quickly.

How to Manage Gestational Diabetes

The main modes of treatment of Gestational Diabetes include:

1. Eating a Healthy Diet: Dietary measures are an essential part of the treatment of diabetic patients whether they are on diet alone or on metformin drug or insulin. Carbohydrate restriction impairs insulin sensitivity and reversed by high carbohydrate diet but it needs to be maintained between 60-65% of total calories. So include more complex carbohydrates or polysaccharides like Multi-grain flour, Oats, Muesli, Granola, Amaranth, Bajra, Ragi, Quinoa, etc. Studies have shown that raising carbohydrates does not adversely affect the fasting blood glucose levels, glucose tolerance or insulin requirements provided that total calories are not increased.

Along with carbs, include more protein-rich foods like pulses and lentils, Rajma, Soya Bean, peas, beans, peanuts, milk and dairy products like yogurt, buttermilk, paneer, eggs, chicken, etc. to ensure weight gain and prevent osteomalacia during pregnancy. Inclusion of fibre like fruits and green leafy vegetables are must as it improves glucose metabolism without increasing insulin secretion. It increases the intestinal transit-time, delay gastric emptying slow glucose absorption.

2. Drugs or Insulin Treatment: Metformin or Insulin therapy is the accepted medical management of gestational diabetes. Insulin is the first drug of choice and metformin can be considered after 20 weeks of gestation. Insulin must be taken without delay if it is suggested by the doctor.

3. Exercise: Stay Active to help keep your blood sugar under control. Exercise regularly – before, during and after pregnancy. Moderate exercise such as brisk walking for 30mins a day for 5 times a week is a good goal to set.

4. Monitoring Blood Sugar Often: Be aware that your blood sugar can change very quickly, becoming too high or too low depending on what you eat and how much you exercise and your growing baby’s blood sugar also varies several times during the day. Check your blood sugar level as often as directed by the doctor and any time you have symptoms.

By adopting these measures one can enjoy a healthy Antenatal period. For more articles on managing Diabetes, check out Healthy Reads.

For further guidance and motivation by certified experts, join the GOQii Diabetes Care program. It’s India’s only diabetes program that is driven by Smart Science and Personal Coaching to improve Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PP), reduce HbA1c levels and let you win gold! You can subscribe here: https://store.goqii.com/diabetescare.

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December 17, 2021 By Parveen Nake Leave a Comment

Should You Consider the Keto Diet?

Lately, a lot of my patients have been asking me about the Keto Diet – if it is safe or if I would recommend it. Despite the recent hype, a Keto Diet isn’t something new. In medicine, we have been using it for around a 100 years to treat drug resistant epilepsy, especially in children.

The Keto Diet is a very low carbohydrate, high fat, adequate protein diet which had originally developed in the 1920s for managing intractable epilepsy. Later, it had been indicated in many other conditions such as obesity, diabetes, cancer, Parkinson’s disease. In recent days, Keto Diet has become increasingly popular among people trying to lose weight.

The diet primarily aims at depriving the body of glucose and putting it in a metabolic state (ketosis), in which fats are burned to produce ketone bodies. These ketones are utilized as fuel for energy production instead of glucose. In order to create this state, the dietary carbohydrates are restricted to as low as 20-25g per day and the fat to carbohydrate ratio is typically kept at 4:1 or 3:1 ratio by weight. Because it lacks carbohydrates, it is rich in protein and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheese, fish, nuts, butter, oils, seeds and fibrous vegetables.

What is Ketosis?

Glucose is the preferred fuel, especially for the brain. Glucose is also required for the complete oxidation of the fats in TCA Cycle. In conditions of starvation or drastic carbohydrates restriction (below 20g/day), i.e. when glucose is not available, fats are broken down in an alternate pathway to produce ketone bodies. These ketone bodies are utilized by the brain and other tissues for energy production instead of glucose. This condition is known as Ketosis.

What Are The Effects of a Keto Diet on Weight Loss?

The effect of Keto Diet on weight loss has been attributed to several possible factors:

The appetite suppressing the action of ketone bodies by modification of hormones.
Reduction in the accumulation of fat (lipogenesis) and breakdown of fat (lipolysis).
Increased metabolic cost of gluconeogenesis (breakdown of fat or protein for glucose) and thermic effect of protein.
High satiating effect of fats which provides the feeling of fullness for longer hours.

Benefits of a Ketogenic Diet Beyond Weight Loss

Due to obesity, excess body fat is closely associated with insulin resistance. The metabolic disturbances associated with insulin resistance due to inefficient utilization of glucose are improved with low carbohydrate high-fat diets. These changes beneficially affect gene expression, improved resistant states, attenuate oxidative stress and inflammatory conditions.

Significant reductions in serum triglycerides, marked increase in HDL cholesterol and decrease in inflammatory markers have been observed with this diet.

Potential Risk of Following This Diet

Despite the metabolic benefits of Keto Diets, the severe carbohydrate restriction and huge fat content of the diet raises question regarding safety. The severe restriction in diet calls for inadequacies of several nutrients.

Selenium deficiency is noted which leads to abnormal cardiac rhythm and impaired myocardial functions.
Arterial stiffness, increase in LDL cholesterol occurs in about half the individuals on Keto Diet.
Although it might show improvements in certain cardiovascular parameters like increased HDL and lowered TGLs, this mostly in the short term. In the long term, it has been shown to cause Hepatic Steatosis (accumulation of fat in the liver), Dyslipidaemia and glucose intolerance in mice.
It affects calcium balance and bone health. Prolonged exposure to the acidic environment caused by the ketones in blood can lead to progressive loss of bone minerals.
In fact, Nephrolithiasis, a very commonly noted complication of the Keto Diet, can be attributed to increased urinary calcium which leads to stone formation.
High amount of fat in the diet gives rise to gastrointestinal tolerance issues which include nausea, diarrhoea, constipation and GERD(Gastro Esophageal Reflux Disease).
Other side effects include dehydration, Hypoglycaemia, Hyperuricemia, Pancreatitis, Ketoacidosis, low serum sodium and magnesium have been reported.

Practical Considerations To Be Taken

It is important to consider the total calorie intake, especially in context of weight loss. Reduction in total calorie intake is always important and not just replacing carbohydrate calories with fats.

With the above considerations, a modified Keto Diet can serve as an effective tool for weight loss with certain added metabolic advantage and can be advised to obese individuals having no other metabolic disorder for a limited period of time. This should, however, be followed up with a healthy and more balanced eating plan on the long term.

Please note that we do not advocate, advise or recommend fad diets to our players. Please reach out or consult your doctor, dietician or nutritionist before making changes to your diet.

For more topics on diets, nutrition and health, check out Healthy Reads or ask a GOQii Coach by subscribing for personalized coaching here: https://goqiiapp.page.link/bsr

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