Pregnant women with risk factors for diabetes should be tested for undiagnosed type 2 diabetes on their first prenatal visit. Standard diagnostic criteria for diagnosing diabetes are used in this case. Women who were not previously known to have diabetes should be tested for gestational diabetes at 24 to 28 weeks of gestation. Gestational diabetes is diagnosed using either a one-step or two-step strategy. The one-step strategy involves using a 75-gram oral glucose tolerance test (OGTT), with plasma glucose measurements taken at fasting, and at 1 and 2 hours after ingesting the
75-gram glucose load. The OGTT test should be administered in the morning following an overnight fast of at least eight hours. The diagnosis of gestational diabetes is made when any of the following plasma glucose levels are met or exceeded:
Testing for and Diagnosing Gestational Diabetes Photo Gallery
• Fasting 92 mg/dL (5.1 mmol/L)
• 1 hour following ingestion of 75 g glucose load 180 mg/dL (10.0 mmol/L)
• 2 hours following ingestion of 75 g glucose load 153 mg/dL (8.5 mmol/L)
The two-step strategy involves performing a 50-gram (nonfasting) screen followed by a 100-gram OGTT for those who screen positive (ADA, 2015).
Physical Activity and Diabetes
Physical activity is a vital component of diabetes prevention and management, as well as for the prevention of potential diabetes complications. At least 2.5 hours of moderate to vigorous physical activity each week should be undertaken to prevent type 2 diabetes onset in high-risk adults (S. Colberg, R. Sigal and B. Fernhall et al. 2010). In addition, epidemiological studies suggest that higher levels of physical activity may also reduce the risk of developing GDM during pregnancy (S. Colberg, R. Sigal and B. Fernhall et al. 2010). Some benefits of physical activity to PWD include (S. Colberg, R. Sigal and B. R. Fernhall et al. 2010):
• Reduction of cardiovascular risk factors
• Promotion of a healthy weight
• Reduction in body weight and body fat
• Improvement in blood glucose control and tolerance
• Increase in peripheral insulin sensitivity
• Reduction in insulin requirements
• Improvement in sense of well-being
• Decrease in stress
Although physical activity is a crucial component of care, the nutrition practitioner must be aware of the individual’s potential restrictions for exercise and the metabolic effects and benefits for PWD in order to maximize rewards and minimize risks of injury and poor medical outcomes. In general, PWD who exercise occasionally may require assistance to maintain normal blood sugar levels, by either the adjustment of medications, the amount of food consumed, the timing of meals, and/or the actual physical activity regimen. Management issues for type 1 people with diabetes may be especially challenging due to their complete lack of ability to make metabolic adjustments to manage fuel homeostasis. PWD who are in good metabolic control and without serious complications may be able to freely participate in recreational and competitive exercise, but those with certain diabetes co-morbidities will require further assessment.
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