Gestational Diabetes Types: A1GDM and A2GDM

Gestational Diabetes Types

When diabetes is diagnosed during pregnancy, it is referred to as gestational diabetes. Gestational diabetes is further classified as A1GDM and A2GDM.

Gestational diabetes that can be controlled with diet alone is called A1GDM while GDM that requires some form of treatment is referred to as A2GDM.

Gestational diabetes occurs when your body cannot produce enough insulin during pregnancy. Insulin is a hormone produced by your pancreas that acts as a key to allow blood sugar into your cells for use as energy.

During pregnancy, your body experiences additional hormonal changes as well as physical changes including weight growth.

These changes cause your cells to use insulin less effectively, resulting in insulin resistance. Insulin resistance raises your body’s requirement for insulin.

All pregnant women suffer some insulin resistance in the latter stages of their pregnancies. Some women, however, have insulin resistance even before they become pregnant.

They have an increased insulin requirement at the start of pregnancy and are more likely to develop gestational diabetes [Ref].

Placental hormones are primarily responsible for gestational diabetes mellitus. However, about half of the patients with GDM have persistent diabetes mellitus. They are referred to as having Type 2 Diabetes Mellitus and are treated like T2DM patients.

The two types of Gestational Diabetes are:

  • A1GDM
  • A2GDM
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A1GDM: Diet-controlled GDM

Diet-controlled gestational diabetes (GDM), also known as A1GDM, is a type of gestational diabetes that can be controlled without medication and responds to nutritional therapy.

By modifying one’s diet and consuming fewer foods high in sugar or carbohydrates, A1GDM can be managed.

Dietary recommendations

A registered dietitian visit is necessary to have your diet evaluated. Your dietist will determine how much carbohydrates you require for meals and snacks. You’ll learn how to count carbohydrates as well.

You can help keep your blood sugar levels in check by eating the foods listed below [ref]:

  • Divide your daily food intake into three meals and two to three snacks.

Your blood sugar can rise too much if you eat a lot all at once. You must eat every meal. You need more nourishment while pregnant, and your unborn child also needs a healthy diet.

  • Consume starch in moderation.

It’s vital to limit your intake of starchy meals because they eventually transform into glucose. However, every meal needs to have starch.

Two slices of bread or around one cup of total starch per meal constitute a reasonable portion.

  • Just consume one cup of milk at a time.

Milk is a nutritious food and a significant calcium supplier. Milk is a liquid carbohydrate, therefore consuming too much of it at once can cause your blood sugar to spike.

  • Limit your fruit intake.

Fruit is a nutritious food but has a lot of natural sugars. Fruit may be consumed in quantities of one to three per day, but only one at a time.

One very little piece of fruit, half of a larger piece of fruit, or around a one-half cup of mixed fruit constitute a portion of fruit. Fruit that has been preserved in syrup should not be consumed.

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  • Breakfast is important

Because of the usual swings in hormone levels in the morning, blood sugar might be challenging to manage.

You might not be able to handle refined cereals, fruits, or even milk with your morning meal. You shouldn’t eat these foods for breakfast if they cause an excessive rise in post-meal blood sugar levels. The finest breakfasts are typically those that combine starch and protein.

  • Skip the fruit juice

To prepare one glass of juice, multiple fruits are required. A full supply of carbohydrates is juice. Juice can immediately elevate blood sugar because it is a liquid.

  • Limit sweets and desserts strictly.

Pastries, cakes, cookies, candies, and other sweets frequently include a lot of carbohydrates. These foods have very little nutrients and often have high-fat content. Avoid all conventional sodas and beverages with added sugar.

  • Avoid foods with extra sugar.

Don’t season your food with sugar, honey, or syrup.

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  • Substitute artificial sweeteners for additional sugars.

It has been determined that the following sweeteners are safe to consume while pregnant [ref]:

  1. Acesulfame K, which includes Sunett.
  2. Splenda appears to contain sucralose.
  3. Aspartame, which includes Equal, NutraSweet, Natra Taste
  • Examine a product more closely if it claims to be “sugar-free.”

Despite frequently being marketed as “sugar-free,” products that include sugar-alcohols may nevertheless contain a significant quantity of total carbohydrates. To find out how many grams of total carbohydrates are present, look at the food label.

Sugar alcohols have laxative properties and might produce gas and bloating. Sugar-alcohols include the following, examples [Ref]:

  1. Mannitol
  2. Maltitol
  3. Sorbital
  4. Xylitol
  5. Isomalt
  6. Hydrogenated starch hydrolysate

Diet sodas and sugar-free candy are only two examples of items with the “sugar-free” label that is free of carbohydrates and won’t raise your blood sugar.

  • Keep a food diary.

It will be easier for you to keep track of your carbohydrate intake if you keep a daily meal and quantity log. When feasible, use measuring cups as well for accuracy.

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A2GDM: Diet + Medication-Controlled GDM:

A2GDM is gestational diabetes treated with medication to achieve appropriate glycemic control.

Pharmacologic treatment should be initiated if the patient’s glycemic control is inadequate despite optimal adherence to diet and exercise.

Insulin is the ADA’s first-line treatment for GDM. When adequate glucose levels cannot be achieved through diet and exercise, insulin therapy has been considered the standard therapy for gestational diabetes management.

Insulin for Gestational Diabetes:

Insulin may be used to help achieve appropriate metabolic control if [ref]:

  • The fasting blood glucose level is greater than 95 mg/dL.
  • The 1-hour glucose level is greater than 140 mg/dL.
  • The 2-hour glucose level is greater than 120 mg/dL.

The patient’s weight formula, 0.2 units/kg/day, can be used to determine the basal insulin dose. If the blood glucose level rises after a meal, rapid-acting insulin or regular insulin can be given before the meal, with a dose of 2 to 4 units.

The total daily demand for insulin is:

  • 0.7 units/kg/day in the first trimester,
  • 0.8 units/kg/day in the second trimester, and
  • 0.9 to 1.0 units/kg/day in the third trimester.

The patient should divide the daily insulin dosage in half, giving one half as basal insulin before bedtime and the other half as rapid-acting, regular, or insulin before each of the three meals.

Aspart and Lispro are both permitted for use during pregnancy. Less hypoglycemia is linked to short-acting insulin.

The use of long-acting insulin detemir during pregnancy has been authorized. Nocturnal hypoglycemia is less common with long-acting insulin [Ref].

Oral hypoglycemic agents

Despite the lack of FDA approval, the oral hypoglycemic agent, metformin and glyburide are increasingly being used among women with gestational diabetes [Ref].

  • Glyburide starts at 2.5 mg and has a maximum dose of 20mg.
  • Metformin therapy should begin with 500 mg, with a maximum dose of 2500 mg.
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Fetal Complications of GDM:

There are two main fetal complications of gestational diabetes: macrosomia and hypoglycemia. While infants of women with gestational diabetes are susceptible to many chemical abnormalities, such as low serum calcium and magnesium levels [Ref]:

  • Macrosomia:

A baby who is much larger than average is referred to as having macrosomia. The mother’s blood provides the fetus with all of its nutrition.

The fetus’s pancreas detects excessive glucose levels in the mother’s blood and releases extra insulin to utilize the excess glucose.

The excess glucose is transformed into fat by the fetus. The fetus can make all the insulin it needs, even if the mother has gestational diabetes.

A considerable amount of fat is deposited in the fetus as a result of the mother’s high blood glucose levels and the fetus’s high insulin levels, which lead the fetus to grow disproportionately large.

  • Hypoglycemia in the newborn:

Low blood sugar in the newborn right after delivery is referred to as hypoglycemia. If the mother’s blood sugar levels have been continuously high, the fetus will experience this issue because of the high insulin levels in its bloodstream.

After delivery, the newborn’s blood sugar level drops dramatically since it no longer gets the high level of sugar from its mother but still has a high quantity of insulin.

After birth, the baby’s blood sugar level is examined, and if it is too low, the baby may need to receive intravenous glucose.

Other complications may include shoulder dystocia in the infant during delivery, preterm birth, and neonatal respiratory distress syndrome.

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Maternal Complications of GDM:

The increased risk of cesarean birth, preeclampsia, diabetes mellitus, and hypertension are all examples of maternal complications. Gestational diabetes increases your chances of pregnancy complications and procedures such as [ref]:

  • Preeclampsia and high blood pressure:

When the blood’s force on the blood vessel walls is excessive, this condition is known as high blood pressure (also known as hypertension).

It can strain your heart and lead to issues while you’re pregnant. Preeclampsia is a condition in which a pregnant woman has high blood pressure and indicators that her liver and/or kidneys may not be functioning normally.

  • Cesarean section (C-Section):

This is a surgical procedure in which your baby is born through a cut made in your belly and uterus by your doctor.

If you have complications during your pregnancy or if your baby is very large, you may need to have a c-section (also known as macrosomia).

Most women with gestational diabetes can give birth vaginally. They are, however, more likely to have a c-section than women who do not have gestational diabetes.

  • Depression during pregnancy.

This type of depression manifests either during pregnancy or in the first year following childbirth (also called postpartum depression).

Depression is a medical disorder that results in depressed feelings and a loss of interest in enjoyable activities. It may have an impact on how you feel, act, and think, interfering with your day-to-day activities.

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Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

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