It creeps up during pregnancy and it's hard to avoid.
When Liz Miersch was pregnant with her daughter, Ruby, she got a routine blood test with surprising results: Her glucose levels were high. Miersch, a certified personal trainer and former dancer, had always been active and lean, so she and her doctors assumed it was a mistake.
A second test confirmed the first. She was diagnosed with gestational diabetes and found herself in an unfamiliar world, doing finger-stick tests and submitting detailed food logs to her healthcare team. “They sent me to a nutritional counselor who was like, ‘This is what a carbohydrate is,’” she says. “I was like, ‘Yeah, I know. I’m not supposed to be here.’”
There aren’t reliable stats on women like Miersch who don’t fit the typical diabetic profile. But Jacques Moritz, MD, an associate clinical professor of obstetrics and gynecology at Cornell Medicine in New York City and a member of the Equinox Health Advisory Board, says he’s diagnosing the condition more frequently in fit women. “I don’t really have a great explanation,” he says. Genetics can play a role, and so can giving birth later in life.
A new study found that women who exercise regularly have a 12 percent lower risk of getting the disorder than sedentary types. Movement helps control blood glucose levels because muscles use sugar for fuel, explains study author Kara Whitaker, Ph.D., assistant professor of exercise science at the University of Iowa in Iowa City. A ripple effect can set in, so that the more you exercise, the more muscle you have, and the more sugar gets used up.
But active lifestyles don’t make women completely immune to gestational diabetes. It doesn’t help that during pregnancy, the body becomes slightly less sensitive to insulin to help the baby get enough nutrients, says Michelle Mottola, Ph.D., director of the Exercise and Pregnancy Lab at Western University in Ontario, Canada. Glitches in the pancreas (which produces insulin) can cause buildup and lead to a diagnosis. In women who are otherwise healthy and risk-free, it’s rarely their fault, she adds.
When Miersch, the vice president and managing director of Furthermore, developed the condition, she lived like a diabetic. She pricked her finger with a needle whenever she ate and had to be hyper aware of everything she put in her body. She eventually found a meal that never caused a spike, so she ate it almost daily: Sweetgreen’s Harvest Bowl—without the apples.
The diagnosis also made pregnancy more challenging for Julie King, another former dancer. During her first pregnancy, King controlled her gestational diabetes mostly with diet, but had to go to the doctor more often than normal. Once a woman develops the disorder, there’s a 66 percent chance she’ll get it during her next pregnancy.
Sure enough, King did. The second time around, she had to inject herself with insulin every night and she couldn’t deliver at her hospital of choice because they didn’t have a neonatal intensive care unit. “It was really tough and stressful,” she says.
Both Miersch and King had smooth deliveries, but the risks at birth are plenty: Babies born to moms with gestational diabetes are more likely to be overweight (since glucose passes through the placenta and into their bodies), have breathing problems, and develop type 2 diabetes later in life.
Vanessa Barthelmes, a yoga teacher in Jacksonville, Florida, was diagnosed at 35 years old. She spent her first trimester vomiting and feeling nauseous. Her doctors wrote these side effects off as morning sickness, but later she learned they were symptoms of high blood sugar. One year postpartum and with a healthy baby, she still qualifies as pre-diabetic. (Miersch and King’s readings returned to normal once they gave birth.) Now, all three women have a 60 percent chance of getting type 2 diabetes in their lifetimes.
Most women can manage the condition with a healthy diet and exercise, but somewhat cruelly, if they already prioritize these things there’s little room for improvement. To keep blood sugar stable, Mottola suggests they start and end their days with protein, skip juice and smoothies in favor of whole fruit, eat smaller meals throughout the day, and exercise regularly.
Barthelmes, a vegetarian, switched to a Paleo diet, eating more meat and less fruit and starchy carbs like potatoes. Any time Miersch indulged in ice cream, she'd either top it with peanut butter or eat it after a meal that included chicken or eggs. Balancing the carb-to-protein ratio was key.
After giving birth, women should concentrate on exercising and eating well, though they can be a little more lax about both. Whitaker says they should aim to be back to their pre-pregnancy weight within six months. The doctor’s appointments don’t end, though. The American Diabetes Association recommends a blood glucose test six to 12 weeks after delivery and every three years moving forward.
As impossible as it seems, Moritz says there’s a positive side to the diagnosis: The risk of type 2 diabetes forces women to focus even more on maintaining a healthy lifestyle. And only good things can come from that.
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