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What is it:
Diabetes is high blood sugar. When a woman has high blood sugar only while she is pregnant, it is a special type called Gestational Diabetes. Usually the blood sugar is kept in the normal range by insulin made by the body. Most of the time, pregnant women make more insulin to lower the blood sugar. However, some women cannot do this, and these are the women who develop gestational diabetes. This usually occurs in the second half of pregnancy.
Who Gets it:
The woman most likely to develop gestational diabetes has had:
- Gestational diabetes before
- a baby that weighed 10 pounds or more
- a history of diabetes in her family
- high blood sugar while using birth control pills
- a stillborn baby
- is very overweight
The goals of treatment are to maintain blood glucose levels within normal limits during the duration of the pregnancy, and ensure the well-being of the fetus. Close monitoring of the mother and the fetus should continue throughout the pregnancy. Self-monitoring of blood glucose levels allows the woman to participate in her care. Fetal monitoring to assess the fetal size and well-being may include ultrasound exams and non-stress tests. A non-stress test is a very simple painless test for you and your baby. An electronic fetal monitor (a machine that hears and displays your baby’s heartbeat) is placed on your abdomen. When the baby moves, its heart rate normally increases 15 to 20 beats above its regular rate.
Your health care provider can look at the pattern of your baby’s heartbeat in relationship to its movements and determine whether the baby is doing well. Your health care provider will look for three accelerations of 15 beats per minute over the baby’s normal heart rate, occurring within a 20 minute period.
Dietary management provides adequate calories and nutrients required for pregnancy and to control blood glucose levels. Patients should receive nutritional counseling by a registered dietician. If dietary management does not control blood glucose levels within the recommended range, insulin therapy should be initiated. Self-monitoring of blood glucose is required for effective treatment with insulin.
There is a slight increased risk of the fetus or newborn dying when the mother has gestational diabetes, but this risk is lowered with effective treatment and careful watching of the mother and fetus. High blood glucose levels often go back to normal after delivery. However, women with gestational diabetes should be watched closely after giving birth and at regular intervals to detect diabetes early. Up to 40% of women with gestational diabetes develop full-blown diabetes within 5-10 years after delivery. The risk may be increased in obese women.
- Low blood glucose or illness in the newborn
- Increased incidence of newborn deaths
- Development of diabetes later in life
Calling your health care provider if you are pregnant and symptoms of glucose intolerance develop.
- Increased thirst
- Increased urination
- Weight loss in spite of increased appetite
- Nausea and vomiting
- Frequent infections including those of the bladder, vagina, and skin
- Blurred vision
Note: Usually there are no symptoms.
Signs and tests:
An oral glucose tolerance test between the 24th and 28th weeks of pregnancy is the main test for gestational diabetes.
Diet – Diabetes
Key principles are to:
- Achieve weight control through reducing calories
- Reduce intake of dietary fat (specifically saturated fat)
- Individualize guidelines for carbohydrates based on the type of diabetes you have and the control of your blood sugar levels.
There are 2 primary types of diabetes. The nutritional goals for each are different.With type 1 diabetes, studies show that total carbohydrate has the most effect on the amount of insulin needed and the maintenance of blood sugar control. There is a delicate balance of carbohydrate intake, insulin, and physical activity that is necessary for the best blood levels of a sugar called glucose. If these components are not in balance, there can be wide fluctuations — from too-high to too-low — in blood glucose levels. For those with type 1 diabetes on a fixed dose of insulin, the carbohydrate content of meals and snacks should be consistent from day to day. For children with type 1 diabetes, weight and growth patterns are a useful way to determine if the child’s intake is adequate. Try not to withhold food or give food when a child is not hungry. Insulin dosing and scheduling should be based on a child’s usual eating and exercise habits.
With type 2 diabetes, the main focus is on weight control, because 80% – 90% of people with this disease are overweight. A meal plan, with reduced calories, even distribution of carbohydrates, and replacement of some carbohydrate with healthier monounsaturated fats helps improve blood glucose levels. Examples of foods high in monounsaturated fat include peanut or almond butter, almonds, walnuts, and other nuts. These can be substituted for carbohydrates, but portions should be small because these foods are high in calories. In many cases, moderate weight loss and increased physical activity can control type 2 diabetes. Some people will need to take oral medications or insulin in addition to lifestyle changes.
Children with type 2 diabetes present special challenges. Meal plans should be recalculated often to account for the child’s change in calorie requirements due to growth. Three smaller meals and 3 snacks are often required to meet calorie needs.
Changes in eating habits and increased physical activity help reduce insulin resistance and improve blood sugar control. When at parties or during holidays, your child may still eat sugar-containing foods, but have fewer carbohydrates on that day. For example, if birthday cake, Halloween candy, or other sweets are eaten, the usual daily amount of potatoes, pasta, or rice should be eliminated. This substitution helps keep calories and carbohydrates in better balance. For children with either type of diabetes, special occasions (like birthdays or Halloween) require additional planning because of the extra sweets.
Meal Plan for Gestational Diabetes
The meal plan controls blood sugar by controlling how much carbohydrate food is eaten. Carbohydrates, both sugars and starches, are converted into blood sugar in our bodies. Eating less carbohydrate prevents high blood sugar. Some carbohydrates are digested more slowly and therefore raise blood sugar less than others.
In general, your GDM meal plan will follow these principles: (Click for a detailed list)
- a very small breakfast with little carbohydrate, such as 8 oz milk with one slice of toast and an egg or peanut butter for protein
- 3 small meals and 2-3 small snacks (smaller meals cause lower blood sugars)
- avoidance of concentrated sweets and sugars, including fruit juice
- plenty of non-starchy vegetables
- low-fat protein foods such as chicken, tuna, or lean meat
- lower-fat food choices in general, to keep weight gain at a healthy level
- low-fat or non-fat milk, yogurt or cheese for adequate calcium
Your Registered Dietitian will determine the correct amounts of the different foods and design a menu based on your schedule, the foods you like, your blood sugar levels, and your nutritional needs in pregnancy. The breakfast is generally very small because the pregnancy hormones, which raise blood sugar, are at highest levels in the morning.
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