I always glance down my list of patients when I arrive at work to see what is in store for my day. I have to admit, seeing kids with type 1 or those that are athletes are my favorites. But a close runner up is women who have just been diagnosed with Gestational Diabetes. And with the new standards for diagnosis, I’ll probably be seeing more and more of them.
I’m impressed with how quickly this group of women learns carbohydrate values for foods, agrees to include some fruits and vegetables, and finds the previously unavailable time to take a short walk after a meal. The concept of checking blood glucose values initially sounds daunting, but once they see how much it can tell them about their choices, the more interested they become.
The challenge appears to be AFTER the pregnancy is over. I spend time encouraging continued blood glucose checking over the next six weeks, to assure the women are returning to normal range. We also discuss the importance of role modeling healthy behaviors for the family and new arrival as time passes. We discuss the added risk factors for women in developing type 2 diabetes over time, and even for the new infant as he or she ages. However, after the pregnancy, women with gestational diabetes often fall off the radar screen of the diabetes educator. They return a decade later, having left the enthusiasm for healthy eating and exercise behind with their pregnancy, perhaps gained additional weight, and feel overwhelmed with the diagnosis of type 2 diabetes.
Have any of you set up “after care” classes or support groups for individuals with gestational diabetes? How do you offer continued support for a healthier lifestyle to forestall the development of prediabetes or type 2 diabetes in years to come, or even with subsequent pregnancies? Do you schedule women for individual follow up education post-partum? And do those sessions continue over time? I’m unaware of any reimbursement for such a service, but perhaps time of service charges could be implemented? I would like to hear any thoughts you might have!