"I always tell them that it is not their fault! Telling them it is related to hormones from pregnancy instead of them being a failure usually brings tears of relief because they are convinced it is their fault."
—Barbara Walker, RN, CDE
"Important topics to cover: Impact of pregnancy hormones on insulin resistance and what insulin resistance means, and the importance of daily light-paced physical activity if not contraindicated."
—Nancy Mack, RN, CDE, MSED
"I tell them, 'You can't study for it, so you didn't 'fail it.' It's outside of normal range.'"
—Juanita Daugherty, MSN, RN, CDE
"I always emphasize consistency with medications/insulin and timing of meals and snacks. I cannot count the number of women who saw dramatic changes to their blood sugars when they got on their own determined schedules and remained consistent with it. I also find it important to explain how their insulin needs and diet regimen might change as their pregnancy advances. This prepares them for ongoing changes and prevents them from becoming frustrated with ongoing GDM care."
—Celia Balderas RN BSN
"At the initial visit I always introduce the idea that they may need medication. When I explain the meal plan, I explain that the goal is to eat healthy to support mom and the pregnancy. I spend time making sure she understands not to over restrict to control glucose and that if levels are too high then medication may be needed. Introducing the idea early and discussing it often helps prevent women from over restricting and decreases fear and guilt if medication is needed.
I also take the time to find out if they have friends or family members who have diabetes. I make sure the woman knows that glucose goals are lower in a pregnant woman as opposed to the non-pregnant person with diabetes. I have had many women that have gotten incorrect information from well-meaning family or friends and this leads to confusion and denial of their diagnosis during pregnancy. This confusion could lead to time wasted getting treatment started."
—Barbara Nadolny BSN, RN, CDE
"I give a talk on GDM to professionals reminding them about the realities of GDM – how to emphasize the importance of care but allay fears, piggy-backing on what was said. Either women are told, “don’t worry about a thing, this will go away when the baby is born” or they are frightened to death that their baby will be born with diabetes. Both WRONG – 60% of women with GDM go on to develop diabetes within 5-10 years so they ALWAYS need to be on the alert plus explaining the precise physiology of BG of Mom to fetus etc., is crucial. An abnormal intrauterine environment is proving to be responsible for many, many things now so we need to pay attention to that more than ever! Neonates will not have diabetes but these offspring are more prone to obesity, diabetes etc. if Mom’s glucoses were high."
—Lois Exelbert, MS, RN, BSN, BC-ADM, CDE, LCCE
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