The long-term risks of gestational diabetesby Nicky Pellegrino
Gestational diabetes can set women up for type 2 diabetes later in life.
West Aucklander Bernice Snook was an active 40-year-old when she discovered she had type 2 diabetes. She was training for a marathon and working out at a gym six times a week, so when she developed a blister on the bottom of her big toe, she assumed a new pair of shoes were to blame. However, the blister wouldn’t heal. And then she woke to find her foot red and swollen.
“My doctor said it was an infection and sent me to hospital. I found out my blood sugar was sky high and the blister was actually a diabetic ulcer,” says Snook, now 51.
Doctors fought to stop the infection creeping up her leg, performing seven operations in three weeks. After the final one, Snook woke to the devastating news her leg had been amputated below the knee.
She wasn’t overweight at that point and had no family history of type 2 diabetes. But there was one clue that Snook had a heightened risk of developing the disease. While pregnant with her daughter 14 years earlier, she had become one of the 3000 to 4000 New Zealand women a year who develop gestational diabetes.
During pregnancy, hormonal changes, weight gain and the demands of the fetus increase a woman’s need for insulin. Generally, two to three times more than normal is required to control blood sugar. If an expectant mother can’t produce enough insulin, blood-sugar levels spike.
Gestational diabetes tends to be diagnosed later in a pregnancy and usually is temporary, resolving itself after a woman has given birth. But it more than doubles the risk of developing type 2 diabetes in the future.
Unfortunately, Snook wasn’t aware of that. She felt fine, assumed she was healthy and didn’t go for further blood tests. “Thinking back now, there might have been signs I missed,” she says. “I felt tired but put that down to the fact that I was a busy mum, working full-time and training. And I was drinking a lot of water, but again, assumed that was because of the training.”
Other health complications arise from type 2 diabetes. Snook is now in renal failure, and relying on dialysis to keep her alive while she hopes for a kidney transplant. She manages to walk with a prosthetic limb but has had falls resulting in serious breaks to her remaining ankle.
Less mobile and often fatigued, she finds it tough to exercise and is the heaviest she has been. Eleven years on, her chances of running anywhere – never mind a marathon – are nil. “I know where my limits are.”
Snook is taking part in five-part TV1 series Attitude: The Disease That’s Killing My Family, screening from May 22, that explores the rise of type 2 diabetes. New Zealand has one of the highest rates of the disease in the developed world.
Gestational diabetes is also on the rise. It is more common in older mothers, those who are overweight and women who have a family history of diabetes. There are risks for the baby, including abnormal blood sugar levels and high birth weight. Complications for the mother include pre-eclampsyia, a high-blood-pressure condition that is potentially life-threatening. Californian researchers say women with the condition also face an increased risk of heart disease later in life. So it makes sense to do everything possible to avoid it.
Although it helps to be a healthy weight before conception, gestational diabetes affects even very slim women. Expert advice is to exercise, maintain a gradual weight gain through pregnancy and eat healthily.
Auckland dietitian and sports nutritionist Caryn Zinn believes the key is to focus on whole foods. “Eat minimally processed foods, things that have had little human interference,” she advises. “If you do that, what you’ll end up with is a diet that is lower in carbohydrates and higher in natural fat.”
You might still want to be careful not to eat too much fruit or carb-heavy vegetables such as kumara and potato. “But it’s all about the load,” says Zinn. “Those foods give us a host of nutrients, and if you take out the processed carbohydrates such as pasta, bread, crackers, rice, muesli bars and breakfast cereals, you’ll have more room in your diet for the vegetables.”
Snook has overhauled her diet and now eats lots of salads. She regrets not understanding the longer-term risks of gestational diabetes. “I would have got checked on a regular basis. Sometimes I look back and think if only I’d known. But I try not to do that; I’ve just got to get on with my life.”
Follow the Listener on Twitter or Facebook.
A historical drama about a 19th-century landowner who secretly diarised her relationships with women comes to Neon.Read more
Lauraine Jacobs traces the evolution of eating in NZ, from the spartan diet of the war years to the vibrant multi-ethnic melting pot of cuisines...Read more