Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Managing Gestational Diabetes and Preventing A Future Diabetes Diagnosis
Discover the unexpected journey of endocrinologist Dr. Divya Yogi-Morren as she navigates gestational diabetes firsthand. Her personal experience offers unique insights and fosters empathy towards those managing this challenging condition. Alongside Dr. Morren's story, we unravel the complexities of gestational diabetes management, from the intricacies of carb counting to the essential lifestyle changes required. This conversation is more than just about coping; it's about empowerment through knowledge, as we uphold our Speaking of Women's Health motto: Be Strong, Be Healthy, and Be in Charge!
Whether you're considering parenthood or seeking to understand the long-term health implications of this disease, this episode is your guide to navigating gestational diabetes and a healthy pregnancy.
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the Executive Director of Speaking of Women's Health, and I am glad to be back in the Sunflower House for a new episode. For a new episode On this podcast, I am going to be talking about gestational diabetes and why is this important? You know you might not be pregnant. Maybe you were pregnant, but it was a long time ago but it's very important that we understand how pregnancy can reflect future health outcomes and if you've ever been pregnant, you've probably heard of gestational diabetes, but what exactly? It is what you should be concerned about.
Speaker 1:Dr Divya Yogi Moran wrote a column for us on speakingofwomenshealthcom in 2023. No, actually 2024. Yes, last year. We're in 2025 now, and she was also in the Sunflower House last year talking about the area she specializes in in terms of Cushing's disease and Cushing's syndrome, and she wrote that, as a physician, she never expected to receive a concerning call from her obstetrician when she was six months pregnant, but the OB's office informed her that she failed. Okay, this is someone who passes all her tests, but she failed her glucose screening test, indicating potential gestational diabetes a pretty serious condition and, as an endocrinologist who's got lots of expertise in diabetes, she knew that this was a problem, so she scheduled a follow-up test at her own office the next week to confirm the diagnosis and, despite her very athletic background and healthy lifestyle, the test came back positive that she has gestational diabetes.
Speaker 1:And she's not the only one who's had gestational diabetes. Some other women that I work with very closely that are smart physicians in fact, just two of them I can think off the top of my head One having her first baby, very excited, in her 30s, and another one in her early 30s having her second baby. Both came down with gestational diabetes, so I thought we got to really focus on this. So Dr Divya Yogi Moran wrote that the news totally blindsided her and she reviewed the risk factors, and she knows that, of course, this diagnosis puts her, as well as any other woman diagnosed with gestational diabetes, at an increased lifetime risk of developing diabetes, and as an endocrinologist she had counseled so many patients about gestational diabetes, but all of a sudden she became the patient pricking her finger to check her sugar five times a day, and this very intimate experience gave her new empathy for her patient's challenges. Now the other two physicians that I referred to that are in my inner circle who also recently were diagnosed with diabetes, got the little monitor that you place on the arm that constantly monitors blood sugar. And then with your phone there is an app, so the old pricking of the finger doesn't always have to be done, and that was like an exciting advance in 2024. And I even had a few patients who didn't have diabetes who got it just because they wanted that biometric feedback. I'm not recommending that. But if you have diabetes, who got it just because they wanted that biometric feedback, I'm not recommending that. But if you have diabetes or are at risk of diabetes or gestational diabetes, really knowing what your blood sugar is and how you respond to food and exercise and medications is very important.
Speaker 1:So Dr Divya Yogi Moran she worked really hard to control her gestational diabetes through mainly diet and exercise and she said she was fortunate to avoid medication during pregnancy. But not everyone is fortunate to avoid medicines. She found that counting carbs proved difficult because even a natural food like an apple, it varied in its carbohydrate content based on the size and the degree of ripeness of the fruit. Now, a big apple is about 300 calories and that's one of the most favorite things I say when women complain about weight gain in midlife is, I say, you only have to eat a big apple, 300 calories a day, for about six months to gain 25 to 30 pounds and make a baby about six months to gain 25 to 30 pounds and make a baby. So she also found that, just besides the size of foods and the ripeness, that processed foods were really bad for her and spiked her blood sugar, regardless of how many carbs it had. And I really think that these processed foods really are the cause of so many problems. Obesity rates are soaring, diabesity is soaring and even in slender, thin, athletic women like I'm thinking of the three physicians that I know recently who've dealt with this gestational diabetes. There's so many substances in our food supply that aren't allowed in other countries and if you have not heard my column on food freedom and banned foods in other countries, that's a good baby at 37 weeks.
Speaker 1:The other physician developed some other medical problems but had a healthy baby boy a little bit early, but the baby boy's doing very well and the other physician's just about ready to deliver. So hopefully they stay healthy but that they realize, just like any patient who's had gestational diabetes, that they really do need extra medical monitoring. So Dr Divya Yogi Moran said that, given her family history of diabetes, she was very much forewarned about diabetes, and so she researched preventive measures and she committed to daily efforts to reduce her own diabetes risk. And she thought that, as an endocrinologist, she should share her personal experience with patients, providing tips and empathy that she gained being a pregnant patient herself, and she said it motivates her every day to take preventive action and to help others do the same. And isn't that our motto at Speaking of Women's Health Be strong, be healthy and be in charge. And our website is full of stories of women having to face challenges and medical problems and really committing themselves to being empowered with knowledge and making changes to stay healthy and stay strong and, in the end, always being in charge of their own destiny. And that really is the motto that we all live speaking of women's health, whether we're in the Sunflower House or working on the team or working in our wonderful Center for Specialized Women's Health.
Speaker 1:The founder of Speaking of Women's Health and our chief creative strategist, the fabulous Diane Dunkelman, lady Di. She outlined her own personal experience with fatty liver and her concern about cirrhosis and how she totally turned that around by educating herself, empowering herself and ridding herself of the fatty liver. And we are seeing so much fatty liver and metabolic disease in the patients I see, and it's very concerning because one in six women with fatty liver will go on to get cirrhosis. And if you have insulin resistance or diabetes or a history of gestational diabetes, you're a woman. Even if you drink zero alcohol and don't have any hepatic toxins, your fatty liver can progress. And with diet and intermittent fasting, maybe certain supplements, some medical interventions, getting out all the seed oils, the trans fats, eating heart, healthy fats, getting the weight down, sometimes using metformin, glucofage, which we've talked about on other podcasts, black coffee, green tea also are very good. So if your liver functions are up a little bit or you get a test result on ultrasound that says fatty liver, even if your doctor's not concerned, you better be concerned and if your sugar or triglycerides are creeping up, you better take action.
Speaker 1:And if you did have gestational diabetes, you need to know that that is a form of glucose intolerance and it occurs when the body's just simply unable to make enough insulin in the pancreas to compensate for the increased natural insulin resistance that naturally occurs during a pregnancy. Now, for most women, gestational diabetes resolves after delivery, but does confer a higher risk of type 2 diabetes. Now one of the physicians that had gestational diabetes. Her sugars have still stayed up despite being thin and athletic after her delivery, and so she needs more intensive medical follow-up. Dr Divya Yogi Moran went right back to normal. So one person's experience may not be your experience, but it's important to get close medical follow-up.
Speaker 1:So you might ask well, what are the risk factors for gestational diabetes? Well, you're more likely to get it if in a previous pregnancy you had it, but it's not 100%, it's only 40%. If you had any signs of prediabetes or high blood sugar before your pregnancy, that's another one. If you've got any first degree relatives with diabetes, if your pre-pregnancy body mass index is 30 plus, so that's definitely not healthy and obese, unless you're incredibly muscular. And so the body mass index has a lot of problems. It doesn't really measure body fat exactly. Measuring your waist to hip ratio, doing total body fat analysis with a bone densitometry machine, which we can do, although insurance does not usually cover it there's caliper test and submersion test, so there are some ways to find out about your total body fat and visceral fat. Now, if you're like a lot of women who gain a lot of weight early to mid adulthood and between pregnancies. That's a problem If you're one of the 10 plus percent of women who have to deal with polycystic ovary condition that's associated with insulin resistance.
Speaker 1:And if you haven't heard the podcast that I did with the fabulous Dr Ula Abed, an endocrinologist in our Center for Specialized Women's Health. I think I showed some of our listeners that she's an artist and a photographer. She's got some photographs on our website and she made this most beautiful jewelry box for me with pearl, and every day I open it up and I put my jewelry in that I'm planning to wear for the next day. It's just so lovely. But she is an expert in PCOS, has done research on showing that dietary therapy she's done has been more effective at helping women with fertility than actually the standard medical treatment. So these innovative women physicians who really work so hard to empower women and give them options and be holistic we love to feature in the Sunflower House and be holistic. We love to feature in the Sunflower House Now.
Speaker 1:Other risks for gestational diabetes include, if you have a Hispanic background, native American, alaskan natives, native Hawaiians, south Asians or Pacific Islanders. Also, I always ask women if they've ever had a baby over or under nine pounds, because when you have a really big baby, that is a concern about insulin resistance. It's not always the case. I have some women who are six foot two, married to six foot six men, who have just big babies that are tall and big. So we're all different and we have to appreciate that. But at eight pounds and eight ounces that's how much Artemis, my granddaughter, weighed. So she was considered macrosomic for her gestational age. So that meant that they constantly kept checking her blood sugar and kept pricking her as a newborn and come to find out she just has very tall, big parents and she's going to be a tall kind of sturdy girl. So we always compare things to ranges and that's what we do in medicine. Sometimes, following that, it gives you a baseline If you know what your baseline is. Of course, your baseline at birth and your birth weight is going to change as you grow, of course.
Speaker 1:But it is important to have this biometric data and I'm very encouraged by so many of my patients getting so much more involved in their own health and wellness by really paying attention to what they're eating and what their numbers are and things that they can do to enhance their health. So you are listening to the Speaking of Women's Health podcast. I'm in the Sunflower House, I am your executive director of Speaking of Women's Health and I'm the lead podcaster of this fabulous podcast and we're talking all things gestational diabetes. So you might ask how many women are affected by gestational diabetes. Well, at least 16.5% of all pregnancies are affected by gestational diabetes. Well, at least 16.5% of all pregnancies are affected by gestational diabetes and unfortunately these rates are rising because of rising obesity and I also think that age as well.
Speaker 1:I know, with my own pregnancies I was so happy to always pass my glucose tolerance test and had just really the most super results with my first pregnancy two pregnancies or two deliveries, because you know there were some miscarriages. But with my last pregnancy, which I had my son Grayson and I really wanted to make sure that I didn't have any babies after age 35. I was just really strict that I wanted childbearing complete. So I conceived him just in time to beat that age 35 mark I had in my mind. And my sugars were normal, but they were completely in the normal range, but still up just a little bit compared to what the others were, and I'm sure that age plays a role and nowadays so many women are just delaying childbearing, which does have some consequences. There's more medical complications. The older you are, fertility rates really decrease. We've seen just really a falling out of the birth rates.
Speaker 1:So if you've got younger women in your life and you know that someday they want to be a mother and that goes for men as well they want to be a father, they want to be parents. There's really never a great time. People don't always have enough time or money and so it is really a challenge. But generally going through pregnancy when you're younger is easier and fraught with less risk, and I don't think we say that enough to women. There's so much attention on preventing pregnancies and building up a career and certainly being a physician, like these wonderful doctors that I'm talking about who were dealing with gestational diabetes. It's a very intensive training, but I have many physician friends who had their children in medical school or early in residency and it's never really an easy time, but they never, ever have expressed to me that they regret becoming a mother at a younger age.
Speaker 1:So what you need to do is, if you have risk factors, you've got to make sure you get your screening for gestational diabetes, which is standard, and all women have to have healthy diets and exercise, and staying healthy, at a healthy weight after birth lowers your chance of developing type 2 diabetes later on, and I think breastfeeding is one of the best things to help you get back to your weight. It requires a lot of calories. I remember our live-in au pair nanny looked at me and said my goodness, you eat more now than you did when you're pregnant, and she was so surprised and I'm like well, that's because I'm really eating for two a growing baby and so that really helped me snap back to my pre-pregnancy weight. Now, not everyone can breastfeed. We've had great columns on breastfeeding and August is Breastfeeding Awareness Month, so if you go back to August of 2024, you can hear that one. I still will tell women that I work with because we have several that are new moms or repeat babies, and we hear that sound of that breast pump going on a lot at lunchtime and break times and I always joke, my goodness, the sound of that gives me PTSD. So it is quite a commitment, but there's a lot of advantages and when you're with your baby it's so simple and it's also metabolically great for the mom.
Speaker 1:Now, the way that gestational diabetes is diagnosed is that your physician will usually recommend doing blood testing between 24 and 28 weeks of gestation, and this crucial screening does identify if you have high blood sugars. That can develop. Two-hour glucose tolerance test using a sweet drink that contains glucose, and they check your blood level before you drink it, an hour after and two hours after, and usually you need to stay in the lab and have this done. At the two-step method. You complete the one-hour screen by drinking a sugary solution and getting your blood sugar tested, and if that's elevated, then they make you come in for a three-hour test to confirm it. So the exact testing approach can vary based on your own physician's practice, but the goal is the same to catch elevated blood sugars and to control the sugar so that your baby doesn't grow too big or that you don't get preeclampsia, hypertension, early delivery or other newborn complications, so lowering your risk.
Speaker 1:You need to make lifestyle changes if you haven't already. So if you're planning a pregnancy and you're not pregnant yet, but you're overweight, it's really hard to regulate your blood sugars if you have insulin resistance. So even if you just shed a few pounds before you conceive and maintain a healthy weight gain. That can help a lot. Exercise, 30 minutes of moderate activity on most days of the week walking, swimming, prenatal yoga classes we have so much about yoga on our website and a podcast on that and staying physically active does improve insulin sensitivity and blood sugar control. Of course, watching what you put in your mouth whole unprocessed foods like fruits and vegetables, whole unprocessed foods like fruits and vegetables, lean protein, heart-healthy fats like olive oil, nuts, fatty fish, whole grains, and really you just need to say goodbye to sugary, high-fat foods and things just loaded with gratuitous carbohydrates that are simple sugars and a balanced, low-glycemic diet supports the blood sugar for both mom and baby. If you smoke, please try to quit before getting pregnant. Some women lose the desire to smoke when they're pregnant, but not all women and it's just so much health benefits to just avoiding using these nicotine products. And if you can have heart healthy habits even before pregnancy and you can continue it after that busy time period after giving birth, many times being sleep deprived, having to learn new skills and still manage your life, that can really help.
Speaker 1:Now, how is gestational diabetes treated? Well, we talked about diet and blood sugar monitoring and exercise, and sometimes medications are needed. Some women need to go on insulin injections. Others can take medications like metformin, glucofage, which lowers blood sugar levels and, as we've talked about on prior podcasts, has some anti-aging effects. So together, you and your healthcare team will find the right combination and if you keep your blood sugar in check, you lower the risk of having too big a baby. An early delivery or a C-section birth, which has more risk for both the mom and the baby and is more expensive, takes time to heal. So generally we try to focus on a vaginal delivery when possible.
Speaker 1:So you might ask does gestational diabetes automatically lead to type 2 diabetes? Well, it is an indicator that you're prone to it and you're more at risk, but the demands of the pregnancy simply unmask this issue earlier than it would have emerged had you not been pregnant. So for women who've had gestational diabetes, they have to pay close attention to what is their blood sugar, what is their lifestyle, what are they eating? Are they getting periodic screenings for type 2 diabetes? They eating? Are they getting periodic screenings for type 2 diabetes?
Speaker 1:One thing that I pretty much recommend to most all of my patients who are not growing children or who are not pregnant is to significantly commit to intermittent fasting. Not everyone can do this. Some people's lifestyle, migraine, headaches you know there are different reasons, everybody's individual, so I work with all my patients individually. But and again, this podcast is just for general information to empower you to be strong, be healthy and be in charge. It is not official medical advice and that's why you need a good relationship with your own physician and healthcare team. But studies indicate that intermittent fasting can many times facilitate weight loss, enhance insulin sensitivity and just improve focus, concentration and glycemic control, and all of this does reduce the risk of diabetes.
Speaker 1:Now, very low carb diets certainly have been an approach to deal with blood sugar. Now, very low carb diets certainly have been an approach to deal with blood sugar. And there is no such thing as an essential carbohydrate, as you've heard me say, where there are essential proteins or amino acids and essential fats. Now, vitamin D. My goodness, my third podcast was everything vitamin D. I talk about vitamin D every day in my office Because, whether you get it through sunlight exposure, which is hard to do in northern climates like right now, dietary sources have some vitamin D, but not as much as that many people need, and many times we do have to go to supplements and it really does help fortify against hyperglycemia and type 2 diabetes.
Speaker 1:Be aware of obstructive sleep apnea. There's been growing awareness that obstructive sleep apnea is potential risk during pregnancy and is linked to gestational diabetes. Anytime I have a woman who tells me she's had gestational diabetes, I immediately want to check her metabolic status and I inquire about her sleeping habits, snoring, and even if she does not have any symptoms or anything that tips me off to sleep apnea, I tell her that she is at definite increased risk for sleep apnea. So there's some questionnaires, increased risk for sleep apnea. So there's some questionnaires, some mnemonics that we physicians remember. Stop bang to ask women, you know, if they're snoring, if they're having trouble waking up, if they're fatigued, if they're having weight gain, if their partner's complaining about their sleep behavior. So in the third trimester, when women have gained the most weight expected, moms need to become extremely vigilant for any poor sleep quality, fatigue or snoring or any daytime somnolence to advocate for screening.
Speaker 1:Now there are some supplements like berberine and alpha lipoic acid, ala, that are natural compounds that may help manage insulin resistance. Berberine is derived from plants like golden seal and it activates an enzyme that improves glucose tolerance and reduces weight in insulin resistant and diabetic individuals. Clinical trials reveal berberine significantly lowers blood sugar, hemoglobin, a1c, triglycerides, cholesterol, in those with type 2 diabetes. Simultaneously, the oxidant ALA, alpha lipoic acid, may help enhance insulin sensitivity while mitigating diabetic nerve damage by neutralizing that oxidative stress. In fact, for any woman with diabetes who has any kind of neuropathic symptoms, I definitely recommend that they consider taking alpha lipoic acid as a supplement. And I've had some women who are just starting to see their sugars go up and they're already exercising and doing intermittent fasting and reducing or stopping alcohol and they add alpha lipoic acid supplements and they notice that their numbers get right back to normal. Get right back to normal.
Speaker 1:And you can go on our Speaking Women's Health website and just put in alpha lipoic acid. We've got lots of information of it and list of foods and substances that help boost this and substances that help boost this. So, before you use any natural product or over-the-counter product just because it's not prescription, you need to talk to your physician about this, based on your other medicines, based on whether you're pregnant or breastfeeding, and there's a lot of things that we don't have a lot of good evidence in, and so if we don't have a lot of good evidence in, and so if we don't have information, it may be discouraged. So lifestyle adjustments, dietary changes and physical activity are definitely the cornerstones of gestational diabetes management but, like I said, insulin and metformin may need to be used to have a positive outcome for your hopeful, healthy, full-term infant. And the challenges of gestational diabetes were navigated by Dr Yogi Morin very successful through proactive self-care and compliance with her physician's guidance self-care and compliance with her physician's guidance and it resulted in a beautiful outcome for her and her baby, and she gave us a picture of the two of them right after birth, which is so delightful. If you go on our website, speakingwomenshealthcom, put in Dr Yogi Morin and or just gestational diabetes, and you can pull up that column in those beautiful pictures.
Speaker 1:So, with awareness and proactive care, the transition from gestational diabetes to type 2 diabetes does not have to happen. But you need knowledge and you need to be proactive and really focus on prevention. So thank you so much for joining me in the Sunflower House for another edition of our podcast. We're so grateful for your support and if you could share it with others, that would be fabulous. You can subscribe to the podcast anywhere you listen to podcasts. It's free on Apple Podcasts, spotify, tunein Podbean anywhere that you listen to podcasts in Podbean, anywhere that you listen to podcasts. So thanks again for listening and we'll see you next time in the Sunflower House. Be strong, be healthy and be in charge.
