2025-07-26

Post Time: 2025-07-26

Gestational diabetes (GDM) is a condition that develops during pregnancy, characterized by high blood sugar levels. It affects about 2-10% of pregnancies, posing risks to both the mother and the baby. Effective management of GDM is critical, and continuous monitoring plays a pivotal role in achieving this goal. Unlike traditional methods that rely on infrequent blood glucose checks, continuous monitoring offers a real-time view of blood sugar fluctuations. This detailed insight allows for more precise adjustments to diet, exercise, and medication, ultimately leading to better pregnancy outcomes. This is not just about avoiding short-term problems; effective GDM management, guided by continuous data, can have long-lasting benefits for the health of both the mother and the child. The real-time nature of this method provides the flexibility needed to manage this condition.

Why Continuous Monitoring is Critical:

Reduces complications: Proper management decreases the risk of macrosomia (large birth weight), preeclampsia, and cesarean delivery.
Personalized treatment: Allows for tailored interventions based on individual glucose responses.
Improved fetal health: Keeps the baby’s blood sugar levels stable, reducing the risk of hypoglycemia at birth.

Aspect	Traditional Monitoring	Continuous Monitoring
Frequency	Infrequent blood glucose checks	Real-time, continuous data stream
Data	Snapshot view of glucose levels	Comprehensive view of fluctuations
Intervention	Delayed, based on retrospective analysis	Timely, immediate adjustments
Risk Management	Less precise, higher risk of complications	Highly precise, lower risk

Types of Continuous Glucose Monitoring (CGM) Systems for Pregnant Women

Continuous Glucose Monitoring (CGM) systems have revolutionized how we manage diabetes, and they are increasingly being used to manage gestational diabetes. There are several types of CGM systems, each with unique features. Primarily, they work by inserting a small sensor under the skin, which measures glucose levels in the interstitial fluid. This data is then transmitted to a receiver or a smartphone, allowing for easy, real-time tracking of blood sugar.

Key Types of CGM Systems:

Real-Time CGM (rt-CGM): These systems provide constant, real-time glucose readings. They send data to a receiver or a smartphone every few minutes, often with alerts for high or low glucose levels. They also usually give users predictive trend arrows, which help people predict where their glucose level is going and when they may need to take action. These are very beneficial during pregnancy when quick action may be critical to avoid adverse effects.
Intermittently Scanned CGM (isCGM): These systems measure glucose levels continuously, but users need to manually scan the sensor to view the data. They usually lack the real-time alarms provided by rt-CGM but offer a good amount of data. The data needs to be pulled manually, usually via an external receiver (or sometimes a smart device).

Features to Consider When Choosing a CGM:

Accuracy: How well the CGM reading matches traditional blood glucose meter readings.
Comfort: The size and design of the sensor for comfortable wear during pregnancy.
Ease of use: How user-friendly the device is, including app interface and data accessibility.
Data reporting: The types of reports generated by the CGM that can help with management and also be shared with a medical team.
Alarm system: The reliability of alerts for hypo- and hyperglycemic episodes.

Practical Implementation of CGM for Pregnant Women with GDM

Integrating CGM technology into the daily routine of a pregnant woman with GDM requires a structured approach. Here is a practical step-by-step guide:

Step 1: Consultation with a Healthcare Provider

Before starting any CGM system, a thorough consultation with an endocrinologist, obstetrician, or a certified diabetes educator is crucial. This consultation will help determine the best device, its settings and address specific needs for each patient.

Step 2: Device Training

Proper training on device application, sensor care, and how to interpret data is essential. Patients must understand how to manage calibration, when to change the sensor, and how to use the accompanying app. This often takes place within a provider's office, or a formal training course.

Step 3: Data Interpretation

Understanding the data is paramount.

Track glucose trends: Monitoring how glucose levels change after meals or physical activity is important for effective management.
Adjust meal plans: Modify diet based on data received, working closely with a registered dietician. For example, a spike after eating specific foods means it should be avoided during pregnancy.
Manage physical activity: Determine the optimal timing and type of exercise to regulate glucose levels. There are some ideal times to do light exercise, such as directly after meals.

Step 4: Real-time Monitoring and Response

React to alerts: When hypo- or hyperglycemic alerts are triggered, respond promptly according to medical advice, which may include having a snack or drinking fluids.
Maintain data logs: Keeping a journal of activity and diet along with the CGM data can help healthcare providers tailor advice to individual patient needs.
Communicate Regularly: Regular appointments with healthcare providers to review data trends and adjust treatment plans. The frequency of these appointments might depend on the severity of diabetes and the provider’s recommendations.

Example Data Interpretation and Response:

Time	Activity	Glucose Level (mg/dL)	Interpretation	Action
8:00 AM	Breakfast	115	Within acceptable range post-meal	Continue monitoring.
10:00 AM	Moderate walking	90	Expected decrease after exercise	None necessary.
1:00 PM	Lunch	160	Slightly elevated after lunch, exceeding target levels	Review lunch and potentially reduce carb portions next time.
3:00 PM	Snack	130	Slightly elevated post-snack	None necessary, continue tracking.
6:00 PM	Dinner	100	Stable readings in response to the evening meal.	None necessary.
10:00 PM	Rest/Relaxation	85	Within normal range before bedtime	None necessary.

The Benefits and Potential Challenges of CGM in GDM

The adoption of continuous glucose monitoring in managing gestational diabetes brings significant advantages, but it’s important to acknowledge the potential challenges. Understanding both aspects is key to maximizing the benefits of this technology.

Benefits of CGM in Gestational Diabetes:

Improved Glycemic Control: The continuous data helps in better management of blood glucose levels, reducing hyperglycemic and hypoglycemic episodes. A recent study in the Journal of the American Medical Association (JAMA) found that women who used CGM during pregnancy had a reduced rate of neonatal hypoglycemia compared to those on traditional monitoring, 1.2% vs. 4.2%, respectively (JAMA, 2020).
Reduced Risk of Complications: Better glycemic control can lower the incidence of macrosomia, shoulder dystocia, and preeclampsia, leading to healthier outcomes for both the mother and the child. A separate publication in the New England Journal of Medicine found similar results relating to rates of macrosomia using CGM technology compared to traditional methods (NEJM, 2021).
Personalized Therapy: The real-time data enables healthcare providers to personalize treatment plans. This can lead to better adherence and better results overall.
Empowerment of Patients: With more direct insights, patients become active participants in their care, promoting self-management and understanding of the impact of lifestyle choices.
Reduced Fear and Anxiety: The continuous tracking system often provides patients with the security that the GDM is well managed, so anxiety rates go down.

Challenges of CGM in Gestational Diabetes:

Initial Cost: CGM systems and supplies can be expensive, and their costs may not be fully covered by all insurance providers, thus creating an impediment for lower-income patients to get access.
Training and Education: Proper use requires education, which is time and resource-intensive, including learning how to maintain the sensor properly, avoid contamination or other malfunctions, and what actions to take in response to different readouts.
Data Overload: It may be overwhelming to some patients to deal with large amounts of glucose data, especially without guidance from a trained healthcare professional. Patients may not fully understand the numbers or the trends and need specific guidance, which can be difficult for a doctor to fully provide during short follow-up appointments.
Sensor Issues: Occasional sensor malfunctions or skin irritations at the insertion site can occur. These are rare but still need to be considered when prescribing to a patient.
Adherence Challenges: Some patients may find continuous tracking cumbersome or difficult to maintain as a daily habit. This is especially true during pregnancy when discomfort or exhaustion is more likely.
Interference: Rare instances of sensor read-out errors exist when patients are exposed to MRI scans or similar high-frequency testing environments. It’s important that patients tell their healthcare providers of CGM usage before such imaging.

By addressing these challenges with appropriate training and support, the potential benefits of continuous monitoring in gestational diabetes far outweigh the risks, leading to improved pregnancy outcomes and a better quality of life for mothers and their babies.

Episode #154 In this Fasting Q&A episode, hosted by Coach Lisa Chance, Dr. Jason Fung answers questions from the TFM Community: 1. If someone is glucose sensitive, not insulin resistant, with an A1C of under 5.0, would they still have a dawn effect happen? If they did, what would the dawn effect bump in glucose possibly be? [02:12] 2. I have a smart scale. In addition to weight, it has metabolic rate, body fat %, etc. I am interested in knowing if the relative changes (as opposed to the absolute number) would be useful to know. Similarly, I am interested in reducing visceral fat. If that number goes down by 10%, might that be a helpful indicator about the direction that things are going in and whether what I am doing is working? [05:56] 3. What’s your take on kombucha? [09:35] 4. I read a book named “The One Minute Cure: The Secret to Healing Virtually All Diseases.” It is a therapy with H2O2 in Food Grade of 35% or 3% (diluted in Distilled Water). I have tried this therapy and every time I test my blood sugar after 30 minutes of taking it, it lowers my blood sugar by more than 17 mg/dL. I was wondering if you have studied this therapy and what you think about it? [11:32] 5. I find it easier to fast during work. However, I have a stressful job with long hours. Could cortisol/high stress be negating the benefits of the fast? Would I be better off using TRE and save fasting for my off days? [13:08] 6. This month’s TFM Group Challenge is ‘Giving Up Your Vices’. Megan’s first video discussed A2 dairy. What is your take on this and what is the appropriate amount of A2 dairy each day? I know Coach Nadia says ‘sparingly’, but it’s not clear what that means when it comes to sheep/goat/A2 dairy. Does it matter what kind of dairy it is if it’s still all insulinogenic? [15:13] 7. I’ve tried many different forms of salt and even tried making my own salt capsules, yet, 112 blood sugar before eating without fail, I end up feeling nauseous shortly after taking it. Is there anything else I can do to quell the nausea? Do some people just not need salt or have a medical reason why salt makes them nauseous? Is there anything else I can try? [19:06] 8. How high should a [blood sugar] spike be after meals, and when should your blood sugar levels return to the pre-meal range? [21:46] 9. How do I know when I’m fat-adapted?[23:37] 10. If someone has high triglycerides, is it a pretty good guess that they also have non-alcoholic fatty liver disease? [26:07] 11. Do you have any tips on how I can do intermittent fasting without osing weight? My goal is to lower my A1C and be less dependent on medication while improving my health. [28:02] 12. I am a lifetime vegetarian and have always eaten very clean, whole foods. I have been fasting since 1979 and I easily fast for weeks, change up the fasting protocol, etc, but the pounds just will not budge. How can I use fasting to drop this weight? [30:39] Please note that you need to be a member of the TFM Community to submit questions to the Q&A webinars with Dr. Fung but you can submit questions to our regular Q&A episodes here: Transcripts of all episodes are available at www.thefastingmethod.com on the Podcast page. Learn More About blood sugar of 125 Our Community: Join our FREE Facebook Group: Watch Us On YouTube: Follow Us on Instagram: pain free blood sugar monitor @fastingmethod This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. You should always speak with your physician or other healthcare professional before doing any fasting, changing your diet, taking or adjusting any medication or supplements, or adopting any treatment for a health problem. The use of any other products or services purchased by you as a result of this podcast does not create a healthcare provider-patient relationship between you and any of the experts affiliated with this podcast. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.

Fasting Q&A With Dr Jason Fung: The Dawn Effect, Smart Scales, Kombucha, Stress, Fat Adaptation [73fc89]