April 30, 2025 • 31 mins
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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Speaker 1 (00:05):
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, andI am glad to be back in the
Sunflower House for a newepisode.
For a new episode On thispodcast, I am going to be
(00:33):
talking about gestationaldiabetes and why is this
important?
You know you might not bepregnant.
Maybe you were pregnant, but itwas a long time ago but it's
very important that weunderstand how pregnancy can
reflect future health outcomesand if you've ever been pregnant
, you've probably heard ofgestational diabetes, but what
(00:53):
exactly?
It is what you should beconcerned about.
Dr Divya Yogi Moran wrote acolumn for us on
speakingofwomenshealthcom in2023.
No, actually 2024.
Yes, last year.
We're in 2025 now, and she wasalso in the Sunflower House last
(01:14):
year talking about the area shespecializes in in terms of
Cushing's disease and Cushing'ssyndrome, and she wrote that, as
a physician, she never expectedto receive a concerning call
from her obstetrician when shewas six months pregnant, but the
(01:36):
OB's office informed her thatshe failed.
Okay, this is someone whopasses all her tests, but she
failed her glucose screeningtest, indicating potential
gestational diabetes a prettyserious condition and, as an
endocrinologist who's got lotsof expertise in diabetes, she
(01:58):
knew that this was a problem, soshe scheduled a follow-up test
at her own office the next weekto confirm the diagnosis and,
despite her very athleticbackground and healthy lifestyle
, the test came back positivethat she has gestational
diabetes.
And she's not the only one who'shad gestational diabetes.
(02:22):
Some other women that I workwith very closely that are smart
physicians in fact, just two ofthem I can think off the top of
my head One having her firstbaby, very excited, in her 30s,
and another one in her early 30shaving her second baby.
Both came down with gestationaldiabetes, so I thought we got
(02:44):
to really focus on this.
So Dr Divya Yogi Moran wrotethat the news totally blindsided
her and she reviewed the riskfactors, and she knows that, of
course, this diagnosis puts her,as well as any other woman
diagnosed with gestationaldiabetes, at an increased
lifetime risk of developingdiabetes, and as an
(03:07):
endocrinologist she hadcounseled so many patients about
gestational diabetes, but allof a sudden she became the
patient pricking her finger tocheck her sugar five times a day
, and this very intimateexperience gave her new empathy
for her patient's challenges.
(03:28):
Now the other two physiciansthat I referred to that are in
my inner circle who alsorecently were diagnosed with
diabetes, got the little monitorthat you place on the arm that
constantly monitors blood sugar.
And then with your phone thereis an app, so the old pricking
(03:49):
of the finger doesn't alwayshave to be done, and that was
like an exciting advance in 2024.
And I even had a few patientswho didn't have diabetes who got
it just because they wantedthat biometric feedback.
I'm not recommending that.
But if you have diabetes, whogot it just because they wanted
that biometric feedback, I'm notrecommending that.
But if you have diabetes or areat risk of diabetes or
gestational diabetes, reallyknowing what your blood sugar is
(04:12):
and how you respond to food andexercise and medications is
very important.
So Dr Divya Yogi Moran sheworked really hard to control
her gestational diabetes throughmainly diet and exercise and
she said she was fortunate toavoid medication during
pregnancy.
But not everyone is fortunateto avoid medicines.
(04:34):
She found that counting carbsproved difficult because even a
natural food like an apple, itvaried in its carbohydrate
content based on the size andthe degree of ripeness of the
fruit.
Now, a big apple is about 300calories and that's one of the
most favorite things I say whenwomen complain about weight gain
in midlife is, I say, you onlyhave to eat a big apple, 300
(04:58):
calories a day, for about sixmonths to gain 25 to 30 pounds
and make a baby about six monthsto gain 25 to 30 pounds and
make a baby.
So she also found that, justbesides the size of foods and
the ripeness, that processedfoods were really bad for her
and spiked her blood sugar,regardless of how many carbs it
(05:19):
had.
And I really think that theseprocessed foods really are the
cause of so many problems.
Obesity rates are soaring,diabesity is soaring and even in
slender, thin, athletic womenlike I'm thinking of the three
physicians that I know recentlywho've dealt with this
(05:39):
gestational diabetes.
There's so many substances inour food supply that aren't
allowed in other countries andif you have not heard my column
on food freedom and banned foodsin other countries, that's a
(06:09):
good baby at 37 weeks.
The other physician developedsome other medical problems but
had a healthy baby boy a littlebit early, but the baby boy's
doing very well and the otherphysician's just about ready to
deliver.
So hopefully they stay healthybut that they realize, just like
(06:32):
any patient who's hadgestational diabetes, that they
really do need extra medicalmonitoring.
So Dr Divya Yogi Moran saidthat, given her family history
of diabetes, she was very muchforewarned about diabetes, and
so she researched preventivemeasures and she committed to
(06:52):
daily efforts to reduce her owndiabetes risk.
And she thought that, as anendocrinologist, she should
share her personal experiencewith patients, providing tips
and empathy that she gainedbeing a pregnant patient herself
, and she said it motivates herevery day to take preventive
action and to help others do thesame.
(07:14):
And isn't that our motto atSpeaking of Women's Health Be
strong, be healthy and be incharge.
And our website is full ofstories of women having to face
challenges and medical problemsand really committing themselves
to being empowered withknowledge and making changes to
stay healthy and stay strong and, in the end, always being in
(07:39):
charge of their own destiny.
And that really is the mottothat we all live speaking of
women's health, whether we're inthe Sunflower House or working
on the team or working in ourwonderful Center for Specialized
Women's Health.
The founder of Speaking ofWomen's Health and our chief
(08:00):
creative strategist, thefabulous Diane Dunkelman, lady
Di.
She outlined her own personalexperience with fatty liver and
her concern about cirrhosis andhow she totally turned that
around by educating herself,empowering herself and ridding
(08:20):
herself of the fatty liver.
And we are seeing so much fattyliver and metabolic disease in
the patients I see, and it'svery concerning because one in
six women with fatty liver willgo on to get cirrhosis.
And if you have insulinresistance or diabetes or a
history of gestational diabetes,you're a woman.
(08:41):
Even if you drink zero alcoholand don't have any hepatic
toxins, your fatty liver canprogress.
And with diet and intermittentfasting, maybe certain
supplements, some medicalinterventions, getting out all
the seed oils, the trans fats,eating heart, healthy fats,
(09:03):
getting the weight down,sometimes using metformin,
glucofage, which we've talkedabout on other podcasts, black
coffee, green tea also are verygood.
So if your liver functions areup a little bit or you get a
test result on ultrasound thatsays fatty liver, even if your
doctor's not concerned, youbetter be concerned and if your
(09:24):
sugar or triglycerides arecreeping up, you better take
action.
And if you did have gestationaldiabetes, you need to know that
that is a form of glucoseintolerance and it occurs when
the body's just simply unable tomake enough insulin in the
pancreas to compensate for theincreased natural insulin
(09:47):
resistance that naturally occursduring a pregnancy.
Now, for most women,gestational diabetes resolves
after delivery, but does confera higher risk of type 2 diabetes
.
Now one of the physicians thathad gestational diabetes.
Her sugars have still stayed updespite being thin and athletic
after her delivery, and so sheneeds more intensive medical
(10:11):
follow-up.
Dr Divya Yogi Moran went rightback to normal.
So one person's experience maynot be your experience, but it's
important to get close medicalfollow-up.
So you might ask well, what arethe risk factors for gestational
diabetes?
Well, you're more likely to getit if in a previous pregnancy
(10:34):
you had it, but it's not 100%,it's only 40%.
If you had any signs ofprediabetes or high blood sugar
before your pregnancy, that'sanother one.
If you've got any first degreerelatives with diabetes, if your
pre-pregnancy body mass indexis 30 plus, so that's definitely
(10:55):
not healthy and obese, unlessyou're incredibly muscular.
And so the body mass index hasa lot of problems.
It doesn't really measure bodyfat exactly.
Measuring your waist to hipratio, doing total body fat
analysis with a bonedensitometry machine, which we
(11:17):
can do, although insurance doesnot usually cover it there's
caliper test and submersion test, so there are some ways to find
out about your total body fatand visceral fat.
Now, if you're like a lot ofwomen who gain a lot of weight
early to mid adulthood andbetween pregnancies.
(11:37):
That's a problem If you're oneof the 10 plus percent of women
who have to deal with polycysticovary condition that's
associated with insulinresistance.
And if you haven't heard thepodcast that I did with the
fabulous Dr Ula Abed, anendocrinologist in our Center
for Specialized Women's Health.
I think I showed some of ourlisteners that she's an artist
(12:01):
and a photographer.
She's got some photographs onour website and she made this
most beautiful jewelry box forme with pearl, and every day I
open it up and I put my jewelryin 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
(12:24):
that dietary therapy she's donehas been more effective at
helping women with fertilitythan actually the standard
medical treatment.
So these innovative womenphysicians who really work so
hard to empower women and givethem options and be holistic we
love to feature in the SunflowerHouse and be holistic.
(12:49):
We love to feature in theSunflower House Now.
Other risks for gestationaldiabetes include, if you have a
Hispanic background, nativeAmerican, alaskan natives,
native Hawaiians, south Asiansor Pacific Islanders.
Also, I always ask women ifthey've ever had a baby over or
(13:09):
under nine pounds, because whenyou have a really big baby, that
is a concern about insulinresistance.
It's not always the case.
I have some women who are sixfoot two, married to six foot
six men, who have just bigbabies that are tall and big.
So we're all different and wehave to appreciate that.
(13:32):
But at eight pounds and eightounces that's how much Artemis,
my granddaughter, weighed.
So she was consideredmacrosomic for her gestational
age.
So that meant that theyconstantly kept checking her
blood sugar and kept prickingher 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.
(13:54):
So we always compare things toranges and that's what we do in
medicine.
Sometimes, following that, itgives you a baseline If you know
what your baseline is.
Of course, your baseline atbirth and your birth weight is
going to change as you grow, ofcourse.
(14:14):
But it is important to have thisbiometric data and I'm very
encouraged by so many of mypatients getting so much more
involved in their own health andwellness by really paying
attention to what they're eatingand what their numbers are and
things that they can do toenhance their health.
(14:35):
So you are listening to theSpeaking of Women's Health
podcast.
I'm in the Sunflower House, Iam your executive director of
Speaking of Women's Health andI'm the lead podcaster of this
fabulous podcast and we'retalking all things gestational
(14:57):
diabetes.
So you might ask how many womenare affected by gestational
diabetes.
Well, at least 16.5% of allpregnancies are affected by
gestational diabetes.
Well, at least 16.5% of allpregnancies are affected by
gestational diabetes andunfortunately these rates are
rising because of rising obesityand I also think that age as
(15:17):
well.
I know, with my own pregnanciesI was so happy to always pass my
glucose tolerance test and hadjust really the most super
results with my first pregnancytwo pregnancies or two
deliveries, because you knowthere were some miscarriages.
But with my last pregnancy,which I had my son Grayson and I
(15:41):
really wanted to make sure thatI didn't have any babies after
age 35.
I was just really strict that Iwanted childbearing complete.
So I conceived him just in timeto beat that age 35 mark I had
in my mind.
And my sugars were normal, butthey were completely in the
normal range, but still up justa little bit compared to what
(16:02):
the others were, and I'm surethat age plays a role and
nowadays so many women are justdelaying childbearing, which
does have some consequences.
There's more medicalcomplications.
The older you are, fertilityrates really decrease.
We've seen just really afalling out of the birth rates.
(16:26):
So if you've got younger womenin your life and you know that
someday they want to be a motherand that goes for men as well
they want to be a father, theywant to be parents.
There's really never a greattime.
People don't always have enoughtime or money and so it is
really a challenge.
But generally going throughpregnancy when you're younger is
(16:49):
easier and fraught with lessrisk, and I don't think we say
that enough to women.
There's so much attention onpreventing pregnancies and
building up a career andcertainly being a physician,
like these wonderful doctorsthat I'm talking about who were
(17:10):
dealing with gestationaldiabetes.
It's a very intensive training,but I have many physician
friends who had their childrenin medical school or early in
residency and it's never reallyan easy time, but they never,
ever have expressed to me thatthey regret becoming a mother at
a younger age.
(17:32):
So what you need to do is, ifyou have risk factors, you've
got to make sure you get yourscreening for gestational
diabetes, which is standard, andall women have to have healthy
diets and exercise, and stayinghealthy, at a healthy weight
after birth lowers your chanceof developing type 2 diabetes
(17:53):
later on, and I thinkbreastfeeding is one of the best
things to help you get back toyour weight.
It requires a lot of calories.
I remember our live-in au pairnanny looked at me and said my
goodness, you eat more now thanyou did when you're pregnant,
and she was so surprised and I'mlike well, that's because I'm
really eating for two a growingbaby and so that really helped
(18:19):
me snap back to my pre-pregnancyweight.
Now, not everyone canbreastfeed.
We've had great columns onbreastfeeding 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 Iwork with because we have
(18:40):
several that are new moms orrepeat babies, and we hear that
sound of that breast pump goingon a lot at lunchtime and break
times and I always joke, mygoodness, the sound of that
gives me PTSD.
So it is quite a commitment,but there's a lot of advantages
(19:05):
and when you're with your babyit's so simple and it's also
metabolically great for the mom.
Now, the way that gestationaldiabetes is diagnosed is that
your physician will usuallyrecommend doing blood testing
between 24 and 28 weeks ofgestation, and this crucial
(19:27):
screening does identify if youhave high blood sugars.
That can develop.
Two-hour glucose tolerance testusing a sweet drink that
contains glucose, and they checkyour blood level before you
drink it, an hour after and twohours after, and usually you
need to stay in the lab and havethis done.
At the two-step method.
You complete the one-hourscreen by drinking a sugary
(19:48):
solution and getting your bloodsugar tested, and if that's
elevated, then they make youcome in for a three-hour test to
confirm it.
So the exact testing approachcan vary based on your own
physician's practice, but thegoal is the same to catch
elevated blood sugars and tocontrol the sugar so that your
baby doesn't grow too big orthat you don't get preeclampsia,
(20:10):
hypertension, early delivery orother newborn complications, so
lowering your risk.
You need to make lifestylechanges if you haven't already.
So if you're planning apregnancy and you're not
pregnant yet, but you'reoverweight, it's really hard to
(20:31):
regulate your blood sugars ifyou have insulin resistance.
So even if you just shed a fewpounds before you conceive and
maintain a healthy weight gain.
That can help a lot.
Exercise, 30 minutes ofmoderate activity on most days
of the week walking, swimming,prenatal yoga classes we have so
(20:53):
much about yoga on our websiteand a podcast on that and
staying physically active doesimprove insulin sensitivity and
blood sugar control.
Of course, watching what youput in your mouth whole
unprocessed foods like fruitsand vegetables, whole
(21:21):
unprocessed foods like fruitsand vegetables, lean protein,
heart-healthy fats like oliveoil, nuts, fatty fish, whole
grains, and really you just needto say goodbye to sugary,
high-fat foods and things justloaded with gratuitous
carbohydrates that are simplesugars and a balanced,
low-glycemic diet supports theblood sugar for both mom and
baby.
If you smoke, please try toquit before getting pregnant.
Some women lose the desire tosmoke when they're pregnant, but
(21:45):
not all women and it's just somuch health benefits to just
avoiding using these nicotineproducts.
And if you can have hearthealthy habits even before
pregnancy and you can continueit after that busy time period
after giving birth, many timesbeing sleep deprived, having to
(22:05):
learn new skills and stillmanage your life, that can
really help.
Now, how is gestational diabetestreated?
Well, we talked about diet andblood sugar monitoring and
exercise, and sometimesmedications are needed.
Some women need to go oninsulin injections.
(22:26):
Others can take medicationslike metformin, glucofage, which
lowers blood sugar levels and,as we've talked about on prior
podcasts, has some anti-agingeffects.
So together, you and yourhealthcare team will find the
right combination and if youkeep your blood sugar in check,
you lower the risk of having toobig a baby.
(22:47):
An early delivery or aC-section birth, which has more
risk for both the mom and thebaby and is more expensive,
takes time to heal.
So generally we try to focus ona vaginal delivery when
possible.
So you might ask doesgestational diabetes
(23:07):
automatically lead to type 2diabetes?
Well, it is an indicator thatyou're prone to it and you're
more at risk, but the demands ofthe pregnancy simply unmask
this issue earlier than it wouldhave emerged had you not been
pregnant.
So for women who've hadgestational diabetes, they have
to pay close attention to whatis their blood sugar, what is
(23:28):
their lifestyle, what are theyeating?
Are they getting periodicscreenings for type 2 diabetes?
They eating?
Are they getting periodicscreenings for type 2 diabetes?
One thing that I pretty muchrecommend to most all of my
patients who are not growingchildren or who are not pregnant
is to significantly commit tointermittent fasting.
Not everyone can do this.
(23:50):
Some people's lifestyle,migraine, headaches you know
there are different reasons,everybody's individual, so I
work with all my patientsindividually.
But and again, this podcast isjust for general information to
empower you to be strong, behealthy and be in charge.
It is not official medicaladvice and that's why you need a
(24:10):
good relationship with your ownphysician and healthcare team.
But studies indicate thatintermittent fasting can many
times facilitate weight loss,enhance insulin sensitivity and
just improve focus,concentration and glycemic
control, and all of this doesreduce the risk of diabetes.
(24:30):
Now, very low carb dietscertainly have been an approach
to deal with blood sugar.
Now, very low carb dietscertainly have been an approach
to deal with blood sugar.
And there is no such thing asan essential carbohydrate, as
you've heard me say, where thereare essential proteins or amino
acids and essential fats.
Now, vitamin D.
(24:51):
My goodness, my third podcastwas everything vitamin D.
I talk about vitamin D everyday in my office Because,
whether you get it throughsunlight exposure, which is hard
to do in northern climates likeright now, dietary sources have
some vitamin D, but not as muchas that many people need, and
many times we do have to go tosupplements and it really does
(25:13):
help fortify againsthyperglycemia and type 2
diabetes.
Be aware of obstructive sleepapnea.
There's been growing awarenessthat obstructive sleep apnea is
potential risk during pregnancyand is linked to gestational
diabetes.
Anytime I have a woman whotells me she's had gestational
(25:35):
diabetes, I immediately want tocheck her metabolic status and I
inquire about her sleepinghabits, snoring, and even if she
does not have any symptoms oranything that tips me off to
sleep apnea, I tell her that sheis at definite increased risk
for sleep apnea.
So there's some questionnaires,increased risk for sleep apnea.
(25:57):
So there's some questionnaires,some mnemonics that we
physicians remember.
Stop bang to ask women, youknow, if they're snoring, if
they're having trouble waking up, if they're fatigued, if
they're having weight gain, iftheir partner's complaining
about their sleep behavior.
So in the third trimester, whenwomen have gained the most
(26:25):
weight expected, moms need tobecome extremely vigilant for
any poor sleep quality, fatigueor snoring or any daytime
somnolence to advocate forscreening.
Now there are some supplementslike berberine and alpha lipoic
acid, ala, that are naturalcompounds that may help manage
(26:47):
insulin resistance.
Berberine is derived fromplants like golden seal and it
activates an enzyme thatimproves glucose tolerance and
reduces weight in insulinresistant and diabetic
individuals.
Clinical trials revealberberine significantly lowers
blood sugar, hemoglobin, a1c,triglycerides, cholesterol, in
(27:09):
those with type 2 diabetes.
Simultaneously, the oxidant ALA, alpha lipoic acid, may help
enhance insulin sensitivitywhile mitigating diabetic nerve
damage by neutralizing thatoxidative stress.
In fact, for any woman withdiabetes who has any kind of
(27:29):
neuropathic symptoms, Idefinitely recommend that they
consider taking alpha lipoicacid as a supplement.
And I've had some women who arejust starting to see their
sugars go up and they're alreadyexercising and doing
intermittent fasting andreducing or stopping alcohol and
(27:53):
they add alpha lipoic acidsupplements and they notice that
their numbers get right back tonormal.
Get right back to normal.
And you can go on our SpeakingWomen's Health website and just
put in alpha lipoic acid.
We've got lots of informationof it and list of foods and
(28:18):
substances that help boost thisand substances that help boost
this.
So, before you use any naturalproduct or over-the-counter
product just because it's notprescription, you need to talk
to your physician about this,based on your other medicines,
based on whether you're pregnantor breastfeeding, and there's a
lot of things that we don'thave a lot of good evidence in,
(28:44):
and so if we don't have a lot ofgood evidence in, and so if we
don't have information, it maybe discouraged.
So lifestyle adjustments,dietary changes and physical
activity are definitely thecornerstones of gestational
diabetes management but, like Isaid, insulin and metformin may
need to be used to have apositive outcome for your
(29:07):
hopeful, healthy, full-terminfant.
And the challenges ofgestational diabetes were
navigated by Dr Yogi Morin verysuccessful through proactive
self-care and compliance withher physician's guidance
self-care and compliance withher physician's guidance and it
resulted in a beautiful outcomefor her and her baby, and she
(29:27):
gave us a picture of the two ofthem right after birth, which is
so delightful.
If you go on our website,speakingwomenshealthcom, put in
Dr Yogi Morin and or justgestational diabetes, and you
can pull up that column in thosebeautiful pictures.
So, with awareness and proactivecare, the transition from
(29:51):
gestational diabetes to type 2diabetes does not have to happen
.
But you need knowledge and youneed to be proactive and really
focus on prevention.
So thank you so much forjoining me in the Sunflower
(30:13):
House for another edition of ourpodcast.
We're so grateful for yoursupport and if you could share
it with others, that would befabulous.
You can subscribe to thepodcast anywhere you listen to
podcasts.
It's free on Apple Podcasts,spotify, tunein Podbean anywhere
(30:41):
that you listen to podcasts inPodbean, anywhere that you
listen to podcasts.
So thanks again for listeningand we'll see you next time in
the Sunflower House.
Be strong, be healthy and be incharge.
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, andI am glad to be back in the
Sunflower House for a newepisode.
For a new episode On thispodcast, I am going to be
(00:33):
talking about gestationaldiabetes and why is this
important?
You know you might not bepregnant.
Maybe you were pregnant, but itwas a long time ago but it's
very important that weunderstand how pregnancy can
reflect future health outcomesand if you've ever been pregnant
, you've probably heard ofgestational diabetes, but what
(00:53):
exactly?
It is what you should beconcerned about.
Dr Divya Yogi Moran wrote acolumn for us on
speakingofwomenshealthcom in2023.
No, actually 2024.
Yes, last year.
We're in 2025 now, and she wasalso in the Sunflower House last
(01:14):
year talking about the area shespecializes in in terms of
Cushing's disease and Cushing'ssyndrome, and she wrote that, as
a physician, she never expectedto receive a concerning call
from her obstetrician when shewas six months pregnant, but the
(01:36):
OB's office informed her thatshe failed.
Okay, this is someone whopasses all her tests, but she
failed her glucose screeningtest, indicating potential
gestational diabetes a prettyserious condition and, as an
endocrinologist who's got lotsof expertise in diabetes, she
(01:58):
knew that this was a problem, soshe scheduled a follow-up test
at her own office the next weekto confirm the diagnosis and,
despite her very athleticbackground and healthy lifestyle
, the test came back positivethat she has gestational
diabetes.
And she's not the only one who'shad gestational diabetes.
(02:22):
Some other women that I workwith very closely that are smart
physicians in fact, just two ofthem I can think off the top of
my head One having her firstbaby, very excited, in her 30s,
and another one in her early 30shaving her second baby.
Both came down with gestationaldiabetes, so I thought we got
(02:44):
to really focus on this.
So Dr Divya Yogi Moran wrotethat the news totally blindsided
her and she reviewed the riskfactors, and she knows that, of
course, this diagnosis puts her,as well as any other woman
diagnosed with gestationaldiabetes, at an increased
lifetime risk of developingdiabetes, and as an
(03:07):
endocrinologist she hadcounseled so many patients about
gestational diabetes, but allof a sudden she became the
patient pricking her finger tocheck her sugar five times a day
, and this very intimateexperience gave her new empathy
for her patient's challenges.
(03:28):
Now the other two physiciansthat I referred to that are in
my inner circle who alsorecently were diagnosed with
diabetes, got the little monitorthat you place on the arm that
constantly monitors blood sugar.
And then with your phone thereis an app, so the old pricking
(03:49):
of the finger doesn't alwayshave to be done, and that was
like an exciting advance in 2024.
And I even had a few patientswho didn't have diabetes who got
it just because they wantedthat biometric feedback.
I'm not recommending that.
But if you have diabetes, whogot it just because they wanted
that biometric feedback, I'm notrecommending that.
But if you have diabetes or areat risk of diabetes or
gestational diabetes, reallyknowing what your blood sugar is
(04:12):
and how you respond to food andexercise and medications is
very important.
So Dr Divya Yogi Moran sheworked really hard to control
her gestational diabetes throughmainly diet and exercise and
she said she was fortunate toavoid medication during
pregnancy.
But not everyone is fortunateto avoid medicines.
(04:34):
She found that counting carbsproved difficult because even a
natural food like an apple, itvaried in its carbohydrate
content based on the size andthe degree of ripeness of the
fruit.
Now, a big apple is about 300calories and that's one of the
most favorite things I say whenwomen complain about weight gain
in midlife is, I say, you onlyhave to eat a big apple, 300
(04:58):
calories a day, for about sixmonths to gain 25 to 30 pounds
and make a baby about six monthsto gain 25 to 30 pounds and
make a baby.
So she also found that, justbesides the size of foods and
the ripeness, that processedfoods were really bad for her
and spiked her blood sugar,regardless of how many carbs it
(05:19):
had.
And I really think that theseprocessed foods really are the
cause of so many problems.
Obesity rates are soaring,diabesity is soaring and even in
slender, thin, athletic womenlike I'm thinking of the three
physicians that I know recentlywho've dealt with this
(05:39):
gestational diabetes.
There's so many substances inour food supply that aren't
allowed in other countries andif you have not heard my column
on food freedom and banned foodsin other countries, that's a
(06:09):
good baby at 37 weeks.
The other physician developedsome other medical problems but
had a healthy baby boy a littlebit early, but the baby boy's
doing very well and the otherphysician's just about ready to
deliver.
So hopefully they stay healthybut that they realize, just like
(06:32):
any patient who's hadgestational diabetes, that they
really do need extra medicalmonitoring.
So Dr Divya Yogi Moran saidthat, given her family history
of diabetes, she was very muchforewarned about diabetes, and
so she researched preventivemeasures and she committed to
(06:52):
daily efforts to reduce her owndiabetes risk.
And she thought that, as anendocrinologist, she should
share her personal experiencewith patients, providing tips
and empathy that she gainedbeing a pregnant patient herself
, and she said it motivates herevery day to take preventive
action and to help others do thesame.
(07:14):
And isn't that our motto atSpeaking of Women's Health Be
strong, be healthy and be incharge.
And our website is full ofstories of women having to face
challenges and medical problemsand really committing themselves
to being empowered withknowledge and making changes to
stay healthy and stay strong and, in the end, always being in
(07:39):
charge of their own destiny.
And that really is the mottothat we all live speaking of
women's health, whether we're inthe Sunflower House or working
on the team or working in ourwonderful Center for Specialized
Women's Health.
The founder of Speaking ofWomen's Health and our chief
(08:00):
creative strategist, thefabulous Diane Dunkelman, lady
Di.
She outlined her own personalexperience with fatty liver and
her concern about cirrhosis andhow she totally turned that
around by educating herself,empowering herself and ridding
(08:20):
herself of the fatty liver.
And we are seeing so much fattyliver and metabolic disease in
the patients I see, and it'svery concerning because one in
six women with fatty liver willgo on to get cirrhosis.
And if you have insulinresistance or diabetes or a
history of gestational diabetes,you're a woman.
(08:41):
Even if you drink zero alcoholand don't have any hepatic
toxins, your fatty liver canprogress.
And with diet and intermittentfasting, maybe certain
supplements, some medicalinterventions, getting out all
the seed oils, the trans fats,eating heart, healthy fats,
(09:03):
getting the weight down,sometimes using metformin,
glucofage, which we've talkedabout on other podcasts, black
coffee, green tea also are verygood.
So if your liver functions areup a little bit or you get a
test result on ultrasound thatsays fatty liver, even if your
doctor's not concerned, youbetter be concerned and if your
(09:24):
sugar or triglycerides arecreeping up, you better take
action.
And if you did have gestationaldiabetes, you need to know that
that is a form of glucoseintolerance and it occurs when
the body's just simply unable tomake enough insulin in the
pancreas to compensate for theincreased natural insulin
(09:47):
resistance that naturally occursduring a pregnancy.
Now, for most women,gestational diabetes resolves
after delivery, but does confera higher risk of type 2 diabetes
.
Now one of the physicians thathad gestational diabetes.
Her sugars have still stayed updespite being thin and athletic
after her delivery, and so sheneeds more intensive medical
(10:11):
follow-up.
Dr Divya Yogi Moran went rightback to normal.
So one person's experience maynot be your experience, but it's
important to get close medicalfollow-up.
So you might ask well, what arethe risk factors for gestational
diabetes?
Well, you're more likely to getit if in a previous pregnancy
(10:34):
you had it, but it's not 100%,it's only 40%.
If you had any signs ofprediabetes or high blood sugar
before your pregnancy, that'sanother one.
If you've got any first degreerelatives with diabetes, if your
pre-pregnancy body mass indexis 30 plus, so that's definitely
(10:55):
not healthy and obese, unlessyou're incredibly muscular.
And so the body mass index hasa lot of problems.
It doesn't really measure bodyfat exactly.
Measuring your waist to hipratio, doing total body fat
analysis with a bonedensitometry machine, which we
(11:17):
can do, although insurance doesnot usually cover it there's
caliper test and submersion test, so there are some ways to find
out about your total body fatand visceral fat.
Now, if you're like a lot ofwomen who gain a lot of weight
early to mid adulthood andbetween pregnancies.
(11:37):
That's a problem If you're oneof the 10 plus percent of women
who have to deal with polycysticovary condition that's
associated with insulinresistance.
And if you haven't heard thepodcast that I did with the
fabulous Dr Ula Abed, anendocrinologist in our Center
for Specialized Women's Health.
I think I showed some of ourlisteners that she's an artist
(12:01):
and a photographer.
She's got some photographs onour website and she made this
most beautiful jewelry box forme with pearl, and every day I
open it up and I put my jewelryin 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
(12:24):
that dietary therapy she's donehas been more effective at
helping women with fertilitythan actually the standard
medical treatment.
So these innovative womenphysicians who really work so
hard to empower women and givethem options and be holistic we
love to feature in the SunflowerHouse and be holistic.
(12:49):
We love to feature in theSunflower House Now.
Other risks for gestationaldiabetes include, if you have a
Hispanic background, nativeAmerican, alaskan natives,
native Hawaiians, south Asiansor Pacific Islanders.
Also, I always ask women ifthey've ever had a baby over or
(13:09):
under nine pounds, because whenyou have a really big baby, that
is a concern about insulinresistance.
It's not always the case.
I have some women who are sixfoot two, married to six foot
six men, who have just bigbabies that are tall and big.
So we're all different and wehave to appreciate that.
(13:32):
But at eight pounds and eightounces that's how much Artemis,
my granddaughter, weighed.
So she was consideredmacrosomic for her gestational
age.
So that meant that theyconstantly kept checking her
blood sugar and kept prickingher 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.
(13:54):
So we always compare things toranges and that's what we do in
medicine.
Sometimes, following that, itgives you a baseline If you know
what your baseline is.
Of course, your baseline atbirth and your birth weight is
going to change as you grow, ofcourse.
(14:14):
But it is important to have thisbiometric data and I'm very
encouraged by so many of mypatients getting so much more
involved in their own health andwellness by really paying
attention to what they're eatingand what their numbers are and
things that they can do toenhance their health.
(14:35):
So you are listening to theSpeaking of Women's Health
podcast.
I'm in the Sunflower House, Iam your executive director of
Speaking of Women's Health andI'm the lead podcaster of this
fabulous podcast and we'retalking all things gestational
(14:57):
diabetes.
So you might ask how many womenare affected by gestational
diabetes.
Well, at least 16.5% of allpregnancies are affected by
gestational diabetes.
Well, at least 16.5% of allpregnancies are affected by
gestational diabetes andunfortunately these rates are
rising because of rising obesityand I also think that age as
(15:17):
well.
I know, with my own pregnanciesI was so happy to always pass my
glucose tolerance test and hadjust really the most super
results with my first pregnancytwo pregnancies or two
deliveries, because you knowthere were some miscarriages.
But with my last pregnancy,which I had my son Grayson and I
(15:41):
really wanted to make sure thatI didn't have any babies after
age 35.
I was just really strict that Iwanted childbearing complete.
So I conceived him just in timeto beat that age 35 mark I had
in my mind.
And my sugars were normal, butthey were completely in the
normal range, but still up justa little bit compared to what
(16:02):
the others were, and I'm surethat age plays a role and
nowadays so many women are justdelaying childbearing, which
does have some consequences.
There's more medicalcomplications.
The older you are, fertilityrates really decrease.
We've seen just really afalling out of the birth rates.
(16:26):
So if you've got younger womenin your life and you know that
someday they want to be a motherand that goes for men as well
they want to be a father, theywant to be parents.
There's really never a greattime.
People don't always have enoughtime or money and so it is
really a challenge.
But generally going throughpregnancy when you're younger is
(16:49):
easier and fraught with lessrisk, and I don't think we say
that enough to women.
There's so much attention onpreventing pregnancies and
building up a career andcertainly being a physician,
like these wonderful doctorsthat I'm talking about who were
(17:10):
dealing with gestationaldiabetes.
It's a very intensive training,but I have many physician
friends who had their childrenin medical school or early in
residency and it's never reallyan easy time, but they never,
ever have expressed to me thatthey regret becoming a mother at
a younger age.
(17:32):
So what you need to do is, ifyou have risk factors, you've
got to make sure you get yourscreening for gestational
diabetes, which is standard, andall women have to have healthy
diets and exercise, and stayinghealthy, at a healthy weight
after birth lowers your chanceof developing type 2 diabetes
(17:53):
later on, and I thinkbreastfeeding is one of the best
things to help you get back toyour weight.
It requires a lot of calories.
I remember our live-in au pairnanny looked at me and said my
goodness, you eat more now thanyou did when you're pregnant,
and she was so surprised and I'mlike well, that's because I'm
really eating for two a growingbaby and so that really helped
(18:19):
me snap back to my pre-pregnancyweight.
Now, not everyone canbreastfeed.
We've had great columns onbreastfeeding 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 Iwork with because we have
(18:40):
several that are new moms orrepeat babies, and we hear that
sound of that breast pump goingon a lot at lunchtime and break
times and I always joke, mygoodness, the sound of that
gives me PTSD.
So it is quite a commitment,but there's a lot of advantages
(19:05):
and when you're with your babyit's so simple and it's also
metabolically great for the mom.
Now, the way that gestationaldiabetes is diagnosed is that
your physician will usuallyrecommend doing blood testing
between 24 and 28 weeks ofgestation, and this crucial
(19:27):
screening does identify if youhave high blood sugars.
That can develop.
Two-hour glucose tolerance testusing a sweet drink that
contains glucose, and they checkyour blood level before you
drink it, an hour after and twohours after, and usually you
need to stay in the lab and havethis done.
At the two-step method.
You complete the one-hourscreen by drinking a sugary
(19:48):
solution and getting your bloodsugar tested, and if that's
elevated, then they make youcome in for a three-hour test to
confirm it.
So the exact testing approachcan vary based on your own
physician's practice, but thegoal is the same to catch
elevated blood sugars and tocontrol the sugar so that your
baby doesn't grow too big orthat you don't get preeclampsia,
(20:10):
hypertension, early delivery orother newborn complications, so
lowering your risk.
You need to make lifestylechanges if you haven't already.
So if you're planning apregnancy and you're not
pregnant yet, but you'reoverweight, it's really hard to
(20:31):
regulate your blood sugars ifyou have insulin resistance.
So even if you just shed a fewpounds before you conceive and
maintain a healthy weight gain.
That can help a lot.
Exercise, 30 minutes ofmoderate activity on most days
of the week walking, swimming,prenatal yoga classes we have so
(20:53):
much about yoga on our websiteand a podcast on that and
staying physically active doesimprove insulin sensitivity and
blood sugar control.
Of course, watching what youput in your mouth whole
unprocessed foods like fruitsand vegetables, whole
(21:21):
unprocessed foods like fruitsand vegetables, lean protein,
heart-healthy fats like oliveoil, nuts, fatty fish, whole
grains, and really you just needto say goodbye to sugary,
high-fat foods and things justloaded with gratuitous
carbohydrates that are simplesugars and a balanced,
low-glycemic diet supports theblood sugar for both mom and
baby.
If you smoke, please try toquit before getting pregnant.
Some women lose the desire tosmoke when they're pregnant, but
(21:45):
not all women and it's just somuch health benefits to just
avoiding using these nicotineproducts.
And if you can have hearthealthy habits even before
pregnancy and you can continueit after that busy time period
after giving birth, many timesbeing sleep deprived, having to
(22:05):
learn new skills and stillmanage your life, that can
really help.
Now, how is gestational diabetestreated?
Well, we talked about diet andblood sugar monitoring and
exercise, and sometimesmedications are needed.
Some women need to go oninsulin injections.
(22:26):
Others can take medicationslike metformin, glucofage, which
lowers blood sugar levels and,as we've talked about on prior
podcasts, has some anti-agingeffects.
So together, you and yourhealthcare team will find the
right combination and if youkeep your blood sugar in check,
you lower the risk of having toobig a baby.
(22:47):
An early delivery or aC-section birth, which has more
risk for both the mom and thebaby and is more expensive,
takes time to heal.
So generally we try to focus ona vaginal delivery when
possible.
So you might ask doesgestational diabetes
(23:07):
automatically lead to type 2diabetes?
Well, it is an indicator thatyou're prone to it and you're
more at risk, but the demands ofthe pregnancy simply unmask
this issue earlier than it wouldhave emerged had you not been
pregnant.
So for women who've hadgestational diabetes, they have
to pay close attention to whatis their blood sugar, what is
(23:28):
their lifestyle, what are theyeating?
Are they getting periodicscreenings for type 2 diabetes?
They eating?
Are they getting periodicscreenings for type 2 diabetes?
One thing that I pretty muchrecommend to most all of my
patients who are not growingchildren or who are not pregnant
is to significantly commit tointermittent fasting.
Not everyone can do this.
(23:50):
Some people's lifestyle,migraine, headaches you know
there are different reasons,everybody's individual, so I
work with all my patientsindividually.
But and again, this podcast isjust for general information to
empower you to be strong, behealthy and be in charge.
It is not official medicaladvice and that's why you need a
(24:10):
good relationship with your ownphysician and healthcare team.
But studies indicate thatintermittent fasting can many
times facilitate weight loss,enhance insulin sensitivity and
just improve focus,concentration and glycemic
control, and all of this doesreduce the risk of diabetes.
(24:30):
Now, very low carb dietscertainly have been an approach
to deal with blood sugar.
Now, very low carb dietscertainly have been an approach
to deal with blood sugar.
And there is no such thing asan essential carbohydrate, as
you've heard me say, where thereare essential proteins or amino
acids and essential fats.
Now, vitamin D.
(24:51):
My goodness, my third podcastwas everything vitamin D.
I talk about vitamin D everyday in my office Because,
whether you get it throughsunlight exposure, which is hard
to do in northern climates likeright now, dietary sources have
some vitamin D, but not as muchas that many people need, and
many times we do have to go tosupplements and it really does
(25:13):
help fortify againsthyperglycemia and type 2
diabetes.
Be aware of obstructive sleepapnea.
There's been growing awarenessthat obstructive sleep apnea is
potential risk during pregnancyand is linked to gestational
diabetes.
Anytime I have a woman whotells me she's had gestational
(25:35):
diabetes, I immediately want tocheck her metabolic status and I
inquire about her sleepinghabits, snoring, and even if she
does not have any symptoms oranything that tips me off to
sleep apnea, I tell her that sheis at definite increased risk
for sleep apnea.
So there's some questionnaires,increased risk for sleep apnea.
(25:57):
So there's some questionnaires,some mnemonics that we
physicians remember.
Stop bang to ask women, youknow, if they're snoring, if
they're having trouble waking up, if they're fatigued, if
they're having weight gain, iftheir partner's complaining
about their sleep behavior.
So in the third trimester, whenwomen have gained the most
(26:25):
weight expected, moms need tobecome extremely vigilant for
any poor sleep quality, fatigueor snoring or any daytime
somnolence to advocate forscreening.
Now there are some supplementslike berberine and alpha lipoic
acid, ala, that are naturalcompounds that may help manage
(26:47):
insulin resistance.
Berberine is derived fromplants like golden seal and it
activates an enzyme thatimproves glucose tolerance and
reduces weight in insulinresistant and diabetic
individuals.
Clinical trials revealberberine significantly lowers
blood sugar, hemoglobin, a1c,triglycerides, cholesterol, in
(27:09):
those with type 2 diabetes.
Simultaneously, the oxidant ALA, alpha lipoic acid, may help
enhance insulin sensitivitywhile mitigating diabetic nerve
damage by neutralizing thatoxidative stress.
In fact, for any woman withdiabetes who has any kind of
(27:29):
neuropathic symptoms, Idefinitely recommend that they
consider taking alpha lipoicacid as a supplement.
And I've had some women who arejust starting to see their
sugars go up and they're alreadyexercising and doing
intermittent fasting andreducing or stopping alcohol and
(27:53):
they add alpha lipoic acidsupplements and they notice that
their numbers get right back tonormal.
Get right back to normal.
And you can go on our SpeakingWomen's Health website and just
put in alpha lipoic acid.
We've got lots of informationof it and list of foods and
(28:18):
substances that help boost thisand substances that help boost
this.
So, before you use any naturalproduct or over-the-counter
product just because it's notprescription, you need to talk
to your physician about this,based on your other medicines,
based on whether you're pregnantor breastfeeding, and there's a
lot of things that we don'thave a lot of good evidence in,
(28:44):
and so if we don't have a lot ofgood evidence in, and so if we
don't have information, it maybe discouraged.
So lifestyle adjustments,dietary changes and physical
activity are definitely thecornerstones of gestational
diabetes management but, like Isaid, insulin and metformin may
need to be used to have apositive outcome for your
(29:07):
hopeful, healthy, full-terminfant.
And the challenges ofgestational diabetes were
navigated by Dr Yogi Morin verysuccessful through proactive
self-care and compliance withher physician's guidance
self-care and compliance withher physician's guidance and it
resulted in a beautiful outcomefor her and her baby, and she
(29:27):
gave us a picture of the two ofthem right after birth, which is
so delightful.
If you go on our website,speakingwomenshealthcom, put in
Dr Yogi Morin and or justgestational diabetes, and you
can pull up that column in thosebeautiful pictures.
So, with awareness and proactivecare, the transition from
(29:51):
gestational diabetes to type 2diabetes does not have to happen
.
But you need knowledge and youneed to be proactive and really
focus on prevention.
So thank you so much forjoining me in the Sunflower
(30:13):
House for another edition of ourpodcast.
We're so grateful for yoursupport and if you could share
it with others, that would befabulous.
You can subscribe to thepodcast anywhere you listen to
podcasts.
It's free on Apple Podcasts,spotify, tunein Podbean anywhere
(30:41):
that you listen to podcasts inPodbean, anywhere that you
listen to podcasts.
So thanks again for listeningand we'll see you next time in
the Sunflower House.
Be strong, be healthy and be incharge.
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