Like other forms of diabetes, gestational diabetes is a condition that develops gradually and is diagnosed when higher than normal blood sugar levels occur in the body, not a good situation for mother or developing child. Like other routine screening tests performed at various times during pregnancy, the test for diabetes is often automatically performed at about week 26 of a pregnancy — although if there are known to be associated higher risk factors, the test would be made at a much earlier stage.

Glucose, the sugar in the blood, essential for the body’s cells
For everyone, the cells of our bodies need sugar, a source of fuel for the body’s cells that is required to perform their metabolic activities that sustain life. The simple form of sugar in the blood, called glucose, enters the bloodstream after the digestion of foods that are consumed throughout the day. It is the carbohydrate portion of the food items eaten that is the major source of the sugars.

An explanation of the process, common to all forms of diabetes
To describe what happens in non-scientific terms, it involves a multi-step process within the body. When glucose enters the bloodstream from the digestive tract after eating food, a signal is generated that prompts the release of a hormone called insulin, also into the blood stream, from the pancreas, an organ in the body.

The insulin then acts as an intermediary between the glucose and the receptors that are on the outside of the cells that need the glucose. The insulin facilitates the entry of glucose into those cells. In this way, insulin acts like a key that unlocks the door to the cells, allowing the glucose to enter. Without the insulin, or if the cells become resistant to the insulin, the glucose stays in the blood and continues to circulate.

In gestational diabetes
The gestational diabetes condition occurs when the system that normally allows the glucose in the blood to be absorbed by the cells, in the way described above, becomes impaired. The reason for this is not fully understood but it may be because of the production of hormones in the placenta that supplies nutrients to the fetus. It is thought that the placenta’s hormones interfere with the activities that allow insulin to aid the cells to absorb glucose from the blood and perhaps creating an insulin resistance by the cells of the body.

Treating gestational diabetes
The medical professionals are well versed in the management of the diabetic condition. As in most cases of diabetes, a first line of treatment is to adopt a suitable diabetic diet tailored to the nutritional needs of the pregnant mother and baby. A health-care dietitian is often available to consult with on this. Some form of exercise or physical activity may be recommended, another normal pillar of general diabetes treatment. There may also be prescription medications necessary, or perhaps the administration of insulin n a few cases. The good news is that the gestational diabetes condition usually disappears when the baby is born.

The gestational diabetes diet
The objective is to achieve normal blood sugar levels, or blood sugar levels that are as close to normal as possible throughout the day while providing a nutritious and balanced diet that meets the personal tastes and preferences of the mother-to-be. The diet will limit the foods that contribute the greatest amount of simple sugars that can too quickly be delivered to the bloodstream, foods such as the sweet and sugared cakes and pastries or the high sugar content “soft” drinks.

The frequency and timing of meals may be factor. The usual recommendation to all diabetics is to have three or four small meals each day with snacks in between in accordance with the instructions of the dietitian and the requirements of the diabetic meal plan.

In conclusion
The scientific knowledge and medical skills of the modern day world are available to the healthcare team that will monitor and manage the pregnancy, including any gestational diabetes that may occur. This will result in a successful pregnancy that ends with the happiest of experiences and the joy of the arrival of the new baby. The gestational diabetes usually then ends and it’s time to celebrate.

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Diabetes is a serious health condition that occurs when the naturally occurring glucose that is produced and enters a person’s bloodstream after eating a meal, remains at an elevated level beyond the range that is normal for a healthy individual. This is caused by the impaired ability to absorb the glucose into the body’s cells where it is needed as a primary source of energy.

New diagnosis and treatment procedures recommended
Following almost two years of investigation, a group of fifty international gestational diabetes experts have concluded that blood glucose levels, currently accepted as normal for pregnant women, pose increased risks of serious complications and they recommend the adoption of new diagnosis and treatment criteria.

The investigation was coordinated by the Northwestern University Feinberg School of Medicine using results obtained from the Hyperglycemia and Adverse Outcomes project involving 23,000 women from nine countries that began in 1999, funded by the National Institutes of Health (NIH), and from the results of a 2008 study led by Boyd Metzger, Professor of Metabolism and Nutrition at the Feinberg School of Medicine. Professor Metzger is the lead author of the report to be published in Diabetes Care.

Dr Metzger commented that the rate of gestational diabetes has soared by fifty percent in the last ten years, pointing out that all forms of diabetes are similarly being diagnosed in increasing numbers, at the same time as an increase in obesity in the general population.

It was also stated that blood sugar levels previously accepted as within the normal range are contributing to a sharp increase in overweight babies born with high insulin levels. Large babies may require early deliveries and more cesarean section. There is also the potentially life-threatening condition of preeclampsia in which the mother has high blood pressure presenting danger to the baby and herself.

While gestational diabetes ends with the birth, there remains an increased risk of developing a full type-2 diabetes at a later time and also an increased risk of cardiovascular disease.

With pregnancy comes new responsibilities and challenges. Among the most important for the newly expectant mother is the need to maintain a state of good health and appropriate weight gain, perhaps requiring a different approach to diet. Diabetes authorities forecast that one third of all babies now being born will become diabetic. Not a happy prospect for the future.

A more encouraging comment by Professor Metzger was that recent studies showed that for mild gestational diabetes when women adopted improved dietary choices and monitored their blood glucose levels, it resulted in greatly reduced risks of complications, with smaller and healthy babies requiring fewer cesarean deliveries.

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The aim of every diabetic

Normal blood sugar levels, meaning those that apply to anyone who does not have diabetes, are specified below, and levels relating to a person who does have diabetes are also cited. For many of us who are diabetic, to even get close to normal blood sugar levels would be an achievement, a triumph in fact, and for some just a dream.

Edit: This topic is now also covered in a new article (September 2010) with explanatory notes and blood sugar targets titled: Normal Blood Sugars and the HbA1c Blood Test, you may wish to check it out as well, after reading this.

Once diagnosed as having diabetes, becoming close to normal may be the best we can achieve, although many well known doctors specializing in the treatment of the disease insist it can be done, and even that the condition can be reversed with the right combination of exercise and diet, usually with the low carbohydrate content approach. But that’s a different topic that is worth discussing separately while we confine ourselves here to identifying normal blood sugar levels in the non-diabetic population and then perhaps compare them to our own.

Units of measure
The United States uses different units of measurement than does most of the rest of the world, Canada and the UK included, but converting to either system is simple. The U.S. uses milligrams per deciliter, shown as mg/dL. Dividing the U.S. values by 18 gives the value expressed in the other system of measurement, which is millimols per liter, written as mmol/L.

The range of normal levels for blood glucose
In checking many sources, I found that that there is a variation in the values considered by some as normal.  But in the main I can summarize the results, including those published by the American and Canadian Diabetes Associations as follows, and where fasting is usually meant as an overnight 8-hour period without food or liquids other than water. The American Association of Clinical Endocrinologists recommend somewhat lower numbers than those of the American Diabetes Association.

Fasting blood sugar levels measured after about 8 hours without food or drink other than water should be less than 108 mg/dL (6.0 mmol/L) but no lower than 72 mg/dL (4.0 mmol/L).

Two-hours after a meal blood sugar levels should be back to normal levels of 90 to 144 mg/dL (5.0 to 8.0 mmol/L)

Except for a two-hour period after a meal, my own healthcare providers inform me that the blood sugar levels should be less than 108 mg/dL (6.0 mmol/L) and they should always be above 72 mg/dl (4.0 mmol/L).
If you are a diabetic, you will probably not get them very often to below the 108 mg/dL level.

According to the American Diabetes Association, for a random test taken during the day they should be less than 140 mg/dL (7.8 mmol/L). That figure can be found in ADA references on normal blood sugars.

A1c – the 12 week period test
For a test that indicates the levels over a 12 week period, called the A1c, or Glycosylated hemoglobin test, the normal level is less than 6%. That is equal to an estimated average glucose level of less than 126 mg/dL (7 mmol/L)`

What that means is that less than 6% of the hemoglobin fraction in your blood has glucose attached to it. The hemoglobin content of blood, including water, is about 35% and it is hemoglobin that carries oxygen from the lungs to the rest of the body for use by the body’s cells.

For most diabetics, targets are:

Fasting levels before meals target is 70 to 130 mg/dL (4.0 to 7.0 mmol/L)

Two hours after eating target is 90 to 180 mg/dL (5.0 to 10.0 mmol/L)

A1c level target is to be at less than 7%, equal to an average estimated glucose level of 154 mg/dL (8.5 mmol/L)

Note: See at the end, variations of the above according to EASD results described below.

Making the blood test
The usual ways to measure blood glucose levels are either by using a small hand-held meter that measures a drop of blood by pricking the finger tip or, alternatively, through a clinical test, usually made after fasting overnight, in which a technician draws a small amount of blood from a vein into a vial that is then sent to a laboratory for analysis. Results from the two methods do differ to some degree but both provide the information required for the overnight fasting levels and the clinical test additionally provides values that indicate the glucose levels over the prior 12-week period. This test is called the glycosylated hemoglobin test, or A1c for short.

Blood glucose levels can vary in a non-diabetic adult depending on a person’s age. Children of various ages will differ in what is considered normal. Similarly pregnant women often have a higher level of glucose in their blood during pregnancy, but their target should be to stay as close to normal levels as possible to avoid the gestational form of diabetes.

According to the American Diabetes Association
After checking with national diabetes association sources of major countries, I found it somewhat difficult to pin down an exact figure to establish normal blood sugar levels and that is understandable. The American Diabetes Association’s information site states that the blood sugar levels change throughout the day and night and will vary depending on your food intake, what you’ve eaten, how much, and when, and whether you have exercised in the recent period of time.

The ADA (American Diabetes Association) gives a fasting level of less than 110 mg/dl (6.1 mmol/L) as being normal and from blood tests taken at random times throughout the day they state a normal blood glucose range is in the low to mid 100’s. I assume that to mean from 110 to 150 mg/dL (6.1 to 8.3 mmol/L)

But Results of European Study announced in 2006 differ from the ADA
I discovered a very good report dating from September of 2006 of a lecture given at the annual meeting of the EASD (European Association for Studies in Diabetes) in Copenhagen that offered much detailed research on the subject of normal blood sugars. Reference was made to a study in which glucose was monitored in a group of adults and the results were summarized in a lecture by Professor J.S. Christiansen, illustrated with slides. There was also a substantial amount of other information of interest to diabetics covered at the meeting.

One of the slides showed graphically how the range of normal blood sugar levels peaked between about 7:30 and 8:30 am for a group of 24 young and healthy and not overweight adults. That one hour period was the time when the participants were served breakfast. For the rest of the day, between 6 am and midnight the levels averaged out within a few points either above or below 80 to 85 mg/dl (4.4 to 4.7 mmol/L) with no peaks that could reveal when other meals had been eaten. That seems low and a long way from my own but these participants were in their prime in their early 20’s, that’s not me.

From the foregoing it seems there is a difference of opinion among authoritative voices regarding the adult non-diabetic normal blood glucose levels and my own thoughts are influenced by the results mentioned above from the EASD meeting.

Doing so leads me to conclude that normal blood sugars for most non-diabetic people are:

Under 100mg/dl (5.6.mmol/L) with a peak of 120 mg/dl (6.7 mmo/L) after a proper breakfast and a return to normal within 2 hours after any meal if there has been a spike.

Caution and just for the record
Please Note: I am not a doctor or health care professional and my conclusions are arrived at from an intelligent perusal of available published material of which there is an abundance in existence, some of it conflicting. After considering as many reports as possible I usually prefer to depend on the values quoted by the major diabetes associations, the ADA in the USA, the CDA in Canada, and the NIH in the UK. Those, together with the EASD’s opinions and research results, give me the most confidence in publishing the information here on my own blogsite.

But I must add that there are a few other sources that seem to make scientific sense and that I can believe in and they do not necessarily totally agree at all times with some of the associations I have mentioned above.

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Chemicals in the body that play an important
role in the regulation of blood glucose

Diabetics, or perhaps some of those newly diagnosed as diabetic, wonder why it is that their self monitored blood test readings can sometimes be higher than they were on their previous test reading taken a while earlier, even though they have not eaten anything in the interim. Similarly, higher readings might be the case in the early morning after an overnight fast since the last meal of the evening before. Logically, it might be assumed that with no food having been eaten and therefore no source of carbohydrates, the blood glucose levels would be lower not higher, but higher they may be, as the meter readings show.

In reality, the amount of glucose in the blood would have dropped to a lower level during the passing time since the latest meal. But when the blood glucose level gets too low, through being used up by the body’s cells, it would then generate a signal and cause the body itself to manufacture glucose from its own store of carbohydrates that have been accumulated in the body from previous occasions when there was an over-supply of glucose in the bloodstream. That is why the meter readings are higher, correctly, because the body has manufactured a supply of insulin without depending on the usual food source.

The regulators, insulin and glucagon

Among its many activities, the pancreas produces two hormones, insulin and glucagon. These are activated, in separate ways, in response to blood-glucose levels.

In a normal functioning system, the organs of the body, including the pancreas, liver, thyroid and pituitary glands, usually work together to achieve a constant blood-glucose balance in the blood stream. Just as when glucose becomes too low, when glucose begins to reach too high a level in the blood, insulin is released and works to get the glucose from the blood into the cells of the body’s organs where it becomes the fuel needed by the cell to produce energy to support its multitude of chemical activities to keep the body functioning.

Glycogen, a major form of carbohydrate storage,
is converted to glucose when needed

When there is a surplus of glucose in the blood, beyond the needs of the cells, the body stores the glucose in the liver, fat cells, and in muscles, by converting it to Glycogen, a more complex form of glucose.

On the other hand, when the level of glucose in the blood becomes sufficiently lowered through the lack of food intake or overnight fasting, the pancreas is signaled to produce the hormone glucagon and, working in the opposite fashion to that of insulin, it stimulates the liver and muscles to break down their previously stored glycogen back to the original glucose form, thus enabling it to be once again circulated as glucose into the bloodstream for the use of the body’s needy cells.

In non-diabetic people, the insulin-glucagon hormone mechanism works efficiently to prevent the blood sugar levels from rising too high or falling too dangerously low.

But unfortunately it does not succeed that way for the diabetic person. In this case, in the absence of food intake, the liver does convert stored glycogen to glucose but the diabetic’s impaired insulin-glucose activity does not work well enough for it to be regulated or fully absorbed by the body’s cells, thus leaving an elevated blood glucose level to puzzle the self testing diabetic when reading their monitor results after a period of time when they have not eaten.

So what’s the solution?

My medical support professionals advise to not go too long without eating, to have between-meals snacks that contain about 15 grams of carbs. For overnight they suggest a small late evening snack, some carbs and protein such as a slice of bread, maybe toasted, with peanut butter or cheese and maybe half a glass of milk. Adjustments can be made depending on the results indicated by the recommended morning blood test.

That has worked for me for a while in the past but I should also mention that sometimes everything, day or night, goes wrong and I lose control for a few days. It is always a battle but worth the effort when the alternatives are considered.

For occasions when blood sugar levels do fall too low, the diabetic should always have available a suitable glucose-containing-food, a small quantity of which can quickly bring the blood sugars back to within a normal range. I favor half a small glass of apple juice, I have found it works quickly and enables a reasonably fast recovery from that queasy feeling that often accompanies a low sugar incident, a condition called hypoglycemia.

In preparation is a post to explain Hypoglycemia and Hyperglycemia (low and high blood sugar).