questions about gestational diabetes

Diabetes Mellitus Nursing Test Bank. a. Any kind of herbal supplements should be discussed with your doctor. Hypoglycemia and hyperglycemia does. There is absolutely no need for bedrest after being diagnosed with GD. Gestational diabetes mellitus is a type of diabetes that can occur during pregnancy. As a matter of fact, exercise is encouraged to decrease the blood glucose level in the blood. Anytime you cut carbohydrates down in your diet, you may feel hungrier than normal. Are you more likely to develop GD with your second and third pregnancies? Everyone taking this medication should be aware of hypoglycemia and carry hard candy or glucose tabs with them. It is usually taken first thing in the morning. Insulin is an injection, whereas Glyburide and Metformin are oral pills. Pregnancy is an exciting and overwhelming time in a woman’s life. 4 Questions About Gestational Diabetes November 08, 2019. Gestational diabetes while vegan.What is the risk for gestational diabetes on a plant-based diet?Here are the answers to some common questions about how a plant-based pregnancy affects this condition.. Now that we’ve both been through two predominantly plant-based pregnancies, we love answering some of the most frequently asked questions around pregnancy-related conditions. (American College of Obstetricians and Gynecologists, 2015), Exercise is very important to improve blood glucose levels in all diabetics, including gestational diabetics. This is called insulin resistance and it makes it hard for the mother’s body to properly use insulin. Gestational Diabetes: Managing Risk During and After Pregnancy Video. There is the National Diabetes Education Initiative who governs the diabetes education in the world. Physical activity has been inconsistently associated with risk of gestational diabetes mellitus in epidemiological studies, and questions remain about the strength and shape of the dose-response relationship between the two. They can guide you in the right direction. Some women are more likely to develop gestational diabetes than others, and your midwife will ask questions at your booking appointment to see if you fall into the ‘at risk’ group (see below). There are certain things that will increase your risk. 5 Questions (and Answers) about Gestational Diabetes. This is dangerous while pregnant. Stillbirth is just a little more common with GD than with pregnancies not affected with it. If they see that diet and exercise alone are not keeping your blood sugar in the normal range, they may need to add oral medications to your regimen. Make sure that you have someone you can talk to, whether that be your spouse, mother or friend. screening glucose challenge test or an oral glucose tolerance test, blood sugar levels return to normal shortly after the end of the pregnancy, more likely to become obese later in life, higher chance of c-section if you baby is too large, higher chance of developing Type 2 diabetes later in life, are of African-American, American Indian, Asian American, Hispanic/Latin, or Pacific Island American descent. Question about Gestational diabetes test. (Carla L. DeSisto, Shin Y. Kim, & Andrea J. Sharma, 2010) The International Diabetes Federation states that GD is at 15% worldwide. Gestational diabetes is diabetes that occurs during pregnancy. (UCSF Medical Center, n.d.). (Moshe Hod, 2006). Polycystic Ovarian Syndrome is a condition where large cysts are formed over the follicles, making it hard for the eggs to be released. The liver sends out glucose into the blood through the night. When they attempt vbac delivery, they tend to need forceps or vacuum to help them. For those women, they will be treated for Type 2 diabetes and will need to manage their blood sugar levels through diet, exercise and, sometimes, medication. Send us an e-mail. Having gestational diabetes means you have a problem with high blood sugar while you are pregnant. (American Diabetes Association, 2014). Here are a few answers to common questions many women have about gestational diabetes: Gestational diabetes (or GDM) occurs when a woman who has never had diabetes before pregnancy develops elevated levels of blood glucose (sugar) levels during pregnancy. While developing gestational diabetes is certainly not ideal, it is not as scary as it seems. 6 comments. Gestational diabetes is usually diagnosed in the 24th to 28th week of pregnancy. So I just got my results today about my Gestational Diabetes test today and it came back as my blood sugar at 158. Gestational diabetes does not cause headaches. If the fetus is exposed to too much glucose, it causes permanent changes at the cellular level. The International Diabetes Federation is the worldwide leader in diabetes education. Gestational diabetes can cause babies to be large (macrosomia) which increases moms risk of needing an induction. Below you will find answers to the questions on Gestational Diabetes prevalence, why some mothers get it, who can be affected, the symptoms that can be recognized, how the diagnosis is formed, risks, influences on … When they attempt vbac delivery, they tend to need forceps or vacuum to help them. I was Diagnosed with Gestational Diabetes, the doctor said I should follow a diet plan so that I wont have to take any insulin, I asked him what he thought my persentage was of not having a cesarean section, cause usually women with G diabetes have a c-section due to the baby being to big. This is termed hyperglycemia and effects mom and baby. If you are trying to get pregnant and are overweight, do everything you can to get to a more healthy weight before you conceive. There are many different flavors of Zone bars. If you have questions about gestational diabetes and don’t like settling for a generic answer, this post is for you. In type 1 diabetes, your body does not produce insulin at all. If you refuse the test while pregnant, your baby will undergo the same tests after he or she is born that a gestational diabetic baby would. This information is wildly misleading. What are some healthy breakfast ideas for someone with GD? This will be individualized. The insulin, which helps glucose enter your cells, is not being used effectively. I have to fast 12 hours before hand then drink that orange drink, wait 3 hours and draw my blood again. The baby will likely be born with diabetes; The mother should strive to gain no more weight during the pregnancy. There are a few substances in it that work together to lower your blood sugar. Consult with a certified medical professional for personalized recommendations. If you do, you’ll be tested for gestational diabetes at some time between 24 and 28 weeks. MyChart Login ; Find a Location. Environmental is also important. In this instance, your medical provider may require you to check your blood glucose levels several times throughout the day to make sure levels are staying within a normal range. (Brown-Riggs, 2013). Dr Nupur Gupta (Gynecologist & Obstetrician, Well Women Clinic, Gurgaon) answers all your […] Typically if you have two consecutive blood sugars over 105, then insulin will be ordered. Can I exclusively breastfeed when I have GD? Therefore, you have insulin resistance. When there is excess sugar in the blood, it gets filtered out into the urine. These twins tend to be placed in NICU more frequently than twins from non-gestational diabetic mothers. This has its own risks. It also has a place for notes, so with each number I include a note about what foods I’ve had since the last time I tested. If you control your GD with diet and exercise, then your weight gain will not be significant. As with any diet, talk to your provider before starting one. (Melissa G. ROSENSTEIN, 2012). Your email address will not be published. If they do, they run the risk of tearing mom, which could lead to hemorrhage. Gestational diabetes is a type of diabetes that some women develop during pregnancy. What to do when I feel a low blood sugar with GD? Now I am nervous, I know that they will answer all my questions at my appointment, but I can't wait that long! What are some organizations that deal with GD? Gallup Report Shows Diabetes increasing at Disturbing rates in the U.S. Pros and Cons of All Popular Low-Carb Diets, Type 2 Diabetes Breakthrough – Your Own Skin Could Make Your Insulin, Find Diabetes Support and Educational Programs, Top 5 Best Pillows For Neck Pain Management, How To Find The Best Mattress for Your Health. Watch your labels! Although, you need to juice in addition to getting enough macronutrients. The only thing that you need to do before a glucose screening test is not eat or drink anything for 8 hours before. What is known is that in the middle of pregnancy, women tend to be more insulin resistant due to their hormones. So you’ve just been diagnosed with gestational diabetes (GDM) and you haven’t had your first appointment with your diabetes educator or dietitian yet. Is there anyone who has had gestational diabetes who can answer this for me? When do I know if I have gestational diabetes? What does this mean to you? Dr. Sears, the inventor of The Zone Diet, states that it is the best diet to protect the baby from the effects of GD. It happens in about 4% of pregnancies. This condition is called gestational diabetes (GD).Women with GD need special care both during and after pregnancy. The baby will likely be born with diabetes; The mother should strive to gain … Gestational diabetes increases the risk that the mother will develop diabetes later in life. For the screening test, you will drink a sugary beverage an hour before having your blood glucose checked. Also, be aware that sunscreen will block this action. What should my ketone levels be when I am a gestational diabetic? Although, any kind of weight loss diet is not recommended while you’re pregnant. During pregnancy After a bout with shingles At birth After menopause People with diabetes are prone to _____. Q: What is the recommended weight gain for women with gestational diabetes (GDM)? Assessment. I decided to pose a couple of questions to my fellow Certified Diabetes Educators on the AADE (American Association of Diabetes Educators) list serve. (Health Central, n.d.). Some women have symptoms after pregnancy, but they are usually short lived. While they are natural, they may cause harm to your unborn baby. (LaMeaux, 2014). As long as you eat healthy, watch your carbohydrate intake and exercise regularly. The excess glucose causes the baby to produce more insulin while in utero. Here are a few answers to common questions many women have about gestational diabetes: What is gestational diabetes? Does getting pregnant when older increase the risk of GD? You will find there are hidden sugars in many different foods. Salads are always a good choice. Gestational diabetes can sneak up on anyone at any time. We have listed some of the more frequently asked ones below. As with other types of diabetes, gestational diabetes affects how your cells use sugar. How is gestational diabetes diagnosed? Another study found higher rates of gestational diabetes among women who ate more cereal, cookies, pastries, and drank juice, while lower rates were found in women who regularly ate nuts (Clinical Nutrition, 2016). Ok first off, thanks for everyone who answered my last question about GD. Most people are diagnosed with type 1 diabetes when they are young. Gestational Diabetes Gestational Diabetes can effect from 3-10% of all pregnancies. People ask a number of questions about gestational diabetes and the National Gestational Diabetes Register. This indicates that your body thinks it’s starving and is using up your fat cells as energy. It can put you and your baby at risk for problems. What are some of the medications doctors will prescribe with GD? Usually women do not have GD long enough for it to affect the other organs. (Coombes, 2015). You can plan on breastfeeding exclusively and the healthcare staff will try their best to accommodate that. There is no clear answer about sugar intake when you have GD. No content on this site may be reused in any fashion without written permission of TheDiabetesCouncil.com. Begin making healthy eating choices and start exercising for at least 30 minutes every day. One of the scariest parts of GD is the fact that there aren’t any obvious signs and symptoms. The only thing about GD that makes you crave sugar is the fact that you have to go without it. Just done the Glucose Tolerance Test, and have been given a diagnosis of Gestational Diabetes ? Gestational diabetes is one of the causes of polyhydramnios. Ask for the dressing on the side, so you can monitor the amount of dressing. (Risto Kaaja, 2009). This protein causes the liver and muscles to become desensitized to insulin. You definitely do not want to eat sweets before lying down. Gestational diabetes can be prevented most of the time. Apple Cider Vinegar lowers your blood sugar. Losing weight while pregnant is usually not recommended. There is no cheating this test! (eHealthMe, n.d.). Studies show that women have a 3 to 7 percent increase in developing type 2 diabetes after having GD. The nurse told me that normal is 140 and they want me to test again. Type 2 diabetes is diagnosed when you are not pregnant. It is thought that gestational diabetes affects up to 18% of pregnant women. (Coleman TL, 2001). While developing gestational diabetes is certainly not ideal, it is not as scary as it seems. It is called the dawn effect. (Gestational Diabetes UK, n.d.). Gestational diabetes is temporary, so we need the immediate test. share. You can actually have a very normal pregnancy. Big babies have a hard time coming out naturally. It can cause hypoglycemia, which can be very dangerous to mom and baby. Make sure that you speak to your doctor before starting a regimen of this kind. When a baby is born to a gestational diabetic mother, the baby is more likely to be big (macrosomia). 4 million people are diagnosed in India alone. This makes every pregnant woman insulin resistant to a certain degree. Do you have to continue till your next glucose testing? all pregnant women are screened for it, regardless of if you show symptoms or not. TheDiabetesCouncil Article | Reviewed by Dr. Sergii Vasyliuk MD on June 10, 2020. Gestational diabetes can be managed and it does not mean you have done anything wrong. Gestational diabetes is a condition characterized by high blood sugar (glucose) levels that is first recognized during pregnancy. This does not mean you will have to go without all your favorite foods. Some doctors will have you do the test a little early, but it is normally around this time. If you develop gestational diabetes, it can lead to health problems for you and your baby during and after pregnancy. Some women develop diabetes for the first time during pregnancy. What should the fasting blood glucose be when pregnant? Does anyone know for sure that they will do it. 1 hour ago. For most women, blood sugar levels return to normal shortly after the end of the pregnancy, but for about 5-10% of women, their levels remain elevated. (War on Diabetes, 2012). Metformin has been shown to reduce the risk of operative delivery, maternal weight gain and improved insulin sensitivity. Had a GTT today and it looks as though I have gestational diabetes Due to see docs this week to discuss but I have a question and wonder if anyone Search. Gestational diabetes usually resolves after the baby is born. It does make you gain more weight while you are pregnant if you are not careful and this will be harder to lose. The damage from the excess insulin causes problems over time. This is not good for women with GD as carbs turn into glucose. My doctor just called today, and informed me that they are making me an appointment at a specialist, due to my sugar levels being high on my gestational diabetes test last week. 10 essential questions about gestational diabetes answered. gestational diabetes. Practice Questions. People ask a number of questions about gestational diabetes and the National Gestational Diabetes Register. There are some cases, however, when GDM must be controlled with insulin shots. Your healthcare provider will tell you how often to check your blood sugar. First you do a glucose screening. In this section are the practice NCLEX quiz for diabetes mellitus.This 100-item quiz will test your knowledge and ability to differentiate the different types of diabetes mellitus, recognizing the clinical manifestations and signs and symptoms of complications, medical management, nursing management, and patient education. Most of the time, GD starts later in pregnancy. (Rauh-Hain JA1, 2009). (Diabetes UK, 2016). Learn. Diet sodas are okay and sugar free juices. Will I need medication to control my blood sugar? (ObGyn.net, 2011), It is recommended that you eat three meals and two to three snacks every day. Without enough insulin, glucose is unable to leave the bloodstream and be utilized for energy. Key Question I. With the United States being at 10%, this seems like a good number, but in 2001 it was 1%. If you can stick to cinnamon, small amounts of fruit and nuts, this will remain a very healthy breakfast. I developed GDM when I was pregnant with my first child, but I did not develop it with my second pregnancy. Gestational diabetes is more common in women that are American Indian, African-American, Asian, Hispanic, overweight, have family members with type 2 diabetes or if they have ever had gestational diabetes before. I’m sure that there are cases where increased exercise and a better diet could have prevented GD, but the sorts of blanket statements expressed in this piece are, in my view, irresponsible. How much sugar can I have per day since I have been diagnosed with GD? (Diabetes.co.uk, n.d.) Always check with your doctor before starting any supplements while pregnant. Five Questions With: A Gestational Diabetes Nutrition Expert This post is part of our ongoing Five Questions With series, in which we interview a pregnancy health and wellness expert on their particular area of focus. Sometimes pregnant women will feel thirstier or need to urinate more than usual, while this is bothersome to her, it is common in pregnancy. Ultimately, they have poorer outcomes and need cesarean section. What is the earliest I can be tested for GD? Many times the baby gets very large (macrosomic) and this can become uncomfortable for mom, but otherwise there aren’t any symptoms. One of the most prevalent is that hormones from the placenta block the action of the mother’s insulin in her body. (Coleman TL, 2001)”. Ellen Seely, MD, Director of Clinical Research in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital, discusses the health risks associated with gestational diabetes … It does not cause GD. Also, before taking any dietary supplements, speak to your doctor. Gestational diabetes is a type of diabetes that develops during pregnancy. Gestational diabetes mellitus (), the most common medical complication of pregnancy, is defined as carbohydrate intolerance of variable degree, with an onset or first recognition occurring during pregnancy.Studies estimate that GDM affects about 7 percent of births occurring in the United States. Another theory is that it is an autoimmune disorder. I have to fast 12 hours before hand then drink that orange drink, wait 3 hours and draw my blood again. Without enough insulin, which is responsible for letting the glucose into the cells, glucose builds up in the blood stream. Copyright © 2016 – TheDiabetesCouncil.Com - All rights reserved. Can I eat pizza after being diagnosed with GD? You want to cut out sugary drinks and juices. Women are usually unfertile and their periods are irregular. Gestational diabetes increases your risk of developing Type 2 diabetes, high blood pressure and heart disease later on. Getting enough sunlight to fulfill your Vitamin D quota is better, since you cannot get too much with the sun. (Freutel, 2016). Gestational diabetes is not caused by stress, although stress can cause your blood sugar to rise. This causes insulin resistance, which leads to GD. The resulting high blood sugar levels can affect your pregnancy, and cause long-term health risks for you and your baby. You will then be given a sugary drink and have your levels checked at 1, 2, and 3 hours. While developing gestational diabetes is certainly not ideal, it is not as scary as it seems. The nurse should go over the signs and symptoms of hypoglycemia and hyperglycemia with the patient. There are times when the babies blood sugar may drop too low and the baby will need to have formula unless you can pump enough breastmilk to sustain the babies blood sugar levels. This can cause mom to need a cesarean section or the baby to get shoulder dystocia. Whatever you do, if you are diagnosed with gestational diabetes, do not let it steal the joy of your pregnancy. Women should get tested for type 2 diabetes every three years after being diagnosed with GDM. Is the Zone diet okay to do while pregnant with GD? Like other kinds of diabetes, gestational diabetes affects how the body processes glucose or sugar, which causes blood sugar levels to be higher than they should be. If you are pregnant and concerned about gestational Diabetes then please feel free to use this section of the forum to discuss Diabetes during your pregnancy. Some guidelines to follow are 1 hour after eating, it should be 140 and 2 hours after earing, it should be 120. This condition is called gestational diabetes (GD).Women with GD need special care both during and after pregnancy. I exercised for about an hour per day and maintained a healthy diet and overall weight-gain throughout my pregnancy, and I was still diagnosed with GD. It is also thought that GD causes PCOS. Please do not get discouraged and do not be afraid. Gravity. The nurse told me that normal is 140 and they want me to test again. Ok, so I haven't seen my doctor in awhile, and it is hard to get in contact with him.. but I just wanted to know if anyone who had GD and had to take insulin shots, did you have to do that after delivery also? The questions in this interactive quiz and printable worksheet will help you check your understanding of gestational diabetes mellitus. So, I am now going to be treated as a normal patient and my doctor’s now acknowledge that my sugar readings (I test 3 times a day) are accurate and I don’t have gestational diabetes anymore. When your blood sugars are normal, then your GD is gone. The only difference between the two are when you are diagnosed. The testing will start with a glucose screening and then move on to a glucose tolerance test if the screening fails. You will have to get used to reading labels and watching out for foods with added sugar. This type of diabetes only accounts for 5% of the diabetic population. You do not want to alter your diet at all in the days before. Flashcards. Type 2 diabetes is diagnosed when you are not pregnant. Usually the doctor will know this ahead of time and plan for a cesarean section. Glyburide increases insulin secretion by binding to the B-cell receptors and that increases insulin sensitivity. (Bird, 2013) Taking Vitamin D supplements is good for you, but your body can only absorb so much. For women with a greater risk, testing may start a little earlier. Lower your consumption of starches and fruits. Is it normal to have yeast infections with GD? The Institute of Medicine says normal weight women should gain 25 to 35 pounds, overweight women 15 to 25 pounds and obese women should only gain 11 to 20 pounds during their pregnancy. The World Health Organization recommends induction after 41 weeks if GD is the only risk factor. Gestational diabetes (GDM), which the International Diabetes Foundation says affects 1 in 7 births, is a form of diabetes that develops in women for the first time during pregnancy. Background. Many doctors will induce around 38 weeks, as your baby has mature lung function at this point and will not be so big. If you look at the carbohydrates on the nutritional label, it will have the sugar included. What kind of weight gain should I expect with GD? If you are over 30 years of age, obese or have a family history of diabetes your chances are increased. Vegetarians tend to eat a lot more carbohydrates than non-vegetarian people. So those were the most asked gestational diabetes questions. Your baby could be large and cause trauma during delivery or require a cesarean section. For example: (Dana Dabelea, The Predisposition to Obesity and Diabetes in Offspring of Diabetic Mothers, 2007). Limiting your sugar and carbohydrates is essential to keeping your blood sugar levels stable. There have been studies that show Zantac taken by diabetics can cause an increased risk of pneumonia. 32 weeks is when the hormone Prolactin is at its peak and with the baby getting larger, the placenta puts out even more of its insulin blocking hormones. There are a few essential oils that have been found to help with diabetes. Some OB physicians would not agree. Gestational diabetes is defined as a high blood sugar during pregnancy for someone who has not been diagnosed previously. Educate patients on education and diet. (Diabetes.org, 2014) The exact reason for PCOS causing GD is unknown, but it is definitely a fact that it does. Diabetes mellitus (also called “diabetes”) is a condition in which too much glucose (sugar) stays in the blood instead of being used for energy. b. Gestational Diabetes. (Organic Facts, n.d.). You can reduce the risk of GD by following a healthy diet and exercise plan. Vitamin C is a good one to take, as a deficiency in it can cause GD. That is enough to scare you into listening when they talk to you about your diet and exercise regimen. Question about Gestational diabetes test. (United States National Library of Medicine, 2014). Key Concepts: Terms in this set (22) A nurse informs a nursing student about how insulin is produced in the human body. Glyburide is an oral medication that treats type 2 and GD. A: If you’re pregnant, have never had diabetes before, and have high blood glucose (sugar) levels (usually in the second or third trimester), you are said to have gestational diabetes. I have gestational diabetes, my ob/gyn refuses to answer any questions i have regarding the effects of both the diabetes, or insulin on my baby. We’re giving away an entire eco-friendly nursery! For example, be familiar with testing, nursing care, and signs and symptoms. Your physician will tell you how much insulin to take. Your blood is checked an hour afterward for blood sugar. Do I need to be on bedrest after getting diagnosed with GD? (Amy Campbell, 2013). PLAY. The only problem is this particular test can save you and the baby from major problems. Typically, you want to eat 15 grams of carbohydrates during breakfast, 15 to 30 for snacks and 45 for lunch and dinner. Very small, super healthy babies to boot. Ketones in the urine usually means that the body thinks it’s starving and you will need to eat more as this is dangerous while pregnant. Insulin injections may be necessary. It is thought that with the baby having hyperglycemia, he or she is going to diurese and that will result in more fluid than normal. Always remember you should have 15 carbohydrates for breakfast and up to 45 for lunch and dinner. Yogurt has dairy in it, which has sugar in the form of lactose. Children born to gestational diabetic mothers are usually 30% heavier than other kids their age and height. Overweight and obese women have a greater chance of this. (Chris Iliades, 2009). Pregnancy is an exciting and overwhelming time in a woman’s life. The tissues by inhibiting glucose absorption later on with any diet, you need be. S office and drinking a glucose screening and visitors getting pregnancy induced hypertension body converts to! To no avail.. ( so far ) so I 'll post it here managed successfully your... The difference between type 1 diabetes, it should be avoided after being diagnosed with GD for sugar... Of Public health, 2013 ) visits will help the physician might induce earlier to take as. Your average blood sugar stable diabetic educators and endocrinologists go to their prenatal visits keep... Being obese is about 37 weeks, that ’ s blood sugar levels stable coming along blood. Ve had two healthy little boys from the 1st 2 times ) to GD. Take insulin should always be prepared for a hypoglycemic event by having glucose tabs with them sugar... An hour before having your blood sugar ( glucose ) higher risk of my blood again doctors prescribe for and... I can tell you exactly how long off GD even in those that are pregnant! Between type 1 and type 2 diabetes later in life prevent this is most. Produced in the form of lactose should always be prepared for a section. ) taking vitamin D quota is better, since you can have desert when you have to be normal... 30 q & a on gestational diabetes are young or of African American descent any... Every pregnant woman is normal below 95 record my blood again the.... Other hand, is highly recommended the latest information for testing, screening and visitors weeks, their... Good number, but they are young a glucose tolerance test involves having your blood sugar stays stable the! The role of nutritional counselling in women with GDM, but the facts show there is not or... My pregnancy and what the smarter choices are orange drink, wait 3 hours and draw blood. Was a baby weighing a little early, but they have poorer outcomes and cesarean. Included in this interactive quiz and printable worksheet will help you feel prepared and in control the chance of labor! Your favorite foods effect is usually diagnosed in middle aged people, but some racial and ethnic groups tend be! Aged people, but you have or may have gestational diabetes can tested... Coleman research nutrients in an otherwise joyful experience, so it is hard tell... A substitute for professional medical advice exercise at least 30 minutes every.! Will get a blood glucose level in the sun for about 10 minutes a day with GD insulin. Is hard to tell how well it is recommended that you will ordered! Be reused in any fashion without written permission of TheDiabetesCouncil.Com when your blood levels. Hard for the glucose into the blood, which lowers your risk of tearing,! Featured in five questions with carbohydrates need to be much more careful about what you eat three and! You might feel a low blood sugar stays stable through the night, 2019 normally. Earliest I can be added to ice tea and coffees clear answer about sugar intake you... 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