Tuesday, October 8, 2013

Guest Post: "Gestational Diabetes"

"Look around the room.  You are not alone!  There are many other moms going through exactly the same thing,"  the movie comforted.  I had to laugh.  This would have been more comforting if I wasn't the only one in the Gestational Diabetes educational meeting.  There was one other pregnant woman who was supposed to attend but she got a flat tire, they told me.

I didn't know much about GD except that I didn't want it.  I had to switch my Ob/Gyn when we moved from Buffalo to CT, and at my first appointment with the new Ob/Gyn, they gave me the slip for the infamous Glucose Tolerance Test.  Of course, I googled my way through the information on the test from fasting a full day before to sitting completely still during the test.  The most important advice was from a mom saying that there is no sense in trying to "trick" the test, one way or another.    
Research shows that you are at an increased risk for GD if you have a strong family history of diabetes, you are non-white, you are overweight, or are older than 25 years old.  I have one family member with diabetes, but otherwise I considered myself to have a healthy diet and was keeping up with walking while pregnant.  When I found out that I tested slightly higher than the threshold set by my Ob/Gyn, I was crushed.  They gave me another slip to go for the three-hour glucose test.

When I found out that I tested slightly high again, I was devastated.  I felt guilty that I wasn't giving my perfect baby boy a healthy place to grow.  I felt like I let him down.  Most of all, I felt overwhelmed.  I was to attend the Diabetes clinic to learn about my diagnosis (this is where I watched my educational GD movie.)
Basically, the placenta and hormone madness of pregnancy interfere with the insulin's ability to process sugars.  If the baby gets too much sugar, they are at risk for health problems, including a difficult birth and high birth weight.  My Ob/Gyn took this very seriously and was not going to negotiate my treatment.  I was given a glucose monitor and finger pricks and was to check my sugars four times per day for 2 weeks and report them to the clinic.  I was given a strict diet and was instructed on how to count my carb intake.  At the time,  I couldn't imagine how I would do this during the workday.  
When I reported my sugars for the first week, the nutritionist told me that she thought I needed to start insulin.  What?  Why?  My fasting numbers (the morning numbers, the sugar levels you report after not eating for the entire night) were the high numbers.  These were the levels that could not be controlled by diet and exercise alone.  
My first reaction was to stop all carb intake, but this is not recommended as the baby needs carbs for proper growth and development.  I asked if I could wake up at 2 am and walk on the treadmill...would that help?  She said it might but that she would personally make sure that I would not do that.    
The nurse showed me how to inject insulin.  I assumed I would just use my thigh or arm.  No, you stick it in your belly.  I started to cry, and told her that that's where my baby was, as if I were carrying my baby differently than any other pregnant woman.  She reassured me that the baby couldn't feel anything.  It was not painful for me either, you just avoid the stretch mark areas and use a new area each time.  I did my injection before bed, but some people have to do them before meals as well.  
The kicker is that when you start insulin (at least in my Ob/Gyn practice), you have to come for Non-stress tests (NSTs) twice per week.  This is when they strap a monitor to your stomach and record the baby's heart rate as they move.  Of course if that baby is sleeping or inactive at that time, these can take a long time!  I brought cold water and a clementine to speed things up.  Otherwise they manually jiggle him around a bit or bang something loud to encourage movement, which I enjoyed much less.  I also had an ultrasound once per week to check the fluid levels and make sure Luke wasn't being affected in any way.  
I did not know much about diabetes.  I give people with diabetes who are working to control their sugar a lot of credit.  The counting of foods, the blood sugar pricking, that is not easy.  The silver lining?  Luke could not so much as make a funny face without the doctor recording it.  They had everything measured, monitored and tracked.  Nothing was going to go unseen with all of these appointments.  I also got to meet many wonderful people in the diabetes clinic that educated me, and was able to meet every doctor in the practice so that whoever delivered me was going to be a very familiar face.  Luke was not affected by the GD.  He was a perfect size and the delivery was (fairly) uneventful.  I also lost my pregnancy weight quickly since I was on such a strict diet.  
I had to repeat the glucose test 12 weeks postpartum.  The funny part was how my perspective changed.  Pre-Luke, I brought books with me and played with my phone during the testing.  Post-Luke, I enjoyed sitting and having a few hours of me time, even if it involved blood work and a terrible sugary drink.  I am so thankful that my postpartum blood work came back normal.  This is the case for many people with GD.  I am at a higher risk for GD for subsequent pregnancies and diabetes later in life, but if there is a next time, I'll be armed with much more information.  

I can share more about my actual diet if you are interested.  For now I would say:

1.  Be prepared when going out for meals.  One time I had a salad with tuna on top with no dressing and my sugar level SPIKED.  There must have been sugar in the tuna, something I did not anticipate, so explain your needs to the server.

2.  Try out Diabetes Lifestyle bread from Stop&Shop.  It has about the same amount of carbs as certain breads but must be processed differently in the body since it didn't cause a sugar spike.  I felt like it took too much experimentation to find foods that worked for me so I stuck with a routine diet and reminded myself that it was temporary (hopefully).

3.  I was SO AGAINST insulin injection even though I didn't know anything about it.  It felt like a medication that I didn't want my baby exposed to.  I felt like starting insulin meant that I had failed, that I tried to control everything with diet and exercise but couldn't.  In reality, do your best and then do what you gotta do.  I regret wasting any time or thought in self pity; this is for the baby!   Even when the nurse told me I had to start insulin, I said I needed to call my dad and check with him first.  I explained the appointment to him and he said "yes, take it, do what they say."  And I did.  I needed someone I trusted to "okay" the whole thing.  Not all medical professionals understand gestational diabetes to the same extent, and the thresholds for treatment seem to vary as well.  Make sure you trust your Ob/Gyn's judgement as this could become very serious if not treated.  Be aware that starting insulin does not mean you can relax and stop checking your sugars.  The placenta/hormone madness changes throughout the pregnancy as do the insulin needs.  Towards the end of my pregnancy, I dropped my insulin dose a few units each week because my sugar was getting too low (as directed by the Ob/Gyn).  Make sure you know the signs of low sugar and that you have an emergency dose of sugar (like juice) with you.

4.  Since I had just started my new job, I could only think about how I would check my sugars at work, how I would have my 15g of carbs spaced throughout the day while seeing patients, and how I would fit in my 2+ appointments per week.  I had to cut down to part time, and I had to speak to HR and my co-workers about taking time during the day to check sugars and eat my snacks.  I was so blessed to have an understanding employer and I realize not all offices make such accommodations for their employees.  My advice on this would be get everything in writing from your doctor and stay in open communication with HR/co-workers.  If your job cannot make accommodations, then you have have to make it work another way.  It's temporary (again, hopefully), and your baby's health depends on your compliance.

Please feel free to leave any GD questions or insight!  I was hesitant to share my experience but feel that it is worth it to be open if I can help even one person.

This website is helpful:

and I did not have this book but it seems informative:

***This is all written from experience only, I am not qualified to give medical advice on GD.  Ask your Ob/Gyn before doing anything!***

This is my blog editor, Luke.  

This post was reposted with permission by the original author, Lindsay Gill, momma to Luke. Please read more about Lindsay at her blog, Wedding Rings to Teething Rings.

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