Plus Size Preggo repost: "One Big RACKET"

On Thursday, we had several appointments…one of which was with a Gestational Diabetes specialist. My endocrinologist has been subjecting me to random glucose tolerance tests (BLECH!) and having me monitor my blood sugar pretty much since the beginning of the second trimester, simply due to the fact that I’m obese and the obstetrician insisted I be monitored closely since I’m “more likely” to develop GD. Throughout the pregnancy, my results have bounced from borderline pre-diabetes to completely normal and back, but never conclusively YOU HAVE GD.
 
One of the OBs in the practice (whom I really never liked because she has a really shitty attitude about everything) decided to give me yet ANOTHER glucose tolerance test because she didn’t believe I hadn’t developed GD (nice, right?)…so I went to the lab SHE wanted me to, took yet another test, and it came back positive for pre-diabetes (again, not full blown GD, just that I COULD develop it, which obviously we’ve known from the get-go). Well, based on that, she decided that rather than retest to see why that test came back high when none of the others had, she’d rather just send me to a diabetes specialist despite what my endocrinologist said.

So, I went…in the waiting room, I met a woman who DID have GD, and she told me she could tell just by looking at me that I was fine, and started pointing out all the physical manifestations of diabetes that she possessed that I clearly did not. I felt good about just letting whatever the specialist said roll off my back, until I got in there and she insisted that I was endangering my baby just by being me. At least, that’s what I took away from the conversation, since my blood work was perfect, so if I was endangering my child, it’s not due to my sugars.

I got REALLY pissed and kind of took it out on the lady, who kept trying to win me over after I went off on her, but I let her know not to bother, she’d lost any hope of me liking her and she should just say what she had to say. Long story short, I was given a booklet on diabetes management and given a VERY strict diet to go on immediately. I was given more testing supplies and told that I was to send her my blood work results once a week for the next 3 weeks to make sure my pre-diabetes could be controlled simply by diet and that insulin wasn’t necessary. I KNOW insulin isn’t necessary because I’M NOT SICK, so I decided to make the best of it….ok, a diet and testing 4 times a day…big whoop. I can stand to eat better and testing isn’t SUCH a drag…if it’ll shut these guys up in only 3 weeks, fine. I’ll play along.

THEN I got a call on Saturday from the specialists office, letting me know that I needed to meet with a nurse AT HOME, and have her give me more supplies, including ketostix (sounds like they’re doing more than monitoring my diet)…and SHOCKER! My insurance won’t pay for all of it, just 70%, so I need to pay $200 co-pay in order to be put on this program that I’m positive I don’t even need. If I thought for a SECOND that I was truly endangering my son, I absolutely would be on board, but since I’ve started the program, my blood sugar levels have been IDEAL. Not just good for a fat woman or good for a pregnant woman, but SIMPLY PERFECT. This is just one big racket to get the scared fat girl to pay for crap she doesn’t need and to squeeze more out of the insurance. How about I just buy some ketostix at Walgreens for $15 and we call it fair that I didn’t just send the whole pile of people involved to hell?

So yeah. The diet doesn’t SUCK (in fact, it’s a LOT of food), it just involves a LOT of planning because it’s not easy to count exchanges for pre-packaged food, so I’ve been eating nothing but home cooked food SIX times a day for the past 5 days, and will be for at least the next couple of weeks. The baby’s movements have been more subtle since I’ve started the diet, hubs thinks it might be because he’s not hopped up on fruit juice anymore LOL
End of rant.

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:
http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html

and I did not have this book but it seems informative:
http://www.shopdiabetes.org/559-Diabetes-And-Pregnancy.aspx?loc=WhatisGestationalDiabetes

***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.

Gestational Diabetes - Now What? (3/3)

So you've been told you have Gestational Diabetes...now what happens?

Usually, the first line of treatment is a diet/meal plan. There is an example of one here. The thing about GD meal plans is that they make a great structure for what your diet should be like in pregnancy anyway! I am not saying "diet" as in "plan to lose weight", I mean "diet" as in "the food you take in". You're building a whole new body within your own, so it can't hurt to eat plenty of fruits and vegetables, whole grains and lean proteins. These will be the building blocks of someone else's (your baby's) entire organism! Just that thought was enough for me personally to start eating more whole foods and less processed junk.

It is also recommended hat one exercise daily, even a brisk walk after ever meal. Exercising increases the muscle tissue sensitivity to insulin, which helps your body metabolize sugar. Ideally, a woman would be on an exercise program before and during pregnancy not just for overall health (at ANY size), but because this is the more surefire way to help your body metabolize. No amount of exercise will keep you from developing GD (as one cannot control their ethnicity or family history), but it can definitely help in its management.

You may also be asked to monitor your blood glucose levels several times a day, usually fasting first thing in the morning and after every meal. The reason for this is to check for patterns and look for any spikes in blood sugar. This can give care providers a window into how you metabolize sugars regularly, outside of a lab setting. High sugars after eating could signal that a change in diet is needed.

High sugars in the morning, however, may signal that the body is overall not metabolizing sugar, and a doctor may then suggest a regimen of medication. The most common form of medically treating gestational diabetes is with insulin injections, which are self administered, usually directly into the belly. Obviously, one is taught how to do this by professionals so that the baby is never in any harm due to the injections. Another alternative is pills, such as glyburide and metformin.

 I hope this series has helped answer some questions about what Gestational Diabetes is and what it really means. I will be sharing a guest post soon about a readers experience with Gestational Diabetes, and I hope if anyone has any questions or would like to share your own experience, you will please comment or email me. Thank you!

Gestational Diabetes - How is it diagnosed? (2/3)

How is the test administered? A one-hour test screens for (but does not diagnose) gestational diabetes mellitus (GDM). If your blood sugar levels seem high after a one-hour test, you'll have to come back for more gestational diabetes testing.The best method for diagnosing gestational diabetes is taking a glucose test (glucose tolerance test). The test measures how the body reacts to a large amount of glucose (sugar).

According to The US National Library of Medicine: "For this test you will drink a glass of water that contains 50 grams of dissolved sugar. You do not need to fast beforehand. One hour later, blood will be taken from a vein in your arm to determine the blood sugar level. If the value is below 7.5 millimoles per liter (mmol/L, about 135 mg/dL), the results are considered normal and no more testing is done.
If an elevated level is found in the glucose challenge test, it is still not considered a final diagnosis. It only serves to determine which women will be offered a second and final test. This second test, called the oral glucose tolerance test, is more involved. For the test, the pregnant woman must fast beforehand, which means not eating or drinking anything but water for at least eight hours. The first step in this test is taking blood. After this the woman drinks a sugar solution containing 75 grams of glucose. Blood is taken from an arm vein again after one hour and after two hours. If any of the following three blood sugar values is exceeded, gestational diabetes will be diagnosed:

• After fasting: 5.1 mmol/L (92 mg/dL)
• After one hour: 10.0 mmol/L (180 mg/dL)
• After two hours: 8.5 mmol/L (153 mg/dL)" 

Testing for Gestational Diabetes can be done as early as 8 weeks in women that have certain risk factors, and is done routinely on all women at about 28 weeks gestation. Interestingly, however, not all women NEED to be tested for diabetes during pregnancy.
 
According to pregnancy.com:

"One of the most intriguing recommendations is that a woman may not need laboratory testing to screen for GD if she meets all of the following criteria:

• less than 25 years old
• not a member of a racial or ethnic group with a high prevalence of diabetes (eg, Hispanic, African, Native American, South or East Asian, or Pacific Islands ancestry)
• a body mass index (BMI) 25
• no history of abnormal glucose tolerance
• no previous history of adverse pregnancy outcomes usually associated with GDM
• no known diabetes in first-degree relative

Women who are at a higher risk for GDM usually have one of the following risk factors:

• age
• ethnicity
• obesity
• family history of diabetes
• past obstetric history"

 Before testing, you should eat normally for the few days prior. Women used to be told to eat less carbs or sugar in the days before their test, but that could just make your body react more aggressively to the glucose in the drink, giving a false higher result. If you are opposed to drinking loads of sugar water and various other chemicals, you can arrange to eat a specific breakfast and have your blood drawn at an interval following your meal instead. Many doctors frown upon such a request, but it is your right to request it.  
 
My own experience and advice for others that are deemed "borderline" like I was: I demanded a retest and that one came back ok but they were "concerned", so I compromised and told them I'd do my best to follow a GD diet and I'd monitor my sugars for a couple of weeks to "put their minds at ease". I figured I could use healthy eating guidelines anyway (though I did still have my daily vanilla ice cream cone) and when monitoring was all good, they left me alone. They insisted I get urine/ketosis sticks and keep a food log which I was meant to fax to them, but I did neither because EFF THAT, THEY'RE NOT MY MOMMA.

I had a bit of a rebellious streak during my pregnancy as you can tell ;) But honestly, I think it's a fair compromise and it'll give you AND the doctors a chance to see how your sugars are doing in the real world over time, rather than just once during a lab test. And then I think no matter what happens, everyone will have peace of mind that they're making the right decision on how to proceed; whether your sugars really ARE high or not. This was something I did in order to appease my doctors because I had one slightly elevated level on my test but otherwise showed no symptoms, but you can also request to have this several-times-a-day self-monitoring in place of the glucose challenge. Again, your doctor might fight you on this request, but as I mentioned previously, this is the best way to get a REAL WORLD view of your glucose metabolism, which is much more accurate than a one-time lab setting.

In the next last post on GD, I will discuss the various ways that Gestational Diabetes can be treated if you are, in fact, diagnosed with GD after your tests. 

Gestational Diabetes - What is it? (1/3)

This will be one of a three part series I'm doing on gestational diabetes. It seems to a be a topic that has been coming up a lot lately in the forums/groups I belong to, and what I'm finding is that a lot of women are being told they have it or being threatened that they will develop it, but no one is really receiving proper information regarding what it is, how it's diagnosed or how to treat it.

What is Gestational Diabetes?

According to the American Diabetes Association: "Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes. Based on recently announced diagnostic criteria for gestational diabetes, it is estimated that gestational diabetes affects 18% of pregnancies."

Basically, your growing baby needs glucose to grow. Your body errs on the side of "too much" rather than "too little" so the baby doesn't go without. As the placenta grows, the hormones it creates may interfere with your body's processing of all that glucose. This is why testing tends to be done later in the pregnancy (if no other risk factors exist) because the placenta is larger as the pregnancy progresses.

Non-Caucasian women, and women that are overweight pre-pregnancy, are likelier to develop Gestational Diabetes.You are also likelier to develop it if there is a history of diabetes, gestational or otherwise, in your family. Granted, it's not to say you WILL develop GD if you fall into any (or all) of these categories, your chances are simply greater.

Some of the risks of having Gestational Diabetes are macrosomia (baby growing too large), which could mean a broken clavicle or collarbone upon vaginal delivery, among other complications. This is why doctors are quick to induce as early as 39 weeks when the diagnosis for GD is present, or even elective c-section.

AGAIN, let me be clear...the doctor will be quick to suggest (or even insist) upon these interventions, but they may not be necessary. Also, ultrasounds are not, have never been, and are not meant for measuring your baby, and they are usually off by 1-2 pounds either way, so don't be alarmed if the doctor decides your baby weighs 10 pounds solely based on ultrasound...but that's another topic for another post.

Women that have had GD are likelier to develop Type 2 Diabetes later in life, but many of these cases are because the women studied may have had undiagnosed Type 2 Diabetes before pregnancy, and GD may not have been a factor.

Most of the time, GD can be kept under control by diet and exercise, and only in extreme cases will an insulin regimen be needed...so please, do not worry right off the bat that you will need to inject yourself several times a day until you've spoken to a specialist about the severity of your case! Stressing about it will do no one any good, though I know that is easier said than done.


On the next post, I will write about information, evidence and resources surrounding testing for Gestational Diabetes and how it is diagnosed. The last post in the series will be about treatment options. I'll also talk about my own borderline GD diagnosis during my pregnancy and what I went through as far as testing and treatment. If anyone would like to share their GD experience, whether just the testing or actual treatment if you were diagnosed, please email or comment. Also, please let me know if you have any specific questions and I will try to answer them in an upcoming post or at least point you to resources that can help.

"Obese and Pregnant"

I watched this special on TLC while I was pregnant (actually, I was "obese and pregnant"...da-da-DUM!!!). Even though I was feeling particularly vulnerable and hypochondriac-y in my state, this special was RIFE with BS. I was pretty upset with it because rather than be educational and show that anyone can have a healthy pregnancy (like I did), this program seemed to be one big scare tactic.

So naturally, when I saw they were playing it again this month, I decided to watch it and give you guys a play-by-play.

Right off the bat, they take the tone that women this heavy (just slightly heavier than I was at that stage) being pregnant is nothing short of a freak show.

Melba is 362 pounds in her last trimester. She already has kids. She has diabetes and was once at 490 pounds. She gained 90 pounds throughout the pregnancy, when obese women are told to gain no more than 15.

I was told the same thing when I was pregnant. I actually gained 33, 23 of which came off the first 2 weeks after delivery. First off, gaining only 15 pounds would mean actually losing weight to make room for the 20+ pounds of baby, placenta, extra blood, etc. Secondly, Melba obviously gained WAY too much during her pregnancy, and that's dangerous no matter WHAT your starting weight was. If they had presented her weight gain in that light (read: accurately), I wouldn't take offense...but they make it seem like she's in such danger because she was already big. Not necessarily the case. A 120 pound woman who gains 90 pounds in 9 months would be in the same danger and carry the same risk.

Christie took 2 years to conceive. They want you to believe its because of her weight, as if thin women never have trouble conceiving. She has PCOS, which lots of women have, regardless of weight.

Lastly, there's Mercedes. She has 2 older kids already and is nine months pregnant with her third. She's gained 200 pounds in the 17 years she's been married. She developed gestational diabetes in her second trimester.

In the next segment, we are reminded that Melba has gained almost 100 pounds during the pregnancy, and then show her going through a McDonald's drive through. Again, we're expected to be disgusted because this fat person is so big and still eating garbage...but I wonder (and I suspect that I know) if a slim woman would be judged the same way going through a drive through. This might be the one time in her whole pregnancy that she ate Mcdonald's, we have no way of knowing. Maybe a thinner woman eats that crap everyday, and her insides are a cesspool...but she wouldn't be judged as harshly just because she's not "fat". Good job sensationalizing, TLC.

In Christie's segment, they talk about how tragic it is that people are going to judge her because she's heavier and she dared to be pregnant. Meanwhile, ironically, this program is cementing that we should judge heavy pregnant women because since they dared to be pregnant and big, they are endangering their unborn children and are monsters. Right. No irony there.

Christie has lost 20 pounds throughout the pregnancy, and the baby is gaining just fine. Good for her, but this is happening because she was eating crap before and has decided during the pregnancy to eat wholesome foods. If you've done this all along, thin or not, you can expect a thriving child. However, the show is edited to seem that the only reason her pregnancy is going well is because she's on a diet. Lovely.

Mercedes is having complications, obviously, with her gestational diabetes. Mercedes is also 38 years old, which adds to complications. They only mention her age, not the fact that such a high age for gestation could also be the cause for her complications. They just focus on her weight.

Melba is 34, was a diabetic to start with, and has hypertension. Her baby is measuring much bigger than average, and the doctor says that it's due to BOTH her diabetes and her weight. Um, I was 318 pounds when I delivered, and my thriving, perfectly healthy son weighed 6 lbs, 9 oz at almost 39 weeks gestation. I call horseshit on the doctor. Diabetes in the mother will DEFINITELY affect the baby's size, but anyone can have diabetes, regardless of their weight.

Mercedes has an ultrasound at 38 weeks, and the baby is perfectly fine regardless of her gestational diabetes.

Now they're telling Melba that she needs an amnio to make sure her unborn daughter's lungs are fine. They need to deliver her immediately because if the baby stays in her, the baby could die. Why? Because of diabetes. That's the only explanation they give Melba, and terrified at the thought of her baby in danger, she gives in. Yay, scare tactics.

Christie had to have an induction after being 8 days overdue. She was given Cervadil and Pitocin (just like I was) because she's slow to dilate. Luckily for her, unlike me, she's not having contractions because she's not actually in labor.

Melba ends up having the amnio, and Dr. Douchebag is "surprised" to find that it wasn't as difficult as he thought it would be with all her extra fat. Swell. She's taken straight into a c-section. They make it seem like operating on Melba is akin to performing surgery on a concrete wall. Poor doctors are going to have to cut through sooooo much fat and skin, the poor things! Boohoo!

Mercedes naturally went into labor and had a perfectly healthy baby without an epidural in just a few short hours. The baby's blood sugar is perfect and there are no complications. LOOKIE THERE. Also, Mercedes discovers she doesn't have continued diabetes. Good news all around.

Melba has her c-section and her daughter is just fine. She weighs 6 lbs, 4 oz. The doctors has rushed her c-section because they had decided the baby was dangerously big and couldn't stay in a day longer. Oops. Good one, Dr. Douchebag. At least they're both fine in spite of the extra interventions.

Christie, however, with her uncomplicated pregnancy, is on day 2 of her induction. She gets an internal monitor (omg, that's just what happened to me!). Unfortunately, her baby goes into distress. She's rushed to a c-section and she has a perfect son.

So in the end, everyone was fine. No one died. No one was horribly disfigured. People were fat, pregnant, and had healthy children. Nothing out of the ordinary. Just lots of scary talk for no reason. I'm not saying that they didn't have complications and struggles, but I am saying that there's no reason to think that the complications were exclusively because of their weight. Bottom line is there's no reason to think that being obese means having complications anymore than being thin will mean a non-complicated pregnancy or delivery.