Gestational Diabetes Update

I haven’t spoken much about having Gestational Diabetes since my first post about it here. I was pretty devastated about it then, but thankfully, these past 16 weeks with GD have not been as difficult or horrible as I had imagined they would be.

Gestational Diabetes is a serious issue, and many women have much harder times controlling their blood sugars than I have. In a nutshell, GD is a form of diabetes that occurs during pregnancy and usually goes away after. Certain women have higher predispositions for GD (being overweight with a family history of Type II Diabetes were my risk factors), it can happen to any woman. For some women it is not about your history, body type or activity level, your body just simply does not produce enough insulin to cover the hormones released by your placenta.

The main risk of GD is to your baby. If your body isn’t processing sugar properly, the baby runs the risk of getting too big, which is bad for both baby and mama. The baby may not develop the right amount of “good” fat and will risk trouble with glucose and temperature control after birth. Also, obviously, a big baby is risky for mom because she has to somehow get that big baby out of her body. Many GD moms are induced early (which often makes labor long and hard and puts baby at risk of not developing all the way) or have a caesarean section (which is major surgery and poses it’s own risks to mom and baby).

All that to say, properly treating Gestational Diabetes is really important!

New guidelines have also come out so that the threshold for diagnosing GD is lower, thus making it a problem for women who would have been considered only borderline before. The new guidelines, my weight and my family history are why I was tested early (15 weeks) instead of waiting until 26 weeks to take the traditional glucose tolerance test (I was diagnosed with just a fasting blood sugar).

GD for me was not quite typical (figures!), as my trouble had nothing to do with what I was eating or my activity level (which should not lead you to believe that I was eating super great and exercising regularly, because I sure wasn’t! I had no idea trouble was in my future and I was fully enjoying being pregnant, each chicken nugget and couch-parked-bootie at a time!), my “fasting” sugars were my problem. Sure, if I ate a crappy meal, my “post-parandial” sugars were high, but so long as I hate a fairly balanced meal, my sugars were under my goal of 140 one hour after eating. It was my morning (“fasting”) numbers that were problematic. It didn’t really seem to matter how well I had eaten the day before, or if I had exercised after dinner or before going to bed, my numbers first thing in the morning were about 10 – 15 points higher than where my doctors wanted (goal is <94).

Having GD did not work within my plan to have a natural pregnancy and birth. Having GD usually classifies your pregnancy as high risk and makes staying with the Midwifery practice unfeasible. In fact, after my diagnosis, I was referred to the Perinatologists and my chances of staying with the Midwives looked bleak.

I went into my PNP (I don’t what that stands for, except that it means Perinatal somehow) appointment very adamant that I was going to refuse treatment and refuse to switch over to their practice. In fact, I pleaded and pleaded with the doctor I was meeting with. I asked for a few more weeks to change my diet and exercise 100% and asked if I could test again. She finally explained that if I had told her I was eating cake with every meal and never, ever exercised she may have been able to recommend a few non-pharmaceutical changes first, but because I had already been altering my diet and exercising, I was risking my baby by not getting my fasting sugars under control.

I explained to her that I realized this was only GD and that in the grand scheme of things, many women are facing much more difficult issues with their pregnancies, but I was super disappointed that something like this could alter my entire plan and hope for my pregnancy and birth. I cried. She brought in her attending (who I didn’t like at all, btw), who practically kept one foot out the door as he blatantly said that I should start Glybruide and that it’s been around for 50 years and used in pregnancy safely for decades. When I asked him how the medication worked, he said “I could look it up in Micromedex.” I told him that would not be necessary and that I could look it up myself. Thanks Doc. You’ve been a big help! He finally left and the first PNP explained that we would start Glybruide, which helps regulate your blood sugars, at night time only. We would start with the absolute smallest dose and see if that made a difference in my fasting sugars. She also agreed to discuss the plan with the Midwives and see if they would be comfortable co-managing my care. I don’t think she does that regularly, by the way, I think it was because she could see how disappointed I was and because I advocated more vocally than she was used to.

I walked out of the appointment quite disappointed. I was so sure I would refuse the medicine, but I couldn’t. It’s easy to be big and strong until they tell you that you are risking your baby’s safety. It’s just stupid to refuse then. Because, really, isn’t a healthy baby the main goal anyway?

About an hour, maybe not even, after my appointment, I received a call from the doctor (she even followed my request to call my unit at work and not my cell phone – no one had ever listened when I asked them to do that!). She told me she had just spoken with the Midwives (and the MW on call happened to be my primary one!) who agreed to manage my care so long as my sugars were well controlled on just the Glybruide at night time only. What a relief! I now just needed to see if the medication was going to work and if my after meal sugars would continue to be good as well.

Thankfully, the Glybruide (2.5 mg) worked exactly as it was supposed to. The morning after my first dose my fasting sugar was 81. I didn’t feel any side effects from the medication and the same dose has continued to control my fasting sugars with little complication. The only time my morning sugars are higher are if I sleep too long or forget to check my sugar right when I get up and start going about my day and check an hour or so after I have woken.

I have had to be diligent with my diet, but not crazy either.  Pretty much, the healthier I eat, the better my sugars. White bread and cheap pizza are my biggest no-no’s, as is cereal with almond milk (regular milk is fine), but I can deal with that! I’ve been able to pretty much eat whatever else I’ve wanted, so long as it’s somewhat healthy, I’ve even been able to have a decent amount of dessert, too, I just have to mind my portions. My dietitian has wanted me to be a little stricter than I have with my carbohydrate count, but since my numbers have been good, she’s OK with where I am.

I’ve not seen the PNP practice again, and my care has thus far been managed by the Midwives. The dietitian even said I was the first patient she knew of that was started on medication yet still allowed to continue my care with the Midwives! There may be a change of plans coming though, because I am about to hit 32 weeks, which is when the PNP’s start to recommend closer monitoring (ultrasounds and non-stress tests). I could see where the extra monitoring would be beneficial if you have had trouble with your sugars, but for a woman who has been well controlled like me, it seems hard to justify the tests. Because, really, since my sugars have been within goal for most of my pregnancy, I shouldn’t really have the risks associated with uncontrolled diabetes. After my appointment with my Midwife this past week, she said she was going to speak with the PNP’s and see where we could alter their traditional GD plan for a woman with good glucose control.

So, there I am for now. I did not intend this to be so long, but it’s been part of my pregnancy journey, and maybe if some mom stumbles across this post and gets even a bit of encouragement, then, it was worth it! GD has been a minor stumbling block for my pregnancy. If anything, it has helped me clean up my diet and helped me gain weight slowly (I’m up 14 ponds thus far). Yes, I have to poke my finger four times a day, but it doesn’t hurt – it’s just a slight pain to have to remember that stupid little black bag and to pick up the stray strips that seem to multiply across my house! Sure, I can’t indulge in every little craving I have, but I’d give up a lot more if it meant that I was keeping this precious little bundle safe and healthy. Every time I feel her move I know that she’s thriving in my body and that reminds me of what I working for…who I’m working for. My sweet, precious girl.

 

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