who else will have gestational diabetes?

[NicaG]

I noticed there are a few of us who had gestational diabetes in previous pregnancies.  Just wanted to see how everyone's doing and ask about your plans for this pregnancy.  Have you been monitoring your bs levels?  Are you planning to see a dietician early in pregnancy?  Were you happy with your care last time, or would you change anything?

I had gd with my ds back in 2005 and again with my dd in 2008.  I was on glyburide with ds and then I had to be on insulin with dd. I actually took the 3-hour test in December because I was pregnant (ended in miscarriage) and my fasting levels had been a little high (around 100). I passed the test, actually did quite well.  So I'm not planning to take the test early.  With dd, I took the test early (like 21 weeks) and passed--I was actually annoyed because it just meant I had to take it again at 28 weeks, and I failed it.

I am having a really hard time getting back towards the diet.  I think I need to find a good dietician.  The ones I've seen have not been very helpful.  I need someone who is more into whole foods, not processed junk.  I think I need to be thinking long-term, since I'm at very high risk for diabetes later (I think something like 70% of insulin-dependent gd mothers end up having diabetes).  I had no risk factors before pregnancy--it doesn't run in my family, and I was normal weight, exercised a lot. 

[ThreeCats]

I had GD while I was pg with my DS. It was diet-controlled, but the OB that my midwife consulted with seemed a little freaked out anyway, he tried to talk me into inducing early for my "giant" baby. My DS was born at 39 weeks, 6 lbs 10 oz. So much for giant.

This time, we've decided to see an OB from the start, as the midwife would just end up having to consult with one anyway - we love our (new) OB and feel like we're just cutting out the intermediary. She ordered a hbA1c a couple weeks ago (measures blood sugar over the past 3 months or so - came back normal) and has me monitoring my blood glucose 4x a day. I won't be taking the GTT at all this time. I eat a fairly low-carb diet and have cut down a lot on my processed food intake. I'm also exercising more than I have in the past. I'm hoping those changes plus the fact that I've lost a bit of weight between when my DS was conceived and now will help keep the GD at bay, or at the very least diet-controlled again.

[lifeguard]

I had gd with ds & fully expect it again this time. I did a A1C recently ( just before I got pregnant) & my numbers were good. Unfortunately with ds not only did I have to go to insulin but it took us a long time to figure out the right insulin combinations to get it under control. Despite that ds & I had ZERO complications from the gd. I personally am of the feeling that the endo I was seeing was overreacting - he made me feel like my numbers were raging out of control whereas when I look at my charts now I can see that they really were not very high at all - just not as incredibly low as he wanted them kept.

I have all different care providers this time so I expect everything will be different. I am on metformin now & am hoping to continue it throughout the pregnancy instead of stopping it at 3 months. I'm already seeing a nutritionist (have been for a few months) & with his help intend to keep my weight gain to the absolute bare minimum. I am exercising daily. Despite all this I am not optimistic I will avoid gd.

I do have a call into a midwife practice but if they will automatically transfer me to an ob if I develop gd than I don't think I will bother. I'd rather find an ob I'm content with from the beginning than find an amazing midwife just to have to switch later - too disappointing. I found all of that very stressful last time.

[Gabesgrrrl]

I"ve never had GD, but I would like to mention that I read somewhere, that there's a special pregnancy diet (can't remember the author but could look it up if interested), where the mothers ate super high doses of Protein, and not a single one had GD. Anyone else try that?

[starling&diesel]

I think you're referring to the Brewer diet.  I'm doing it to avoid pre-eclampsia, so can't speak to how it works for GD.

[emmaegbert]

I had GD with #2- passed a 3-hour at around 20 weeks and "failed" at around 28 weeks. But borderline (fasting and final numbers good, first hour high, second hour literally on the borderline). I used a very strict diet and daily exercise for control and it worked. I plan to do the same- it was a whole-foods based, low-carb diet. I am starting this pregnancy 30lbs less than the last one (lost the 30lbs with a moderately low-carb diet) and I am already eating a fairly low carb diet anyway so I'll continue with that.

I don't plan to take a GTT this time, and will instead basically assume that I will develop GD and go from there. My midwives are okay with this approach. I will begin spot checking around probably 15 weeks (like one reading a day, rotating around which one) and if I start seeing higher ##s I'll start more rigorous testing. My last birth was  HB with "shadow" care from a hospital based MW practice. The hospital folks wanted my fasting #s under 90 and my 1-hour post-prandial under 130. I was able to achieve that and will aim for similar this time, but my current MWs say that sounds a little stricter than they would "require". I logged food, exercise, sleep and blood glucose readings every day, and that did help me to adjust things. For example, I learned that a brisk 15-20 minute walk would drop my readings quite significantly (far more than any other exercise I tried). So if things were higher (or I ate more carbs than I knew I could really handle) I'd make sure to get a good quick walk in. I even noticed the effects of an evening walk on morning fasting numbers. I have no idea if this is true for other people, but it was helpful for me.

I definitely saw it as a wakeup call (I already know I have high risk of developing type II b/c my mom has it, as did her brother and dad, and she probably had what would now be called GD with me, so I was exposed to the hyperglycemic uterine environment.) When I went back onto a much lower carb diet and lost all that weight without ever limiting my food intake otherwise, well, it was even more "proof" to me that this is healthy for my body, and that basically I have the bad luck of poor insulin function, so, why tax and stress my pancreas by eating a normal high carb diet?

FWIW the "GD diet" suggested by the dieticians had WAY too much carbs for me, I would have been on meds if I'd folllowed it. I used the meter to determine what I could eat, and was lucky to be able to bring numbers down effectively that way. 

My mom has tons of extra strips (she has well-controlled, non-insulin-dependent type II and doesn't need to constantly test), so I may just look for a good price on a meter that accepts the same strips, and use hers. Since without at GTT I may have a hard time getting a prescription for the strips. And they are so darn expensive!

I found the blood sugar 101 website SUPER informative and gave me hope that I could slow or maybe halt the progression of insulin resistance/type II by eating differently.

[ThreeCats]

Emma - you may be surprised about the prescription. I had no trouble getting one for a new meter and strips (my insurance decided they would no longer cover the strips my old meter used - lame) without a diagnosis - I wonder if having the diagnosis from last time was enough? Anyway, just something to think about if you have trouble finding a meter. I could have written most of your post, including the part about the GD diet being too high in carbs. I won't be following it this time. Instead, I'll be continuing to eat mostly South Beach style - I lost a bit of weight (easily) with it pre-pregnancy, and I really feel good [healthy] when I stick to it.

[NicaG]

How do you find a good dietician? With both my pregnancies I was just referred to dietitians affiliated with my hospital's gd program. With my most recent pregnancy (3 yrs ago) the dietician was just awful, seemed like she was mostly an educator for elderly diabetics. I'd like to avoid seeing her (or her department) again, but I don't know if I shoul start now or wait. My ob isn't very proactive about any of this (won't even see me unti 8 weeks).

If your gd was diet/exercise controlled, how did you keep your fasting numbers low? Was there a certain bedtime snack that worked? Or something else?

[lifeguard]

emma - that's an interesting website - thanks. I too find that the recommended amount of carbs are too much. I also found that my body could NOT tolerate fruit in the mornings (which was recommended to me) but it was fine in the afternoons - so each body is different.

nica - not sure how to find a good one. With ds I used the one the doctor recommended - she was ok but not fabulous. This time I am seeing a nutritionist who actually specializes in strength athletes - I will be his first pregnant woman all the way through the pregnancy - but I trust that he is going to work with me & help me adjust things as we go.

FWIW - I think we can do everything "perfectly" with food & diet & some of us will still end up on insulin. Try not to stress too much about that. Try a few different things to keep your bs within the limits you're giving but don't beat yourself up if it's not enough. I was doing everything EXACTLY the way I was told & still could not get the numbers they wanted, we switched up my insulin & instantly the numbers were good. This time I fully intend to skip the stress about it (hahaha - easier said than done!).

[AlexisT]

My 8wk GTT was 127 and I have insulin resistant PCOS, so I'm nervous that I'm going to get it. (Last time, I was 110 at 28 weeks!) We'll see what happens.

[Gabesgrrrl]

oooh...yes! That's it. Sorry if I got my lines crossed. I also have read something about Vitamin D helping with GD...

[emmaegbert]

yes, lifeguard, I hear you. I have to watch my tone (hard online anyway). I truly believe that I was LUCKY to have good information and support, and to have a body that responded well to diet and exercise. and, I fully recognize that my GD was really borderline. Actually something I really appreciate about that website I mentioned is that she stresses that we do not cause our own diabetes, insulin resistance, etc. And that the goal is to have safe, normal, healthy blood glucose levels. For some people, diet will work, but medication is much preferable to out of control blood sugars. I think I was probably too hard on myself about having perfect numbers- I stressed out about it WAY more than I should have given how good my numbers actually were. It does bother me that the recommend carbs at relatively high amounts though. I don't think many people who are insulin resistant could eat that diet and have good numbers.

Originally Posted by lifeguard 

FWIW - I think we can do everything "perfectly" with food & diet & some of us will still end up on insulin. Try not to stress too much about that. Try a few different things to keep your bs within the limits you're giving but don't beat yourself up if it's not enough. I was doing everything EXACTLY the way I was told & still could not get the numbers they wanted, we switched up my insulin & instantly the numbers were good. This time I fully intend to skip the stress about it (hahaha - easier said than done!).

I also heard that about vitamin D possibly having a link. I have been much better about supplementing ever since the pregnancy with #2 so I will keep that up and hope it is helpful. (I wasn't woefully low but certainly just on the line of normal... when I was tested PP after months of vit D supplement, in the midsummer, as a light-skinned person in San Diego. So maybe I was low during the winter when I was pregnant and developed the GD).

[NicaG]

Originally Posted by emmaegbert 

yes, lifeguard, I hear you. I have to watch my tone (hard online anyway). I truly believe that I was LUCKY to have good information and support, and to have a body that responded well to diet and exercise. and, I fully recognize that my GD was really borderline. Actually something I really appreciate about that website I mentioned is that she stresses that we do not cause our own diabetes, insulin resistance, etc. And that the goal is to have safe, normal, healthy blood glucose levels. For some people, diet will work, but medication is much preferable to out of control blood sugars. I think I was probably too hard on myself about having perfect numbers- I stressed out about it WAY more than I should have given how good my numbers actually were. It does bother me that the recommend carbs at relatively high amounts though. I don't think many people who are insulin resistant could eat that diet and have good numbers.

I also heard that about vitamin D possibly having a link. I have been much better about supplementing ever since the pregnancy with #2 so I will keep that up and hope it is helpful. (I wasn't woefully low but certainly just on the line of normal... when I was tested PP after months of vit D supplement, in the midsummer, as a light-skinned person in San Diego. So maybe I was low during the winter when I was pregnant and developed the GD).

I really struggled psychologically with gd, it came out of nowhere (I had no risk factors except being over 30), and I was not able to control it with diet and exercise.  It was difficult for me to be kind to myself, not blame myself, etc. but I was doing everything right and still could not control it.  I have to remind myself not to go on "should I test for gd?" threads here on mdc, because so many of the responses are "gd doesn't really exist" or "read henci goer" and it just makes me feel even worse, like if I were a better mother I wouldn't be prone to gd. 

It's really interesting to read about how different dieticians' diet plans vary so much.  Seems like the more I read, the more I think I should just cut out bread/starches and liquid dairy altogether, and go even lower on carbs at each meal and add lots and lots of leafy greens.  Easier said than done for me....it's already hard enough that I am short-order cook to my picky kids and dh, next I will be cooking 4 separate meals 3 times a day!

It's really frustrating how there doesn't seem to be one standard of care for gd, or even one reliable source/website for information. Or even a decent blog!

[lifeguard]

I am SO glad I'm not the only one that has had these struggles with feeling like it's my "fault".

The lack of information available for gd. I have read everything I have found during my pregnancy with ds until now & there is very, very little & most of it is simply "some people get gd, it's usually controllable through diet & exercise". Totally unhelpful. I actually found the old gd thread here the most helpful.

[NicaG]

Lifeguard--I remember you from that thread, back in 2008!

[emmaegbert]

YES. Also frustrating that of course there are probably multiple reasons why women develop "GD"-- and so management of it probably has to be very different depending on the particular patient.

Originally Posted by NicaG 

It's really frustrating how there doesn't seem to be one standard of care for gd, or even one reliable source/website for information. Or even a decent blog!

The dietitian I saw at the hospital education session gave us all the official info, then she put the charts and plans down and said "what really matters is your meter readings". She emphasized to us verbally that as a GD and Type II diabetes educator for years, she has come to believe that fats and protein can be eaten to satiety, and that carbs cannot be tolerated by some people except in very small amounts. She also said most GD patients have to eat a very low carb breakfast, often no carb servings at all. And that you should spend a week or two adjusting your diet depending on your meter readings. At which point either you will pretty much know what you can and cannot eat, or, if that is not effective, its time to start medication. I appreciated her expertise and info- she was much more helpful than I expected. But it made me mad that in the reams of paper we brought home, this was nowhere! So a conscientious educator KNOWS the official diet is problematic for most patients, yet still has to go on handing out the info.

My HBMW was also really knowledgeable about nutrition and diet, and she said similar things- that the standard american diet is really not a good starting point. She was gluten-free herself, so understood how challenging it can be to cut out something considered a vital food group by most people (i/e grains/starches: I think we can probably live just fine without grain... relatively recent in human evolution to have a grain-based diet... but it sure is inconvenient!) She really read my food logs carefully and gave me feedback. She was concerned that I not be undernourished (the 5 weeks of weight loss in third trimester bothered her) or start experiencing hypoglycemia (around week 37 we realized I was dropping into mid-70s in between meals and she was adamant that I start eating more or closer together b/c that wasn't good for me either). The hospital-based folks only worried about high numbers and weight gain, and not the flip side.

Funny you mention there isn't even a decent blog. DH has been urging me for a while to do a food blog (for my vegetarian, whole-foods, low grain, low sugar recipes), and when we found out the (HUGE surprise) that I'm pregnant again he says even more so... he remembers how hard I searched for any info when pregnant last time. I ended up using the things my mom has learned from dealing with type II and the info on that blood sugar 101 site, along with the old GD support thread to guide me.

Sadly I think there is so much stigma around diabetes in general. Its such a prevalent disease, very much misunderstood. And those stupid ad campaigns like "eating junk food will give your kids diabetes" don't help- so many people get the takeaway message that diabetes is caused by eating junk food. So, we all must be these gluttonous unhealthy people who did this to ourselves. Not that I am advocating feeding kids junk: of course not! But I think its clear that diabetes is caused by complicated genetic and environmental factors and interactions, many of which we have no control over. This stigma all interferes with a message that might actually help people prevent the progression of and complications of a truly serious disease.

Having the GD kind of made me feel like I had an induced eating disorder (something I've never had, but it really gave me some insight into what that might be like!)... I became so obsessed with my eating, and I really judged my self-worth by those stupid numbers. I remember we'd walk once a week to the $1 cone day at Baskin Robbins (about a mile each way), and I'd stop right before we got there and check my blood sugar reading, I remember how BADLY I wanted to see a low number so I would feel like I was "allowed" to have my once a week junior size scoop of ice cream. And how "scared" I was to test my levels an hour after eating it (they were always fine). I really hope I can steer away from that attitude more this time.

[lifeguard]

Originally Posted by emmaegbert 

Sadly I think there is so much stigma around diabetes in general. Its such a prevalent disease, very much misunderstood. And those stupid ad campaigns like "eating junk food will give your kids diabetes" don't help- so many people get the takeaway message that diabetes is caused by eating junk food. So, we all must be these gluttonous unhealthy people who did this to ourselves. Not that I am advocating feeding kids junk: of course not! But I think its clear that diabetes is caused by complicated genetic and environmental factors and interactions, many of which we have no control over. This stigma all interferes with a message that might actually help people prevent the progression of and complications of a truly serious disease.

Having the GD kind of made me feel like I had an induced eating disorder (something I've never had, but it really gave me some insight into what that might be like!)... I became so obsessed with my eating, and I really judged my self-worth by those stupid numbers.

Yes, yes & yes! It angers me SO much that I eat healthier than 95% of the people I know irl yet I'm the only one who's had to deal with this. I totally feel like people think it is my fault for what I eat & if I'd just lose more weight (something that has proven to be incredibly difficult for me despite my healthy lifestyle) it wouldn't be an issue. Even the endo I had last time hospitalized me for 3 days "to get my numbers under control" after a day of them feeding & monitoring me (waaaaaay more carbs than I had been eating) he came in & went "OH". So he pretty much figured I'd been lying about what I had been doing. Sigh.

Oh the mood swings from the readings!!!! Especially before we got the insulin right & there was no rhyme or reason for the numbers - even when I would eat the same thing at the same time. Super frustrating.

I hope this time will be different for all of us. Ideally no gd at all but if that's not possible for it to at least be a lot less stressful for us.

[NicaG]

It is really strange that diabetes is now an epidemic in this country, yet there are so many conflicting messages about what to eat if you are diabetic/prediabetic/gestational diabetic.  I've had two dieticians tell me that there's no difference between eating white bread vs. whole grain bread. Neither of my dieticians have said anything about glycemic index.  I've looked at countless websites with all kinds of yucky looking "substitute" foods (pizza crust made from eggs and soy flour, desserts made with all kinds of artificial sweeteners). It seems like no one is willing to stand up for a more radical approach to diabetic eating--celebrating all the fresh great vegetables and lean meat that diabetics CAN eat, rather than just trying to recreate foods that were never very good for you to begin with, in a way that doesn't taste very good either. 

Re: mood swings over meter readings: during my last pregnancy I had to report each week's numbers to my gd clinic and to my dietician.  My numbers were generally very good (especially once my nightime insulin was right), but I usually had one or two slightly high readings here or there.  And sometimes that's even helpful, to know what to avoid next time.  Without fail, my dietician would call me back and ignore all my great numbers and ask in a stern voice, "what went wrong there?"  It made me feel so awful I considered lying about my numbers to her, or "forgetting" to call them in.  The gd clinic was always much more positive and understanding.  Emmaegbert, I love your comment about having "an induced eating disorder" that's such a perfect description.

Wow, it feels good to vent some of these feelings!  It's really helping me adjust mentally to the changes I have to make, knowing that others are going through the same thing.

[emmaegbert]

NicaG, check out the paleo and primal people. they celebrate all the delicious stuff you CAN eat. I find them dogmatic and crazy in their own way at times, but far more inspiring in terms of actually preparing satisfying and delicious food than the low-carb substitute stuff (though I have come to really like some of my own favorite "substitute" foods... which are whole-foods-based... things like cheese/egg pancakes with berries and yogurt... waffles made with coconut milk, coconut, and almond flour... enchiladas rolled up in collard greens... zucchini fritters (rather than potato pancakes) with sour cream... cheese/coconut flour biscuits... yum). Also the traditional foods board here on MDC usually has a grain-free/paleo/primal thread going and people have lots of ideas. Because I don't eat meat, I can't eat a lot of the stuff, but even just the idea that a meal can be based on protein and veggies and can be delicious and satisfying is very inspiring for me when I am feeling at a loss as to what to eat. Girl Gone Primal is a great blog with delicious recipes, and she's recently started writing about her own emotional dysfunctionality with food which is also interesting. And Nourishing days has good recipes that I've enjoyed.

[anthasam]

I have yet to make any announcements as I had a late miscarriage in Oct, but I will be joining you all with a super-early Oct due date. Anyway, I had GD with my first and second pregnancies. I am thin, no family history and the first time around, I was just under 30 year old. I was able to control the GD both times with an extreme diet (especially at breakfast) and exercise. I fully expect to have GD this time around as well (I am still thin, but now of "advanced maternal age" ;)

With the second pregnancy, I declined the blood tests and just got a prescription from my midwife for a meter and strips. It was covered by insurance - no "proof" needed. I tested my bs 4 times a day and made adjustments to my diet accordingly. I ate TONS of non-starchy veggies, eggs, nuts and meat. Cheese also worked, but milk and yogurt would elevate my bs. I ate miniscule amount of pasta, potatoes, barley, etc. I had to replace bread with wraps at lunch.  Personally, I found a difference when I ate carbs with different glycemic levels.

I declined to submit my bs levels each week with my second pregnancy. If I had a "bump" or trouble spot, I was able to speak to a nurse/dietitian at the perinatology office. She was great!

Both babies were just over 8lbs and LATE. I had to fight both times to avoid induction, but the natural births and healthy babies that resulted of my hard work were totally worth it :D