GD moms, how is it going?

[emmaegbert]

So... there was a thread a while back and I remember quite a few moms expecting to deal with GD... wondering if anyone wants to check in? We are getting closer to the time when it might actually start affecting blood sugar numbers, right?

I'll start- but I'd be interested to hear how others are doing, how your healthcare providers are approaching this, etc.

I have done a little spot checking- numbers have been fine. But I checked fasting this morning and it was 93 which I wasn't thrilled about. But I am sick, and I go upstairs to use my mom's meter (we live downstairs from them, she has type II. I don't have a meter of my own right now), so it wasn't an immediate number. I am going to try again a few days when I feel better and hope to see it a little lower.

I'm almost 16w now. As far as I can tell I really haven't gained weight (I don't weigh myself all that often, but at most a few lbs, however I think really pretty much stable). I am basically doing a low-carb diet, though not as strict as I sometimes follow. Little to no grains, no potatoes, no juice or liquid milk, limited fruit (like 1 or 2 servings a day) and limited sugar (am having some but keep it to ice cream or dark chocolate which are much lower carbs than cakes and cookies and whatnot). I have been allowing myself one small breadlike treat a day... not every day... but usually for morning snack. Something small. I tracked for a week using babyfit and I may do that- like a week once a month or so? I was keeping total carbs under 150, and some days well under that. (and that doesn't include the fiber, which for blood sugar regulation purposes you can basically subtract from the total carbs).

My midwives are fine with skipping the GTT and pretty much treating me as a GD mom. We are just going to spot check my numbers and once my insurance is worked out they will order me my own meter and I'll probably check fasting every day and one post-prandial number which I'll rotate around. They feel like if numbers are looking good, no reason to obsess about it. If numbers are looking high, I'll start logging food regularly and testing more often, make sure to keep them within healthy limits.

They say due to age (I will be 37) and the GD, they would like me to do an anatomy scan at some point, maybe later in pregnancy though, 36 weeks or so. Since we are planning a homebirth and would want to know of serious problems ahead of time.

Oh... and my GD was fairly mild with #2 (didn't have it with #1). It was diet-controlled- and VERY tight control. But I think I obsessed and worried over it far too much and want to take a more relaxed approach this time- but one that doesn't ignore health either. I had a HB with #2, she was 9lbs, and seriously born with 3 pushes. Whole labor under 3 hours. So I am personally not worried about having a big baby (I assume I will, and I know my body can birth big babies). I am more concerned with long-term implications for myself and for my unborn child of being much higher risk to develop type II later in life.

[NicaG]

Hello, I just got back from the doctor, I am almost 16 weeks along. I have been really sick up until a few days ago, all-day nausea and sometimes vomiting, so my diet has not been great.  But I am hoping to cut back on carbs as soon as I'm feeling better.  I have been arguing with my doctors somewhat because they want me to do the 1-hour test early, like around 22 weeks.  This is my 3rd baby, and I had gd with the first two.  With my last pregnancy, I took the 1-hour test at 22 weeks and failed, but then I passed the 3-hour.  So then I had to do it all over again at 28 weeks, when I failed both tests.  It was a huge unpleasant hassle, and I'd rather just start treatment without the tests this time.  The doctor tentatively agreed that I could bring in a week of numbers instead of submitting to the 1-hour test.

My fasting numbers have been a little too high, like between 90-100, but I've only been spot-checking here and there.  Post-meal numbers are fine.  I am going to try to experiment with bedtime snacks to try to get my fasting numbers lower, but I suspect there's not much I can do. 

Anyway....how's everyone else doing?

[Shonahsmom]

Originally Posted by emmaegbert 

Oh... and my GD was fairly mild with #2 (didn't have it with #1). It was diet-controlled- and VERY tight control. But I think I obsessed and worried over it far too much and want to take a more relaxed approach this time- but one that doesn't ignore health either. I had a HB with #2, she was 9lbs, and seriously born with 3 pushes. Whole labor under 3 hours. So I am personally not worried about having a big baby (I assume I will, and I know my body can birth big babies). I am more concerned with long-term implications for myself and for my unborn child of being much higher risk to develop type II later in life.

This is me exactly. I wasn't even officially diagnosed with GD, my numbers were borderline, but I became pretty obsessive. I checked my number 4 times a day, every day from 28 weeks on. As long as I ate well and stuck to high protein and low carbs, my numbers were totally fine. If I ate white pasta or cookies, my numbers jumped and they jumped high. So, this time around, I know how I need to eat and I think I'm just going to spot check a couple of times a week, alternating times to make sure nothing surprising is going on. But I don't want to drive myself totally nuts. Also? DS was only 7 lb 6 oz and had no blood sugar issues.. so I think its okay to be a bit more relaxed this time.

Like you, I am also much more concerned about the long term implications.

[emmaegbert]

NicaG: yah that GTT is SO GROSS and obviously unhealthy. I don't get it, if you've already had GD, why not just go straight to testing. I am so glad my MWs are cool with that. I hope you can talk some sense into your docs ;)

Shonahsmum: I was pretty much borderline with the second 3hrGTT I did (passed the first). Fasting- normal. 1hr- slightly high. 2hr- literally borderline. 3hr- normal. So, no surprise, my 1hr postprandial numbers were generally the issue, when there was one. But it was usually obvious why, like I ate some unsweetened steel-cut oatmeal or something else equally "healthy". Blah.

[lifeguard]

I saw my ob today. He mentioned doing the test after the next appt (in 6 weeks) but we discussed me doing testing on my own briefly. I plan to go to the next appt with a log of at least a week's worth of numbers (good or bad) & hopefully avoid the test. I know I will fail the 1 hour & really who has the time or desire to sit there for 3 hours?!

On the upside when I asked what numbers he would want to see he said under 5 for fasting & under 7.8 for post-meal. That is significantly easier to follow than what I was given with ds (under 4 for fasting & under 6 for post-meal) & based on my numbers last time I will not have any trouble following these guidelines. Kind of irritating that just changing care providers changes how the whole thing is approached!

[~pi]

Just crashing the thread to translate for the Americans from mmol/L to mg/dl. (I do this a gazillion times a day, as my pump and meter are in mmol/L but my continuous glucose meter is in mg/dl.)

5 = 90

7.8 = 140

4 = 72

6 = 108

[emmaegbert]

Hi Pi- thanks for that! And you're not crashing- totally welcome here, but I'm not sure how relevant the GD thread is to someone with Type I.

And Lifeguard- that is kind of crazy. The wanted your fasting number LOW. like, unhealthy low from what I understand (below 80 is hypo, that is what I was told!) Your new numbers are what I had to hit last time... well, my post-meal was a little lower and was an 1-hr target, and fasting the same. My new MWs are less crazed about it, they want to see 2hr numbers.

[emmaegbert]

okay, very happy to report that after a dinner of split pea soup, bean and corn salad, green salad, and broccoli, with a little pasta (all take-out), and then a (homemade) whoopie pie for dessert (that is what DS likes to have on his half-birthday, definitely not a staple around here)... I borrowed my mom's meter and checked, and my 2hr blood sugar number was only 99! (and, thanks Pi for the formula, I am editing to add, that is 5.5mmol/L) That was the first time I've been brave enough to test after a haphazard meal that included a bready-type dessert and I am happy that it was so normal. Phew. I am going to stop worrying for a few weeks.

Edited by emmaegbert - 5/12/11 at 6:32am

[lifeguard]

Thanks Pi! I didn't have the patience the other night to google the conversion - I used to know it as my care in Costa Rica was in one but meter in the other but I can't remember it now!

emma - the discrepancy is SO frustrating to me. Even when I was dealing with gd last time everything I read indicated that higher numbers were ok but my care providers insisted on these low numbers which were IMPOSSIBLE to meet. I was SO stressed about it all the time. So far the haphazard testing I've done would happily keep within the new numbers so that gives me some hope I can avoid an actual diagnosis this time. That's great to hear about your good reading!

[~pi]

Originally Posted by emmaegbert 

Hi Pi- thanks for that! And you're not crashing- totally welcome here, but I'm not sure how relevant the GD thread is to someone with Type I.

Not very relevant, but thanks.

Originally Posted by lifeguard 

Thanks Pi! I didn't have the patience the other night to google the conversion - I used to know it as my care in Costa Rica was in one but meter in the other but I can't remember it now!

You multiply by 18. So 5 mmol/L = 90 mg/dl. In a pinch, just multiply by 20 to get a rough guess.

[emmaegbert]

okay reviving the thread to ask... what are your thoughts on a low fasting numbers? My AM fasting number today was 71, I read that 70-90 (or 85 depending on who is deciding) is normal, I know its not hypo. But I am usually in the low 80s so low for me. I was at the beach all day and eating carbs and crap the day before, pretty much. Anyway, is this something that has happened to any of you all? Good, bad, doesn't matter?

I have a MW appt on the 28th so I'll show the MW my spot-checking numbers and see what she thinks.

[ThreeCats]

Originally Posted by emmaegbert 

okay reviving the thread to ask... what are your thoughts on a low fasting numbers? My AM fasting number today was 71, I read that 70-90 (or 85 depending on who is deciding) is normal, I know its not hypo. But I am usually in the low 80s so low for me. I was at the beach all day and eating carbs and crap the day before, pretty much. Anyway, is this something that has happened to any of you all? Good, bad, doesn't matter?

I've been monitoring my sugar my entire pregnancy - first 4x a day, then 2x, and just fasting for the past couple of months. Mine's been averaging about 78, but has been as low as 69 (on a handful of occasions) and has been as high as 86. 71-72 isn't at all uncommon for me. My doctor hasn't mentioned anything (even about the 69's) so I assume it's fine.

[emmaegbert]

Interesting. I didn't realize they could bounce around so much. When I had GD with my second, the hospital-based diabetes in pregnancy program loved all my low #s. My HBMW, who had a much more holistic/big picture perspective... She wanted me to not drop too low either. To keep blood sugar levels more in a band of normal. But I won't worry for now, I'll just let my mw know at the next prenatal.

[~pi]

Keep in mind, too, that all sorts of things can alter your readings. What you have on your hands, how hydrated you are, how old the strips are, and so on. Meters are considered accurate as long as their readings are +/- 20% of plasma lab values.

Try testing twice in a row a few times with the same drop of blood -- you'll see that there can be quite a variation. I have to do this for my continuous glucose monitor as calibration to start a new sensor, and last time, I had an 11 point difference between the two readings. Same meter, same vial of test strips, same drop of blood, same everything, just different readings. That's a bit more gap than I usually see, but it's well within normal range. And I have a top of the line, regularly calibrated meter.

Personally, I wouldn't even blink about a variation of 10 points, but my perspective is totally different. I.e., I consider the range from about 70 to about 90 to be essentially equivalent as far as fasting numbers go. But type 1 has much larger variation, so I may not be the best person to comment here.

[emmaegbert]

Pi, thanks for that reminder. I just don't have a lot of strips (and they are dang expensive if they aren't covered by insurance) so I am reluctant to use too many. If it had been below 70 I probably would have retested. I may have been somewhat dehydrated, which could have thrown off the reading. Anyway I shouldn't be stingy, my mom lives upstairs and has type II, and she generally has extra strips. I purposefully bought the same brand meter so I wouldn't have to worry about it.

Anyway... I figured I might do fasting every day for a while just to see what I'm getting.

I did get my own meter and strips last week, so now its easier for me to be testing at least 1x per day. (rather than just occasionally borrowing my moms meter... and her blood sugar has been all whacko, getting hypos and stuff, so she actually is using it more than she was before... until the past few months her blood sugar control has been very good. But thats a whole other topic!). So far I've not had high numbers (well, 126 1hr post-meal after one dinner, but that is within targets... other 1hr post-meal numbers have been high 90s and low 100s) so that is good news. I am currently about 23 weeks and with #2, I passed at 3hr GTT at 20 weeks and retested at 28, when I had one high reading and one borderline. So, I guess we'll see how numbers look in the next month or so. MWs are treating me as if I have GD but also keep reminding me that its even possible I won't develop it again. Anyway like I've said before, we aren't even planning to do a GTT (unless, I guess, we decided we could really get more info from that than just by testing post-meal and fasting numbers at home. But for now, I can't think what we really would find out...)

[lifeguard]

Well, with ds I was certainly never given any indication that low was bad unless it was WAAAAY low & then you know it 'cause you feel it.

I saw my ob today & he wants me to do the glucose challenge this week & again in 4 weeks (depending on how the first one goes). I tried to get him to let me skip the 1 hr & just go directly to the longer one (here they do the 2hr not the 3) but it was a no-go. Not in line with his protocol - sigh. I really just wanted to avoid drinking that AWFUL crap more than once. Plus, either way I can't see how I could possibly bring ds with me so if I need to get someone to care for him while I go do it I'd rather do that just once.

Everyone thinks I am being negative but I'm certain I won't escape the diagnosis this time. I've tested periodically & although the numbers are never high they are also not consistently as low as they like, especially my fasting. Sigh. Despite being sure I will have it I know I will be very upset when I actually get the results - I've been working so hard with my diet.

[emmaegbert]

Lifeguard, I think you will have a much better experience this time. Your OB has given you targets that are much more achievable. Please but those numbers from your last pregnancy out of your head. Seriously. Also, it sounds like you are starting out at a significantly lower weight (and healthier and stronger body) and with such better handle on your diet, etc. Sorry you have to do the GTT though. After my 3 tests last time I swore I wasn't going to do it again unless it was, in my opinion, medically necessary. I actually asked about it when interviewing MWs and partly chose these ones b/c they seem very knowledgable about managing GD AND were fine just skipping the GTT and going straight to self-monitoring (one of them had it herself and told me it is actually one of her "passions", educating people about GD and helping moms to manage it through diet and realistic blood glucose goals). And FWIW you don't sound negative at all. Realistic, proactive... IMO its the *label* and what comes from that which is so negative.

And I don't know. My HBMW for #2 who was concerned that I not have super low numbers either (and also did not like my unintentional weight loss over a few weeks) has been attending home births for over 20 years, and has a whole other practice in holistic health, is an acupuncturist, etc. She insisted that its important to pay attention that if my fastings were going too low, it was a sign I was not eating enough or frequently enough, and that if my post-meal numbers (1 hr) weren't at least around 100, same thing. She was saying, normal pregnant women have slightly elevated blood glucose, fetus actually needs glucose to grow, etc. I don't know, she was pretty out of mainstream for a lot of things, but I did think it interesting that the mainstream medical folks, for example, did not care AT ALL what I was eating, what exercise I was getting, whether I was getting fasting numbers that were dipping low, they really ONLY looked at highs and weight gain. I think that in my case, I was fine, but it might miss problems too, like reactive hypoglycemia, etc. With many things to do with diabetes... because there are so many different ways that a particular person's body is handling glucose/insulin, and many ways it can go awry, focusing only on the high numbers might mean that health care providers are missing other info.

[lifeguard]

I totally agree that the focus on just high numbers is misguided & unhelpful. I do think my ob this time is much more realistic (& to be fair last time it was not my ob but rather the endo that caused me the stress) & it will go better. I think part of my stress/disappointment is that so much of motivation for continuing with my workouts & the diet has been to avoid a gd diagnosis & it doesn't look like we are heading that way after all. Realistically I know it is still the best thing for me to do but some days it just doesn't seem worth all the work. I miss carbs!

[emmaegbert]

I hear you lifeguard, I am feeling discouraged sometimes and sort of wish the MWs had never suggested that I might not develop GD this time around. But being able to have targets you can actually hope to achieve with careful diet is going to be so much easier on you. those numbers from your last pregnancy are crazy and make no sense. I still think they sound unhealthy.

[Shonahsmom]

I have totally slacked on my diet and on monitoring myself. I ran out of test strips and kept forgetting to buy them. I finally bought some on Amazon yesterday and they should be here tomorrow. Time to get my butt in gear over here.