gestational diabetes mama help please!

[herenow2]

I failed my 1 hour test back at 28 weeks (just by one point), but had a previous bad reaction to the 3 hour test so my ob has let me monitor my blood sugar instead of doing the 3 hour.  I have been monitoring and all my numbers have been great (my doctor has said - she's sure I would have passed the 3 hour test based on my numbers) though I eat a very low carb diet naturally, so that makes it a little complicated.  My fastings have been in the mid 70s and postprandials were 100 or so and go down really quickly.

However, out of nowhere this past week (I am 36 weeks right now) my fastings have climbed up to the mid 80's, though post-prandials are the same.  My diet has not changed but I am not exercising nearly as much as I was because I have had pubic symphysis problems that prevent me from swimming and walking much, so it may just be that my exercise had been keeping my numbers down.  

I know my doctor had said at one point that the endo she works with puts people on insulin if they can't keep their morning fasting number under 80, but that seems really strict to me.  

I am a little hesitant to tell my doctor unless they get over 90 because I know she will want to either send me for insulin and / or induce at 39 weeks and take my baby away from me for blood sugar testing at birth etc.  Especially, if mid 80's really isn't that bad, I don't want all the interventions.  

So, is mid 80's really that bad?  I have read in some places that fasting numbers are okay until 95.  Anyone know anymore about this?  I definitely don't want to put my baby at risk but feel like unnecessary interventions may be doing that as much as not doing anything at all considering how little time I have left.

Would LOVE some input.  Thanks!

[azohri]

Fasting under 90-95 is the new standard, and even that has been lowered in the past year from 100-110.  I definitely wouldn't worry about it or mention it, though I'd watch to make sure it didn't go higher.  You're so close anyway!  I mean really, any intervention at this point seems worse than whatever the supposed problem is from borderline fasting numbers. You could try changing your bedtime snack up if you are worried about it.

[katelove]

My targets are <5.5mmol fasting and <7.0 post-prandial ( there are online converters if you want to know what that is in mg/dL).

I would be interested to know what the endocrinologist is basing his/her insulin criteria on because those numbers do seem very low to me.

If you are concerned about your fasting levels you could try looking at what you're eating at your after dinner snack and see if you could add a bit more protein and fat but if everythIng else is ok in terms of the baby's growth and your overall health it sounds fine.

ETA - I just reread your post and saw that you normally eat low carb. In that case it may be that you need to add a little bit of extra carbs to your dinner and/or pre-bed snack. The liver naturally releases glucose in the early hours of the morning to maintain blood sugar levels during the overnight fast. If your glucose requirements have increased due to pregnancy your liver may be releasing more in the early hours which is being reflected in your fasting BSL. A bit of extra carb at night might help to keep things more even. I'd probably try it for a couple of days and see if it made a difference.

[Monkey Keeper]

Chiming in with my numbers--my situation is similar to yours in that I didn't take the 3 hour and may or may not actually have GD.  

I need to be under 90 fasting.

One thing that definitely has helped me is to be sure to eat a bedtime snack and particularly one with both carbs and a good dose of protein.

[herenow2]

Thanks everyone.  The under 90-95 fasting numbers seem to be a pretty universal standard.  I swear this endo is a little nuts.  When I spoke with her she honestly seemed to think I was crazy for eating lower carb (really it's just a lower grain diet, plenty of fruits and veg and I am really confident that it is a healthy way to eat!) and she wanted to hold me to totally different standards.  If I start getting over 90's, I'll definitely speak with my OB, but till then I am just going to watch and fiddle with my evening meals a little, as you all suggested.  I do wonder why my fasting numbers are rising now, I was under the impression they usually go down as pregnancy progresses.  Hmmm.

[jenrford]

Originally Posted by herenow2 

 I do wonder why my fasting numbers are rising now, I was under the impression they usually go down as pregnancy progresses.  Hmmm.

I've been tracking my blood sugar levels all pregnancy (am now 32 + 1), and I've noticed my morning fasting numbers creeping up over the last few weeks, too. Since the beginning, my fasting numbers were between 84 and 91 or so, but now some mornings I've had as high as 96. I don't know how it can be explained.

My midwife isn't worried, because all of my other numbers have been stable, but of course that doesn't stop me from worrying.

Anyway! I wanted to say that I think the endo is unreasonable, and it sounds like you're doing great. I wish I had some info to share about the elevated fasting numbers, though. 

[katelove]

Overnight your liver releases glucose to maintain your BSL while you're fasting. Your pancreas also releases insulin to allow uptake of the glucose into the cells. As pregnancy progressed insulin resistance increases as do the levels of some placental hormones which probably also play a role although the evidence is still patchy there.

The fasting BSL can't really be controlled by diet and exercise so, while you may be able to keep your post-prandial levels within the target range there isn't much you can do, lifestyle-wise to influence your fasting level.