Gestational Diabetes Support Group - Page 64

[lady1297]

Is there a new thread? I didn't see one.

I have GD and am having some push back from my diabetes clinic to go on insulin. My morning numbers are in the lower 90's through 110 this morning. Vary a lot.  Then the breakfast numbers can be normal (under 130) or just over, highest being one time at 140. 

The other numbers I can keep low by taking a walk, but it's just not possible in the a.m. with the kids scheudles. Well, I guess it would be if I walked them to school, but every day isn't always nice enough for that. And I'm 32 weeks pregnant...I really don't WANT to walk 3 times a day right after meals then come home and clean up after meals and be present to my kids.  I just don't have it in me.  I guess I'm whinning a bit, but does anyone have suggestions? I am supposed to see the dietician on Wednesday, but it is just not going to work for 8 a.m. with three children who need to be in school between 8:30 and 9.  They were less than accomodating for me (this is my first dietician visit in 4 weeks after the initial one. And at that first visit, she kept telling me to eat 'this or that or this or that" and most of it was not stuff we eat (we are highly perimeter shoppers with few processed foods thrown in.  So I left frustrated).  I saw that exercise before bed may help (gah, one more 'walk") or to eat something in the middle of the night? Thoughts??

[ellairiesmom]

I only have a sec but wanted to say that if medication becomes necessary, see if metformin is an option over insulin.  Metformin has not seemed to be as much of an issue in creating the larger babies like insulin has been linked to & it is in a pill form.  Much easier to deal with.

Yes-for awhile, certain snacks at midnight & late evening ex helped my AM fasting #s & I know we'd like to think we can control it & avoid medications but the fact is, some women have blood sugar that needs a little.  You can try all the tricks but if they don't work, and your high blood sugar is posing a risk to your baby, a little metformin is not a big deal.  

I had GD with both.  Did insulin the last 2 mos with DD1 because my AM fasting could not be controlled any longer with diet & ex.  She was almost 10lbs & I ended up with the section after a long labor.  With DD2, I took metformin the entire pregnancy, never had any insulin & she was 7 lbs, 8oz and I got my VBAC.  Obviously, there is more to it than this, but I believe metformin was a major factor 2nd time around.   

[Plummeting]

Originally Posted by ellairiesmom 

I only have a sec but wanted to say that if medication becomes necessary, see if metformin is an option over insulin.  Metformin has not seemed to be as much of an issue in creating the larger babies like insulin has been linked to & it is in a pill form.  Much easier to deal with.

Insulin does NOT "create the larger babies". In fact, insulin doesn't even cross the placenta. The reason women who need insulin are more likely to have bigger babies than women who manage on metformin alone is because needing insulin is a sign that their blood sugar is less well-controlled. It's the blood sugar that causes the bigger babies, not the insulin.

[lady1297]

This is kind of a side question, but will the check the size of the baby before worrying so much about how big? I've had a 9 lb 6 oz baby, big babies don't really scare me much (though he did have shoulder dystocia and meconium in the water because he was stressed by 2 weeks of 'trying' to get out and not making it. OB didnt' seem worried about baby's size last time around, so i wasn't so worried. Are there other concerns?  They warned me of maybe needing to give baby glucose which I already told them won't happen unless sugar levels are dramatically low, I'll breastfeed and they can retest as much as they want (they tried that with my other son and breastfeeding raised his levels to 'normal' rather easily).

Other than size, what is the concern really? Are there studies of how "abnormal" the levels should be to affect the baby's size? Mine really are with 5 or 6 points of where they want them, I'm personally not as worried as the diabetes clinic seems to be. I think they are pretty darn close (97 rather than under 95 for example, or 131 rather than under 130).

[Plummeting]

Other concerns:

Takes longer for lungs to mature

Increased risk of respiratory distress syndrome

Polycythemia (too many red blood cells, which can cause all kinds of other problems)

Reduced iron stores, increasing risk of infection throughout the first year of life

There's are the ones I know of, and those actually concern me more than the baby's size.

I don't know if there are studies showing what BGs cause macrosomia. I would imagine that would be hard to pinpoint, since babies come in all different sizes anyway. There is new research showing that shoulder dystocia is much better predicted by measuring the baby's abdominal circumference and something else - I don't remember what. You should be able to find it if you google. :)

[lady1297]

Any shot you can point me in the direction of those studies ? I google it and find the "baby will be big, increases mom's risk of diabetes" generic answers.

[Plummeting]

Which studies are you referring to? Just google something like "gestational diabetes risks to fetus" or something like that. You should get a ton of links mentioning everything I said - not studies, just informational articles and such. The shoulder dystocia studies are looking at abdominal circumference compared to the diameter of the head, I think. I think this one might be the one I originally read, but I read the full text somewhere. It may have been a different one, but here's this abstract anyway: http://journals.lww.com/greenjournal/Abstract/1996/07000/Sonographic_Prediction_of_Shoulder_Dystocia_in.3.aspx

I really haven't seen any exact cut off for any negative outcome, because I don't think there can be one. They've found that the risk increases the higher your blood sugar is, even in women whose blood sugar is considered normal. So for every little bit higher your blood sugar is, your risk of those things increases a little bit. There's no exact cut off. A woman with normal blood sugar that tends to run 115 an hour after meals and 75 fasting is going to have a slightly higher risk for a macrosomic baby than a woman whose tends to be 110 an hour after meals and 70 fasting, but those are both completely normal. Basically, you just have to try to keep it as close to normal as you can, while still eating as much as you need to eat. I think I posted a couple weeks ago what "normal" really is during pregnancy. Average is around 110 one hour after a meal, around 100 two hours after, and around 71 fasting. However, because there is normal variation in what non-diabetic woman experience, the newest recommendations (which I don't think many doctors are following) is to try to keep it 122 or less an hour after meals, 110 or less two hours after, and 80 or less fasting. :) It's possible that the reason most doctors aren't following those recs is because they would increase the number of women who needed medication or insulin by a LOT. Currently, they say most women can control GD (keep to the doc's recommended targers) with diet and exercise. If they adopt those recommendations I just listed, I doubt that would be the case any longer. I think most people are still being told under 130-140 an hour after meals and under 95-100 fasting. Personally, if my numbers are higher than the above recommendations, I'm okay with it, but if they're higher than the old ones that most docs are using, then I'm really not.

[folkgirl]

I have used a combination of insulin and Metformin for three pregnancies. In all of my pregnancies, my fasting glucose has been the most troublesome number. We are currently having the best results increasing the met (insulin giving so-so results) but there's only so much farther we can go with that, and i still have 4 months left of pregnancy.

I was very reluctant to go on insulin at first, but I have long since made peace with it. I cried when they first showed me how to make the injections. I can't be a judge of whether any individual does or doesn't require it (and I have to say, fastings in the 90s-110 would make me happy, mine tend to be higher than that and we are constantly fighting it with meds), but I will say that the way I look at it, you do what you have to do to achieve that control. I have heard it said that GD w/insulin is the same as being "uncontrolled," but my doctors don't consider it that way. They consider it controlled, but controlled with medication. Again, not saying that you need it, but that for me if I didn't take the insulin/met mine would certainly be uncontrolled because diet/exercise alone don't work for me. And for the record, my last baby was a VBAC and I am planning my second VBAC for August. I don't consider either of my babies to be particularly huge. They were 7-10 and 8-11.

Good luck!

[Plummeting]

Originally Posted by folkgirl 
I have heard it said that GD w/insulin is the same as being "uncontrolled," but my doctors don't consider it that way. They consider it controlled, but controlled with medication. Again, not saying that you need it, but that for me if I didn't take the insulin/met mine would certainly be uncontrolled because diet/exercise alone don't work for me.

I wonder why they use that term, too. I'm sure it must suck having to do injections and take the meds (I haven't needed anything, so I'm just imagining) but it's not such a big deal or so unsafe that it's worth considering it some out of control situation just because a woman needs medication or insulin. The meds and insulin work, so problem solved.

[lifeguard]

There is a newer thread around here somewhere...

Just wanted to jump in & mention that not all care providers will use meds - some jump immediately to insulin if diet doesn't do it. So the idea that insulin is somehow an indication that the gd is harder to control is not necessarily correct. Fwiw - I used insulin with both of my pregnancies & I actually found it easier than the meds 'cause we could make little changes as the pregnancy progressed to address the small changes. The complications that can come with gd are because of uncontrolled bs. It's the high bs that cause the problems NOT the meds/insulin used to control it.

[jabottom]

I was diagnosed  with GD during my first pregnancy.  The only BS not controlled by diet/exercise was my fasting sugar.  The dietician immediately put me on insulin one shot before bed to control the fasting and it worked with no issues.  I asked about metformin but was told that because diabetes runs in my family they were not going to even let me try it.  At the time I was not informed about the reprecussions of being on insulin.  After my baby was born the hospital policy was that my baby be taken away for 3 hours immediately after birth for sugar observations.  Even my midwife asked if there was any way around it and they could check sugars with baby in my room and the answer was no.  This was devastating to me and the hardest thing I had to endure with the birth of my first child. 

I am now pregnant with my second child (28 weeks currently) and have been diagnosed with GD again (not surpisingly).  I am on a mission to avoid insulin if possible because I don't want my baby taken away after birth again, and my midwives practice will require an OB to deliver if I go on insulin so I cannot have my midwife attend my birth.  To give myself a better chance of avoiding insulin I have switched the dietician and high risk Dr to a different city a couple of hours away to a more knowledgeable, flexible staff.  They put me on glyburide at night to control my fasting sugars and it has mostly worked.  I have had two fasting sugars over the past two weeks that are out of range (both 103 when typically with the glyburide I have been running b/t 78-90.  I consistantly eat the same bedtime snack at the same time every night before going to bed and take the glyburide at the same time every night to try and regulate but that doesn't seem to matter.  Has anyone else had such variations in fasting even on glyburide?  They still have the option of adding metformin if they need to in order to help control so I am pretty confident that I won't have to do insulin but I guess we will see.

Also they told me up front that their GD patients they do not allow to go beyond 39 weeks so I feel like I am up against a deadline already.  With my first child they were going to induce at 39 weeks too but I went into labor the night before I was to be induced so it worked out.....but that added stress of having to make the baby come early I am not looking forward to.  Is it pretty common for the 39 week induction?  Has anyone had success in getting their Dr's to let them go to term?  My last baby was 7 lb 7 oz so perfectly normal size.......

[folkgirl]

Jabottom, I'm so sorry your baby was taken away from you for three hours. I understand how heartbreaking that can be. I experienced the same thing with my oldest. It was more because I had a c-section than because of my GD, but she was healthy so there was really no excuse. My vaginally-born baby never left my side, and of course they can do the sugar checks in the room. It's a heel prick and it takes all of a minute. Between the birth of my two daughters I also researched the correct procedure for a heel prick. My first daughter was pricked without warming her heel first, which is both more uncomfortable for her and can cause false readings. Second daughter, I insisted on a heel warmer. I am sure they thought I was some kind of control freak, but I didn't want to risk false results because the first time around a BORDERLINE low blood sugar led to much freaking out and formula pushing.

I hate to say this, but no matter what i would be prepared (and have your partner be prepared) to put your foot down and say "I do not consent" when necessary. Your baby is YOUR baby. They can't taken him or her away from you without your permission. They might not like it, but it's true. And even if you successfully avoid insulin, it's possible that they could find some other reason to take the baby. Some hospitals just like to do it, or they're just inconsistent in that way--it may depends on who is working and a bunch of other things you can't control. Women in my ICAN group have a lot of experience in this area so it's something that I was prepared to do the second time around, although luckily I didn't need to. Our back-up plan was if we just couldn't refuse separation from me (like they had an actual reason to be concerned and not just "we need to check sugars") then my DH was not to leave baby's side. That way at least we could make sure there were no procedures done or supplements given without his consent.

As far as going past 39 weeks--I am pregnant now and my provider does not induce at 39 weeks. I have bi-weekly fetal monitoring (BPPs and NSTs) for most of my third trimester and as long as my baby is looking okay, I remain pregnant. As it happens I went into spontaneous labor at 39 weeks last time, anyway, but I was fully prepared to go to 42. Now of course having a supportive provider makes it a lot easier for me in this instance. I don't have to refuse anything. I would definitely start an on-going conversation about it with your provider. I would ask him to show you the evidence that supports a 39 week induction in a well-controlled gestational diabetic. I have asked for this info from a perinatalogist before and she admitted the evidence wasn't really there, she just felt more comfortable with that recommendation. I think that it is a personal bias that a lot of providers have. And again, if you feel up to it--well, no one can make you show up for that induction (or even schedule it). They can strongly advise it and try to talk you into it, but they can't come to your house and apply prostaglandins to your cervix or hook-up pit. Given that my induction with my first daughter led to a c-section, I sometimes wish I hadn't shown up.

[lifeguard]

jabotton - glyburide was awful for me - made my numbers really unpredictable. fwiw - I ended up using insulin with both of my pregnancies & was never separated from my baby, so this is a hospital policy thing. I would definitely be having discussions ahead if time on this issue. And like folkgirl, we had a strict rule that if baby did need to leave me than dh would be glued to that baby.

[jabottom]

Thank you so much for the information!  I need all of the help I can get!  I spoke with the head nurse at the hospital I am going to deliver at and they were very helpful.  As long as I stay only on glyburide and the baby does not have any low sugar readings baby can stay at my side.  And if for any reason the baby requires going to the nursury the my husband will be able to go with the baby. 

Got a great report from my high risk Dr and he said unless something goes haywire that I don't need to go back!  I am really excited!  And nowhere in the report to my midwife (I ased for a copy) does it mention the 39 week induction so  I think as long as I keep my mouth shut I won't be faced with induction!

Thanks again for the information!

[iixivboots]

I'm bumping this...

I failed my 1 hour with a 137.

I should get my 3 hour results tomorrow, I am not optimistic. I had a terrible reaction after hour 1 and almost passed out, was drenched a in a cold sweat. I know 137 isn't a very high number for the 1 hour, but I have been previously diagnosed with insulin resistance, and both my parents have type II.

My biggest concern is what my OBs policies are about induction (should've asked before now) and what hospital policies are about taking baby away for testing, insisting on formula supplementation, etc.

I also am a bit stressed about trying to follow any diet. I'm about 30 weeks now, and my reflux has been so bad in the past few days that I am just trying to eat whatever sounds mild to control that.

[Plummeting]

Bootsvalentine, personally, if I already knew I had insulin resistance and then I got a borderline reading on either of the tests, I would move straight to home monitoring. It is NOT true that you can't develop GD after 28 weeks. Some people do, and it's all along a continuum, so you could have high blood sugar 3 weeks from now, and you want to know if you do or not, IMO.
 

[HassaBella]

I just found this in the middle of last night, and I'm so glad I did. I needed to hear the stuff about remembering they can't take the baby away from you in the hospital. I know I've got a battle ahead of me and the more support and information I have at my hands the better shape I'll be in. I'll tell y'all about me and then I have a couple of questions perhaps someone can help with.

I am 26w with my third pregnancy (it will be my second child, I lost one). My daughter was 10lbs 6.5oz born via scheduled C at 41w 1d. I was pushed into the C being told that she was too big, would never come on her own, if I did go into labor she would be hurt and have lasting effects. I bf her in recovery and then she was taken away (my husband went with her) for a couple of hours. I was told her blood sugar dropped and they had to give her formula, we were never asked, I was never asked to feed her. Dr. put her on formula supplementation for a couple of weeks until I saw a specialist who told me there was no reason for it. Because of her size I was tested at 20w for GD. Failed the 2 hour and was sent to a nutritionist/endocrinologist. They have me monitoring BS levels but they have not been high enough to warrant insulin. I am overweight and because of that I have to go to a special ultrasound office (better machine). Here's where the big problems start. As soon as they found out I was GD it became we'll need to see you every two weeks, you need a fetal echocardiogram, you don't have GD you have pre-diabetes. They at first claimed they were basing this on three things- high weight, GD, and a high hemoglobin h1c. I found out my hh1c was 5.7 (not high at all) , and as for GD it's only been the one failed GTT, so really it's just cuz I'm fat. Since they no longer had the medical reason for the fetal echo., they scheduled me for a regular ultrasound but did the fetal anyways, telling me not to worry that they wouldn't charge me for it.

So my questions are: Does anyone know of any research showing that GD can legitimately be tested for at 20w? That I don't have diabetes!!! Also, do we know from research the bf will help a little one's BS? I bf my girl til she was 2.5 and I don't want anything to screw us up this time around. Also, has anyone had any luck working with a doula for labor with a big baby? I'm thinking having one in my pocket might help if they begin with c-section ori induction bs.

Sorry, this is so long! I truly appreciate the support and hearing everyone's story!

[iixivboots]

Hi, sorry this thread isn't that active, but maybe some people will pop back up. You can also join our plus size mamas group in social groups, we had a GD discussion although varying experiences.

I don't see HOW they can tell you it's prediabetes and not GD when you're pregnant. I heard that early testing is common with people they consider high risk, I was but I changed docs and did my testing at 28 weeks like everyone else. The thing about testing early is that they will most likely make you do it again if you pass. What I read is that your blood sugar is likely to be worse later in pregnancy. I do think they will consider a 20 week test 'legitimate' but I really question that prediabetes diagnosis, makes no sense unless you have labs from before you were pregnant that were high.

Good luck! Especially hope you get some answers about the BFing and make sure your baby can stay with you after birth. xoxo

You might want to check out the baby center community boards, plus size and pregnant and pregnant with diabetes. That board is definitely not as crunchy as mothering, but there's a huge community of plus size pregnant women.

http://community.babycenter.com/groups/a425315

[deltachristy]

Hi I'm new here
I was wondering if anyone else's blood sugars spiked all of a sudden one day? I'm 32 weeks pg and have been diet controlled and doing great with that up until 3 days ago. I woke up with fasting in the 100's and even after following my diet, my numbers will just NOT come down. No matter what I do or how boring and strict I am with my food. I'm soooo confused as to why this is happening when I'm doing everything right...
Any advice would help!
Thanks!

[yogamama1980]

Hello! SO glad to have found this thread! Wondered if there was anyone out there who had experience or knowledge on high blood sugar and/or gestational diabetes. (Also, would like to participate in the Ask The Experts forum with this subject, but can't figure out how...can someone fill me in?).

I gave birth to my first son October 19th (he is three months, 2 weeks old now, and so wonderful! :-) I used a wonderful midwife as my primary caregiver and my family physician as "back up"...he is an MD (family doc and ER doc with lots of experience with homebirths). At 28 wks, concern was raised about my blood sugar. I'd gained quite a bit of weight (almost 70 by the end of the pregnancy) and looked to be having a very big baby. Instead of doing the 3 hour glucose test, they had me use a glucometer to test/monitor my blood sugar...it ranged from 90 to as high as 110 fasting, and would sometimes go pretty high after meals...the highest I ever saw it EVER was 165. After eating scrambled eggs and veggies it would drop to around 80, after eating whole grains it would go to anywhere from 130-165 and sometimes stay up pretty high (over 120) for a couple hours. 

Should also note at 25 weeks started a strict diet of whole foods only, trying to get only about 50 grams of carbs per day, no processed food/sugar etc. 

I took an A1c, and had great numbers. Also ended up taking the 3 hour glucose test which I passed, though I personally thought I was rather close to not passing according to the numbers they told me (my personal opinion). Also took a brisk walk around the building several times during the test which I later learned probably cheated it in my favor. 

Baby was born, was 10 lbs 4 oz, 23 inches with a 15 inch head. 21 hour labor, all natural, no meds, no tearing. Baby was born with his hand on his head and a double knot in umbilical cord and crowned VERY slowly which caused him to be stressed by the time he managed to get out. Caused a few very scary minutes, but after a bit recovered and was just fine. I personally don't think he was a "sugar baby" as i was 9 1/2 lbs and big babies run in my family; he also wasn't ft, just big boned.

Currently, at 3 months postpartum, my blood sugar is usually around 85 fasting, and between 95-110 between meals, though I have caught it as high as 140 half an hour after eating a whole grain (example: plain oatmeal) though it seems to go back down to 100 within an hour or two. (NO idea if this is good or bad??)

Are these numbers I should be concerned about?!? During the course of my pregnancy I got so many conflicting opinions and read so much differing information felt I never got a clear answer on the matter, and am left feeling completely clueless...one end of the spectrum tells me I am/was fine, the other tells me I had a serious problem. I am thinking ahead to my next pregnancy and want to be informed and prepared should the same situation arise. 

I have read a lot on the matter and am familiar with all the typical charts on sugar levels.

Any advice/info/input would be very appreciated!