[kohlby]

I'm still a long way off from delivery and have yet to see my OB. I've been seeing an RE for first trimester since I'm high risk due to five first trimester losses. I also have insulin resistance. Due to the insulin resistance, I'm on a diabetic diet for the rest of my life. I did give birth to two healthy, though large babies. However, my daughter had dangerously low blood sugar at birth at only 38. And she had the typical diabetic/GD chest pudge. And she was 11lb 4oz when she's small boned. I did pass the 3 hour GTT then. I've taken glucose tests when not pg too and they're fine. But my fasting insulin was through the roof high - even high for what's considered high. So, my RE thinks I definately have a problem but it's one that's hard to catch. In her opinion, I should have an amnio at 38 weeks and if the baby's lungs are mature, then I should have a c-section then. (I'm not a candidate for VBAC due to two previous c-sections). I don't like that idea. I believe babies should come when they're ready unless there's a medical reason.

If my blood sugars are well controlled, I still can't be certain that my insulin levels are fine. So, I can't pretend to be in the controlled diabetic/controlled GD category. But insulin resistance issues while pg are a fairly new subject that doesn't have a lot of research backing it up to say what the exact risks vs. benifits there are to taking a baby early. My other kids were born at 41 and 42 weeks so 38 weeks is considered early to me.

Does anyone have any similar experience? Or even know of anyone who was in a similar situation and what was done in their case? I'm only 11 weeks so it's still a long way off but I like to gather all the info I can so I can be certain that I make an educated decision later on.

*To complicate matters further, I have a blood clotting disorder (FVL hetero) which does increase the chance of stillbirth. However, this clotting disorder has no effect on most women who have it. Since I had two healthy post-date babies and my losses were all first trimester, the clotting disorder likely won't be an issue.

 

[paquerette]

Are you familiar with kmom's site? http://www.plus-size-pregnancy.org/gd/gd_index.html

Induction or c-section due to maternal diabetes alone is contraindicated as per ACOG.

Is there something in particular about your 2 previous sections that makes you not a vbac candidate, ie uterine abnormality or a wonky scar?

 

[sapphire_chan]

A mom in my DDC (August 2008) had insulin resistance, and I know that she was having to keep her blood sugar levels even more strictly under control than someone with diabetes. And she had to keep on her doctors about it since they kept trying to say she had gestational diabetes when insulin resistance is different.

 

[kohlby]

Quote:

Originally Posted by paquerette Are you familiar with kmom's site? http://www.plus-size-pregnancy.org/gd/gd_index.html Induction or c-section due to maternal diabetes alone is contraindicated as per ACOG. Is there something in particular about your 2 previous sections that makes you not a vbac candidate, ie uterine abnormality or a wonky scar?

Yes, I'm very familiar with tha website though I haven't been there yet this pg. Thanks for the reminder! I've had two c-sections so that alone makes me not a VBAC candidate. Both c-sections were due to true cases of CPD. (I did labor and used no pain meds and got into optimal positions). I am very small but I figured my pelvis would be able to open up enough - but it didn't. DS's head was even starting to mold and then he got stuck for 6 full hours even while I was on pitocin. And I was 42 weeks. DD's chest was too big for her to even come down. And if she had fit, she would have been a definate shoulder dystocia case. I have a blood clotting disorder so there's no way I'd try a VBA2C at home and the hospital doesn't allow them. I go into hard labor with contractions close together without dilating much at all so getting to the hospital on the later side isn't possible either.

My RE's concern is that I've had 5 first trimester miscarriages so she thinks that my insulin resistance does hurt my babies. Add in DD's dangerously low blood sugar at birth, her chest pudge, and her size, and it's obvious my insulin resistance played a part in that. (I don't think it played a part with DS's size though my RE does. He was big then and he's still big at 5). If a baby's blood sugar is too low, they can have brain damage or die. DD's was only 38.

The RE said that if I had diabetes instead of GD that they like the blood sugars lower. With regular diabetes, I was told it was 120 at any time, even right after a meal! I can't imagine keeping my blood sugar that low. I don't have a monitor but based on past glucose tests both when pg and not-pg, 120 sounds very low to me. But I don't technically have either diabetes or GD. So it's a bit of a gray area and therefore, very tricky to find the info I need.

 

[sapphire_chan]

Isn't brain damage caused by uncontrolled sugar spiking in the first trimester with true diabetes? I thought it didn't happen with GD.

Of course, insulin resistance isn't the same thing... odd that you having high blood sugar would result in low blood sugar for the baby. Scary.

 

[Jaysfamily]

Hello from a fellow insulin resistant Momma! I also have PCOS, so the insulin resistance affects my fertility too.

Have you ever been checked for pcos? You can have it even if you have regular cycles too. It and insulin resistance seem to be linked somehow. Pcos has up to a 45% chance of miscarriage rater and also has premature birth as a side affect too.

I take Metfomin/Glucophage to treat it. Keeping my blood sugers low isn't enough for me since it's the insulin that's the problem. The Metformin drastically lowers the chance of miscarriage and all the other side affects. It can also prevent it from turning into diabetes. I wonder if it would lessen the chances of the side affects to your baby too? I would recommend you do some research on it and discuss it with your doctor or midwife.

 

[~pi]

Quote:

Originally Posted by sapphire_chan Isn't brain damage caused by uncontrolled sugar spiking in the first trimester with true diabetes? I thought it didn't happen with GD.

You're thinking of birth defects, though you're right, generally, high BGs in the first trimester are not associated with GD.

The OP is talking about neonatal hypos. They are potentially very serious and can cause brain damage or death.

Quote:

Originally Posted by sapphire_chan odd that you having high blood sugar would result in low blood sugar for the baby. Scary.

Not odd at all, actually. Basically, while gestating, the baby produces her/his own insulin, so if mom's BGs are high prior to the birth, chances are that the baby's pancreas is cranking away. Then s/he is born, suddenly the high source of glucose is gone, and s/he has too much insulin on board and crashes. (I've always wondered whether delayed cord clamping might mitigate this in a small way.)

OP, I am type 1, so I really don't know much about nondiabetic insulin resistance, but I have been in the situation of not knowing whether it's smarter to go with an earlier date or wait. There are tiny probabilities of severe problems on both sides -- it is not an easy thing to resolve.

 

[avivaelona]

Kohlby blood sugar does naturally drop a bit in pregnancy, so if you normally run 130-140 or so after a meal, 120 wouldn't be a stretch while you are pregnant. I think your case is very complex and you might be best served by a long conversation with your endocrinologist about the possibility of staying on medication through the pregnancy (met or glyburide?) and doing NST to monitor the baby as you get close.

I'm hearing that you are doing a c-section anyway so perhaps you just want to negotiate for actually waiting til you get to your due date if your biophysical profile looks good still that might give you the balance you are looking for.

Fwiw I have PCOS/hyperinsulanemia (though it seems not as badly as you did) and it did eventually progress to being diagnosed with type II while I was ill between pregnancies, and then it receded or became a non-issue to control when I was better and so for this pregnancy we are treating it "as if" its diabetes despite me not actually having high sugars unless I really pig out on carbs, and honestly that works pretty well... I eat a modified GD diet, I monitor four times a day and take metformin and thus far I'm holding steady with good blood sugars and low A1C's. I should excercise but I can't because I'm on bedrest, but that really does help if you can.

 

[kohlby]

Thanks ladies!

I was tested and definately don't have PCOS, just insulin resistance. (Add in that I'm a healthy weight, eat healthy, and exercise and I'm thankful the IR was caught now). But I've been reading a lot about PCOS since it seems to be the most widely recognized condition that often has IR as part of it. I went on metformin for the first time a few weeks before I got pg. I requested to stay on it for first trimester, but had to go off of it since I have hyperemesis and it was making it worse. However, my RE thinks it may have made a difference that I was able to do the metformin for the start of pg at least. All the studies I've seen show metformin is safe in pg. But I don't know of any large widely supported studies. My RE was hesistant to even let me stay on it after I got my hpt but I wanted to give it a shot, especially after reading the stats on it reducing the miscarriage rate significantly in women with PCOS/IR. I have read studies where metformin drastically decreases the number of women who get GD as well. But I don't think I'm comfortable with being on met my entire pg without it being studied more - especially because I did manage to have two babies before without it.

I started a diabetic diet about 6 months ago when the IR was diagnosed and will be on it for the rest of my life. (My 5th miscarriage was while on the diet but not on met). I will be finally well enough to start going back to the gym in a week I think. I am going to request to take the one hour glucose screen when I see my OB the next/first time. The RE even mentioned that I should see a fetal maternal specialist a couple times during third trimester. That's probably what I will need to do - though it's taken me a few days to realize that I can't pretend that I'm low risk anymore!