I had a great 29-week checkup at the OB, but hearing “You’re diabetic” put a screeching halt to all the positivity. After failing my one-hour glucose tolerance test by one point and taking a three-hour test — having blood drawn after 12 hours of fasting, drinking 100 mg of fruit-punch-flavored glucose, and having blood drawn after one, two, and three hours — I had failed two of the blood draws. My one-hour draw came in at 204, while the highest level allowed is 180. My two-hour draw came in at 155, with the highest level allowed by my practice at 145. The terms “borderline” and “prediabetes” were thrown around, but inside, I felt like a total failure.
I felt like it was my fault. The doctor was great, trying to make me feel better by saying that I’d be in a better, healthier position than most women in the third trimester because I would be more carefully watching what I ate and walking more (which can significantly lower blood sugar after a meal). And then he said, “Which will be a great thing for you, because you’re only supposed to gain up to 35 pounds in pregnancy and you’ve already gained 29 pounds in 29 weeks, with 11 weeks still to go. You’ve gained five pounds in the last two weeks. You gained eight pounds in the month before that. Six in the month before that.” And I wanted to stick my head in a drawer and cry. I felt like I was being told, “You’re a big fatty fat, and your fatty fattiness is going to make your baby an unhealthy fatty fat fat. Good going, fatty.”
I calmed down a bit by the next afternoon, after I’d met with a diabetes nurse who explained that
1. Gestational diabetes is not related to anything you eat or do and
2. The risks are associated with women whose blood sugar levels are highly elevated over a period of time. Following a diet and monitoring my levels for problems will mitigate those risks.
What is gestational diabetes?
Essentially, gestational diabetes happens when a pregnant woman’s pancreas can, for some reason, simply not produce enough insulin to process the additional sugars produced during pregnancy. The risk is not necessarily high for the mother, but for the baby, excessive blood glucose can pass through the placenta into the baby’s bloodstream, causing them to put on more weight than normal babies.
The nurse also explained that this excess glucose can eat away at the placenta over time, breaking it down so it passes along fewer nutrients — much like excessive sugar builds up in your mouth when you don’t brush and rots away your teeth. So while you might have a 9-pound baby at 37 weeks, you might also have a baby whose lungs and other organs are less developed than a typical 37-week-old fetus. None of that is good.
Not only that, but the baby is at a higher risk of hypoglycemia because once the cord is cut — along with the high sugar supply he or she once received through the placenta — the baby’s blood sugar will suddenly drop and can cause, among other things, seizures.
No, no bueno.
What can you do?
So to help me manage this condition, the doctor’s office set me up with a company that tracks you for 21 days. A nurse met with me the day after I got the diagnosis, and showed me how to test my blood sugar four times a day (at fasting, or upon waking up; one hour after breakfast; one hour after lunch; and one hour after dinner) with a glucometer. She went over ideal ranges, my meal plan, and exercise goals.
And she explained that if my levels are too high for an extended period of time, they can be further managed with insulin. I’m not going to lie — this terrifies me.
Now that I’m having biweekly doctor’s visits, they’re measuring my belly for adequate growth related to where I am gestationally. If I’m growing too quickly or having other issues like reduced fetal movement, I’ll be given a late sonogram to see roughly how big Bean is, and a non-stress test to monitor his heartbeat and development.
How am I doing?
Testing my blood sugar is easily the worst part of this whole thing. The finger pricks aren’t terribly painful, but I have serious psychological issues with needles and blood, so having to poke myself four times a day is akin to some level of hell. I get dizzy and lightheaded beforehand and I swore the very first night that the diet was giving me low blood sugar, when really my levels were fine and I was just nervous and feeling like I’d drained all the blood from my body (drama queen?).
I also stress about each individual number. They’re all over the place, and even though they’re all pretty much within range, it boggles my mind that I can have the exact same thing for breakfast three days in a row and get an 86 an hour later one day, a 114 the next, and a 126 the next. The nurse explained to me that the meter is less than precise and whatever reading I get could be 10-15 points off, which means that 126 could be 110. Or, as my mind immediately told me, it could be 141. Yes, I am a negative Nancy.
My fasting blood sugar is the biggest indicator of whether I’ll need insulin, because it shows what my body does without food. The nurse assured me that, based on my tested level of 78, the chances are remote I’ll need insulin. But since I started testing at home five days ago, I’ve gotten a 66, 88, 96, 88, and 101. After getting my 101 this morning, I retested on a different finger, different hand, and got a 94. So now I’m driving myself nuts with that kind of nonsense. I don’t understand, because I’m eating the prescribed evening snack of a carb and a protein, and getting different numbers every morning. And it’s the number I can do the least amount, and the one I’m most worried about. All of which stresses me out — and raises my blood sugar.
What about the food?
The diet is really not that bad. OK, I can’t have my nightly full-sugar Sprite with dinner or my random “just because” candy bar. I can’t eat a quarter of a pint of Ben and Jerry’s while watching “Dexter.” I can’t down half a pizza when I’m home alone at night.
The idea is to help keep my blood sugar level by eating regularly throughout the day, eating a smaller amount — but not a low amount, because duh, I’m pregnant — of carbs, and spreading those throughout the day. It has me eating more food than before, because it adds snacks I wasn’t having before, and adds carbs I never packed into lunch and dinner. It basically forces me to take that afternoon Twix and transform it into a dinnertime potato and bread.
The plan is spread out like this:
- Breakfast: 15-20 g of carb with a protein
- Morning snack: 15-20 g of carb with a protein
- Lunch: 55-60 g of carb with a protein and a nonstarchy vegetable
- Afternoon snack: 30-40 g of carb with a protein
- Dinner: 55-60 g of carb with a protein and a nonstarchy vegetable
- Evening snack: 15-20 g of carb with a protein
It gives me a fair amount of flexibility. So far, I’ve had:
- Breakfast: One or two scrambled eggs and a piece of toast, a hard-boiled egg with some raisin toast.
- Snacks: One chocolate/peanut butter Nature Valley Granola Thin with two tablespoons of Smart Balance creamy peanut butter; a Luna protein bar; a couple of squares of cheddar cheese, half an Arnold’s whole grain flatbread thin, and an 8-ounce glass of milk
- Lunch: Largely leftovers so far but on Saturday I had a Morningstar Farms tomato basil pizza veggie burger on two slices of whole wheat bread, half an orange, and an 8-ounce glass of milk.
- Dinner: Turkey-Vegetable Bake, Adobo Pork Chops with half a sweet potato, steamed broccoli, half an Arnold’s whole grain flatbread thin, and an 8-ounce glass of milk.
I’m struggling the most with breakfast, because there are only so many carb/protein combos you can come up with for that. Insulin resistance is highest in the morning and late evening, so that means I can’t have any milk, fruit, juice, or yogurt in those time frames. The nurse gave me some ideas I’m going to try, like turkey bacon, a tomato, and melted cheese on a whole wheat English muffin, or oatmeal (though I can’t have any fruit with it, and it seems like all the diabetic recipes are for apple oatmeal, berry oatmeal, etc.). She also mentioned cottage cheese, which counts as a protein, which was slightly confusing since I can’t have milk, but whatever.
I’m a natural-born worrier, and I’m terrified of so many things. I’m scared I’ll stick to the diet and we’ll still have a huge baby with health problems. I’m scared my levels will continue to rise as I progress in the pregnancy, and will require insulin — and I’m absolutely paralyzed by the idea of injecting this into my stomach. I’m scared about what this means for my labor — whether I’m high-risk now, whether I can’t be delivered by the practice’s midwives anymore, whether they’re automatically going to induce me or give me a c-section, whether they’re going to hook me up to insulin during labor and/or monitor my blood sugar, whether they’ll automatically admit Bean to the NICU. I didn’t have a chance to talk to my doctor about any of this stuff because my head was just swimming with the “fatty fat fat” stuff. So I’ll have to talk to him at my next appointment, and hopefully have my mind set at ease — or at least have a heads up of what’s to come.
This isn’t a death sentence, and it isn’t my fault. And while pricking my finger makes everything from my head to my toes tingle with panic, and I can’t eat a cupcake whenever I damn well please, I’d eat bread and ketchup and draw blood from a syringe 18 times a day if it meant it would keep my baby safe and healthy.
Were you or somebody you know diagnosed with GD? How did you handle it?